Quality Of Health Promotion Research Articles

Knowledge, attitudes, and practices towards prevention and early detection of chronic kidney disease

To describe the knowledge, attitudes and practices of Jordanian patients with chronic illnesses towards prevention and early detection of chronic kidney disease. Patients with chronic illnesses such as hypertension and diabetes need to adopt healthy attitudes and practices and gain knowledge regarding prevention and early detection of kidney disease to decrease the prevalence of dialysis-related complications and costs. A total of 740 patients were recruited from out-patients clinics in Jordan. Knowledge, attitudes and practices about kidney disease prevention and early detection were measured using the Chronic Kidney Disease Screening Index which was developed by the researcher and tested for validity and reliability. The results revealed that most of the participants have knowledge about kidney disease; however, half of them had wrong information related to signs and symptoms of chronic kidney disease. The majority of the participants were not aware about the importance of discovering health problems at early stages. Improvement in population understanding about chronic kidney disease is needed to advance their awareness and practices to make appropriate decisions towards health promotion and better quality of life. Nurses need to be involved in development of protocols for screening and intervention programmes, taking into consideration the cultural issues and the financial status of individuals at risk for kidney disease. Governments should adopt a public health policy for chronic kidney disease that supports programmes for screening and programmes for improving public awareness for kidney disease prevention.

Relationship Between Productivity and Burnout in Nurses of Military Hospitals in Tehran

Background: Due to nurses’ important role in patients’ quality of care and health promotion, it is vitally important that nurses remain productive. Undoubtedly, burnout is one of the factors that has the greatest effect on productivity. If the strong relationship between burnout and productivity is proven, then managers can be encouraged to provide better conditions for nurses to be more productive. Objectives: The current study was conducted to investigate the relationship between productivity and burnout in nurses of the Aja Hospitals in Tehran. Materials and Methods: This cross-sectional study was carried out on 322 clinical nurses working in Aja Hospitals in Tehran. The subjects were recruited by multi-stage sampling methods in 2012-2013. Data was collected using the Persian version of the productivity questionnaire which was prepared by Nayeri et al. and the Maslach Burnout Inventory, which was then analyzed by SPSS software Version: 19, IBM Company. Results: The findings showed that many nurses (35.1%) obtained a high productivity score. From the viewpoint of burnout intensity, the majority of nurses (85.4%) were at medium to high levels in the dimension of emotional exhaustion. Moreover, most (79.8%) obtained high scores in the dimension of depersonalization. In the dimension of personal accomplishment, 61.5% of nurses felt little success. Pearson’s correlation coefficient indicated a weak statistical reverse relationship between total productivity score and burnout dimensions (P < 0.001). Conclusions: Based on the high levels of burnout found in this study, greater awareness and knowledge of the contributing factors are essential in order to increase nurses’ productivity. Formulating policies in order to remove these contextual factors, prophylaxis, treatment and training methods, and adaptive coping strategies, are also required.

Delivery of primary health care to persons who are socio-economically disadvantaged: does the organizational delivery model matter?

BackgroundAs health systems evolve, it is essential to evaluate their impact on the delivery of health services to socially disadvantaged populations. We evaluated the delivery of primary health services for different socio-economic groups and assessed the performance of different organizational models in terms of equality of health care delivery in Ontario, Canada.MethodsCross sectional study of 5,361 patients receiving care from primary care practices using Capitation, Salaried or Fee-For-Service remuneration models. We assessed self-reported health status of patients, visit duration, number of visits per year, quality of health service delivery, and quality of health promotion. We used multi-level regressions to study service delivery across socio-economic groups and within each delivery model. Identified disparities were further analysed using a t-test to determine the impact of service delivery model on equity.ResultsLow income individuals were more likely to be women, unemployed, recent immigrants, and in poorer health. These individuals were overrepresented in the Salaried model, reported more visits/year across all models, and tended to report longer visits in the Salaried model. Measures of primary care services generally did not differ significantly between low and higher income/education individuals; when they did, the difference favoured better service delivery for at-risk groups. At-risk patients in the Salaried model were somewhat more likely to report health promotion activities than patients from Capitation and Fee-For-Service models. At-risk patients from Capitation models reported a smaller increase in the number of additional clinic visits/year than Fee-For-Service and Salaried models. At-risk patients reported better first contact accessibility than their non-at-risk counterparts in the Fee-For-Service model only.ConclusionsPrimary care service measures did not differ significantly across socio-economic status or primary care delivery models. In Ontario, capitation-based remuneration is age and sex adjusted only. Patients of low socio-economic status had fewer additional visits compared to those with high socio-economic status under the Capitation model. This raises the concern that Capitation may not support the provision of additional care for more vulnerable groups. Regions undertaking primary care model reforms need to consider the potential impact of the changes on the more vulnerable populations.

Quality of life and health promotion: focusing pregnant women

The aim of this study was to evaluate the Quality of Life of pregnant women attending the Family Health Strategy andidentify the dimensions of Quality of Life better and worse evaluated. This is a descriptive, cross sectional study case,done in a Family Health Unit in the outskirts of Sao Bernardo do Campo. 42 women were evaluated using WHOQOLbref.The higher the score the better the assessment of Quality of Life. The scores of the domains were: Physical 57,65;Psychological 68,75; Environment 59,75; Social Relations 77,98; General 75,00. Each domain consists of a few facets,and these contributed positively or negatively t the score of the domains. The worst facets evaluated were: Energy andFatigue; Thinking, Learning, Memory and Concentration; Financial Resources; and Sexual Activity. The best aspectsevaluated were: Mobility; Positive Feelings, Body Image and Appearance; Health and Social Care; and Personal Relationships.We concluded that WHOQOL-bref is relevant as a monitoring instrument and it is, for the expansion ofprenatal care and the evaluation of quality of life during prenatal care, an important tool for an integral assistence andpregnant woman’s health promotion.

Nutrition and eating as bases for programs for health promotion and life quality in organizations

According to the Food Guide for the Brazilian Population, from the Ministry of Health, adequate food depends on theconsumption of food, not nutrients, and should be based on food practices that have social and cultural significance. ForWHO/UN, despite many advances, there are nutritional deficiencies affecting large numbers of people around the world.The world is plagued by an epidemic of obesity and chronic non-communicable diseases; among silent diseases there arealso eating disorders. Many authors have said that food consumption and the way in which this happens has varied greatlyin recent decades in the light of social changes that have taken place, mainly the changing role of women in the formationand maintenance of a family structure. A good program to favour quality of life should include a rigorous planning of actionswith a good diagnostic of current social, physical and health condition of workers before any effective action. Foodcan and should help to improve the quality of life both physically and mentally and socially. Food is factor that greatlycontributes for a happy and dynamic society that constantly progresses.

Odontologia e Saúde Suplementar: marco regulatório, políticas de promoção da saúde e qualidade da atenção

Based on the regulatory framework and an overview of dentistry in supplementary health, this paper discusses the specifics of the dental sector with respect to health promotion policies and quality of health care services proposed by the National Supplementary Health Agency (ANS). The State's activities in supplementary health are based on law 9.656/98, which defines the relations between operators, products and their beneficiaries, and law 9.961/2000, which created the ANS. Concomitantly there was a great increase in dentistry in the private health plan market, because of changes in the practices of the profession. This required the need to know the logic of the organization of the services regarding the assistance provided and the model of care. The ANS develops measures to encourage operators to implement health promotion programs, striving for an integral care model. At the same time, it promotes the qualification policy of supplementary health care, with emphasis on the scope of care, though in dentistry the focus of evaluation is still individual and fragmented care. Indeed, the great challenge of dentistry is making it a public health policy, accessible to all, and the qualification of dental care in supplementary health.

The Comparison of Health Promotion Behavior, Post Traumatic Growth and Quality of Life according to Stages of Survivorship in Patients with Female Genital Neoplasm

Purpose: The purpose of this study was to compare health promotion behavior, post-traumatic growth and quality of life according to the stages of survivorship in patients with female genital neoplasm. Methods: Data were collected from August 1st, 2011 to September 31st 2011 from 142 gynecologic cancer patients who completed treatment or were treated at an out-patient clinic. The instrument were HPLP developed by Walker, Sechrist & Pender, PTGI developed by Tedeschi & Calhoun, and Korean C-QOL. Results: Health promotion behavior scores were significantly higher in the acute survival stage than the extended survival stage. Post-traumatic growth score was higher in the acute survival stage than the extended survival stage. The quality of life scores were higher in the lasting survival stage than the extended survival stage. Conclusion: Gynecological cancer patients in the extended survival stage reported low scores of health promotion behavior, post-traumatic growth and quality of life. Intervention needed to be developed to improve health promotion behavior, post-traumatic growth and quality of life for patients with female genital neoplasm in the extended survival stage.

The influence of household environment on caregivers’ overload of children with cerebral paralysis

The environment is considered an extremely important factor in individuals' health promotion and life quality. The influence that the environment exerts on caregivers' lives is due to all the complications they have to experience. Current study investigates the influence of family environment on the overload of caregivers of children with cerebral paralysis. The research comprised 21 caregivers, whose overload intensity was assessed by three instruments: a caretaker characterization form, Zarit Caregiver Burden Interview (ZBI) and an environmental characterization protocol. Results showed that all caregivers revealed a certain level of overload (52.4% intense and 47.6% moderate). Physical modifications were observed in 52.4% of the residences under survey but none was undertaken by a professional in rehabilitation. A statistically significant correlation occurred in children's spatial movement (p=0.031). Research suggests that caregivers of children with cerebral paralysis are overburdened due to the health care activities and that the environment constitutes a risk factor.

Relationship between nonprescribed therapy use for illness prevention and health promotion and health-related quality of life.

This study describes the nonprescribed therapy use (prayer, over-the-counter medications [OTC's], home remedies, vitamins, herbs and supplements, and exercise) for health promotion among rural elders. It also delineates the association of such therapy use with physical and mental health-related quality of life (HRQoL). The sample (N = 200) consisted of African American and White elders from south-central North Carolina. Participants completed baseline interviews and repeated measures of nonprescribed therapy use over a 6-month follow-up. Prayer had the highest percentage (80.7%) of use for health promotion followed by OTC (54.3%); vitamins only (49.3%); herbs and supplements (40.5%); exercise (31.9%); and home remedies (5.2%). Exercise was significantly associated with better physical HRQoL (p < .05). However, elders who used nonprescribed therapies had poorer mental HRQoL than nonusers, adjusting for potential confounders. This analysis suggests that use of some nonprescribed therapies for health promotion is associated with poorer mental HRQoL.

Practitioner opinions on health promotion interventions that work: Opening the ‘black box’ of a linear evidence-based approach

While attempts are being made to improve health promotion by following a linear Evidence-Based (EB) approach, the actors involved are aware that the quality of health promotion is not just a matter of supplying ’evidence-based’ interventions to local practitioners, but the result of a situated coproduction process that depends on many factors. This paper explores what constitutes an intervention that works from the perspective of health promotion professionals (HPP), and how, according to them, the development and implementation of interventions should be improved. We interviewed 81 HPPs about the use of 10 health promotion interventions at 30 Municipality Health Services in The Netherlands. The HPPs described an intervention that works as something that produces its intended effects after being realized in a local situation. Interventions are realized by combining elements of a supplied intervention (e.g. a theory, artefacts) with elements that are situated in the local context (e.g. funding, local network). Interventions that are transferred contain implicit assumptions about local contexts, but it is often unclear what precisely constitutes an intervention and what is assumed of local contexts. An intervention that works is a situated configuration of aligned elements. A linear EB approach depends on the realization of the local circumstances in which ’evidence based’ interventions can work. Various strategies are possible for approximating such circumstances, but the core assumption that the configuration that is realized in practice is similar to the ’evidence based’ intervention seems unrealistic for most health promotion in the Netherlands. Under such circumstances, attention should shift from central quality assurance to the system of actors and the distributed actions and heterogeneous learning processes that together add up to interventions that work.

Using Improvement Science to Promote Evidence-Based Practice in a Childhood Cancer and Hematology Center

A major children's cancer and hematology center established a Quality Transformation (QT) Core to develop and monitor empirical outcomes that demonstrate excellence in clinical care. The QT Core, based on the Institute of Medicine's domains of quality health care, aims to ensure that care is safe, effective, patient centered, timely, efficient, and equitable. Specific goals for the first year of the QT Core were to develop a team of improvement science experts, engage faculty and staff in QT initiatives, promote accountability for excellence in clinical care, and establish specific metrics to evaluate process, structure, and outcomes for QT Core projects. The purpose of this article is to discuss the successful development of a quality transformation core within a pediatric subspecialty and demonstrate the principles of improvement science through an actual quality transformation project designed to implement an evidence-based guideline for procedural sedation for children with cancer. The QT Core within this subspecialty was founded on principles of successful transformation of patient care that includes motivation to change, leaders committed to quality, active engagement of staff in meaningful problem-solving initiatives, alignment with organization goals with resource allocation, and integration to bridge boundaries throughout an organization. These key principles are demonstrated through the discussion of the development of the QT Core and implementation of an evidence-based procedure sedation guideline. Pediatric and pediatric subspecialty groups can be on the forefront of national initiatives that promote quality health care, exemplified by the QT Core developed within the cancer and hematology center.

Evidence-Based Refinement of Health and Social Services

To promote evidence-based refinement of quality health and social services delivery and care, decision makers, researchers, and practitioners often undertake intervention research. Intervention research tests and describes new strategies for achieving desired outcomes. But theoretical, methodological, and practical issues continue to plague even alternative participatory approaches to intervention research, raising questions about its potential for promoting quality health and social services and care. In response to this persistent challenge, the authors of this article propose a radical solution, namely intravention research, laying out its unique features as well as its theoretical and practical implications. Their conceptualization sets the stage for dialogue on options for advancing research methodologies and methods that might better promote evidence-informed health and social services.

Health Promotion Education Politics and Schooling: The Greek Case.

This paper seeks to explore the politics of health promotion as a continual process of public health globally and locally. Our main objective in this study is to present the health promotion education initiatives taken by the World Health Organization (WHO) at an international level and also to examine the politics of health promotion in Greece, putting emphasis on the school system. In this approach, the possible influences of the WHO’s politics are going to be sought. Available data point out that several efforts have been done over the last three decades by international organizations and national governments, including Greece, to establish the appropriate policies for the achievement of better health conditions. These initiatives have resulted to the significant improvement of the quality of health promotion provided in Europe. However, systematic health promotion programs and policies are still required to further improve the current situation of health education promotion in the European countries. On the other hand, health promotion and health school education policies in Greek schools are still being implemented in the extracurricular activities. The fundamental conditions for health promotion are thus constantly expected to include socioeconomic and environmental factors that can influence the level of health and quality of life.Investing on health should increasingly be seen by the European countries, including Greece, as a target towards the socio-economic development, the improvement of the environment and, finally, the upgrading of peoples’ quality of life. Key words: Health promotion politics, education, school, WHO, Greece.

The effectiveness of the Omaha System intervention on the women’s health promotion lifestyle profile and quality of life

This article is a report of a quasi-experimental study of the effectiveness of the Omaha System intervention on the women's health promotion lifestyle profile and the quality of life. The Omaha System is a model for organizing, documenting and evaluating the outcomes of comprehensive, community-based, client-centred care. Therefore, the Omaha System is important for public health nurses whose aim is to protect and promote health. However, few studies addressed the influence of the Omaha System on health promotion activities or quality of life in adult population. The design of the study was one-group pre-test and post-test. The study took place in Turkey in 2007; the sample comprised 76 women from an urban primary healthcare centre. The women completed questionnaires consisting of demographical characteristics, the health promotion lifestyle profile scale developed by Walker and colleagues and the quality of life scale developed by Burckhardt and colleagues. The researcher then visited selected women in their home weekly or biweekly for a 4-month period. At the end of intervention, the scales were applied to the women as the post-test. The mean scores of self-actualization, health responsibility, interpersonal support, stress management subscales of the health promotion lifestyle profile and the total score increased in post-test, except for nutrition subscale. There were statistically significant differences between pre- and post-test scores. This study demonstrated that the Omaha System intervention increases health promotion lifestyle profile of the women. It is recommended as a nursing care to health promotion.

근로자의 삶의 질 예측모형

Purpose: The purpose of this study was to propose and to test a predictive model that could explain the workers' quality of life. Methods: Data were collected using self-report questionnaires from 901 workers in Daejeon, Korea. The questionnaires included nine measured variables (safety culture, self-efficacy, activity of occupational health provider, knowledge in occupational health, age, health promotion behavior, workplace environment, health level, and quality of life), as revised PRECEDE model has suggested. The collected data were analyzed using SPSS/WIN 15 and AMOS 6.01 version. Results: Based on the constructed model, behavior, environment, and health were found to have significant direct effect on quality of life. Indirect factors were perceived biological, predisposing, reinforcing, and enabling. The proposed model was concise and extensive in predicting quality of life of the participants. The final modified model yielded GFI=.85, AGFI=.89, NFI=.79, and RMSEA=.11 and exhibited good fit indices. Conclusion: Findings of this study may contribute to development of effective nursing interventions for promoting quality of life in workers.

Aboriginal Recruitment and Retention in Nursing Education: A Review of the Literature

Increasing diversity in the nursing workforce is a means to promote quality health care for multicultural populations. Though Aboriginal people comprise 4% of the Canadian population, Aboriginal nurses represent less than 1% of the nursing workforce. Despite isolated efforts in nursing education, Aboriginal students are neither recruited nor retained in nursing programs at a rate significant enough to close this gap. A literature review was conducted to identify the current state of knowledge on recruitment and retention of Aboriginal people in nursing education programs. Thirty six articles met inclusion criteria, and major themes were identified and organized according to characteristics of students and academic environments. Characteristics of academic environments were further segmented by secondary school, classroom, program, and university levels. With published literature in its infancy, we suggest an organizing strategy based on a decolonizing multiple intervention and evaluation approach, and commitment from Aboriginal-university partnerships, governments and the health professions.

Psychometric properties of the OLQ-13 scale to measure Sense of Coherence in a community-dwelling older population

BackgroundWith the ongoing demographic shift, the quality of life and health promotion among older individuals are becoming increasingly important. Recent research suggests that Sense of Coherence positively affects quality of life. Hence, a valid and reliable measurement of Sense of Coherence is pivotal. The 13-item Orientation to Life Questionnaire (OLQ-13) can be used to measure Sense of Coherence. The purpose of the present study is to assess the psychometric properties, validity, and reliability, of the OLQ-13 in community-dwelling individuals, aged 65 and older.MethodsThe OLQ-13 scale was administered as part of a healthy aging project for non-institutionalized people aged 65 years and older. Internal consistency and reliability were assessed by means of inter-item and test-halves correlations and Cronbach's alpha. Construct validity was explored using cluster analysis and exploratory factor analysis (n = 703) and tested using confirmatory factor analysis on a separate subset of individuals (n = 658). Item face validity was investigated by means of 12 semi-structured interviews.ResultsThe reliability and the validity of the OLQ-13 in this population of non-institutionalized individuals aged 65 years and older was ambiguous, at least partly due to the poor performance of two items (b and d), which was confirmed by results from the qualitative part of this study. The psychometric properties of the proposed OLQ-11, obtained by deleting the two items, were better. In particular, the interpretation of exploratory factor solution improved. Whereas the underlying theoretical constructs could not be linked to the exploratory analyses of OLQ-13, this was to some extent possible in OLQ-11. The superior validity of OLQ-11 over OLQ-13 was supported by the better model fit in the confirmatory factor analysis.ConclusionsThe present mixed-method study suggests the proposed OLQ-11 as a more suitable instrument for measuring Sense of Coherence than the OLQ-13 in a population of ageing individuals. This study confirms that the validity and reliability of OLQ-13 may differ substantially in different populations.

O adolescente enquanto protagonista em atividades de educação em saúde no espaço escolar

O paradigma do protagonismo juvenil reconhece nos adolescentes potencialidades e valores de mobilização e participação, os quais podem contribuir para a promoção da saúde e melhor qualidade de vida desta população. O objetivo desta investigação foi conhecer e analisar a participação de adolescentes escolares em atividades de educação em saúde na escola e a sua inserção enquanto sujeitos protagonistas na referidas atividades. O estudo foi realizado em duas escolas municipais de ensino fundamental de Ribeirão Preto, São Paulo, Brasil, no período de fevereiro a junho de 2007. Estudo transversal, a partir de uma abordagem quantitativa, cujos dados incluíram respostas a um questionário com instrumentos validados, e a análise estatística se constituiu basicamente da categorização de variáveis e obtenção das listagens de frequências, realizadas através do Programa Epi Info 3.3.2 (Centers for Disease Control and Prevention, Atlanta, Estados Unidos). Os adolescentes entrevistados apontam que ainda permanecem em uma relação de dependência da escola e dos educadores para a realização e participação de atividades educativas em saúde no espaço escolar. Isto significa dizer que esses adolescentes ainda convivem com uma relação educador-educando unilateral, pouco participativa, indicando uma urgente necessidade de se promover a inclusão desses adolescentes como atores ativos do mundo escolar. Descritores: Adolescente; Participação cidadã; Educação em saúde; Instituições acadêmicas.

Motivational interviewing may be effective in dental setting

Medline, PsychInfo, Cinahl, ERIC and the Cochrane Library were searched to identify relevant studies. Study quality was assessed using a scheme combining the Type of Evidence Schema, the Health Gains Notation framework and the Cochrane Health Promotion and Public Health Field quality assessment screening questions for qualitative studies, quantitative studies and systematic reviews. A qualitative synthesis was presented. Thirty-two studies were identified, nine of clinical prevention and health education, three of counselling, nine of models-based interventions and 11 of motivational interviewing. Motivational interviewing interventions were found to be the most effective method for altering health behaviours in a clinical setting. There is a need to develop an effective model for chairside oral health promotion that incorporates this evidence and allows oral health professionals to focus more on the underlying social determinants of oral disease during the clinical encounter. There is potential to further develop the motivational interviewing approach within the oral health field.

Health Informatics Meets eHealth

Health informatics develops methods and tools that should, when applied to health care, contribute to a high-quality, efficient care of individuals and populations [1]. The translation of health informatics research into practice can be seen as a “continuum” from IT development to healthcare problem solving [2], starting with developing and validating early solutions (tools, algorithms, technologies ...) that are then integrated and tested in clinical practice, first in small pilot projects, later in larger evaluation studies. Scientific publication of the outcome of these projects and studies is an important step to increase awareness on new solutions, to allow sharing of experiences, and to decide on continuation or stop of the developments as part of evidence-based health informatics [3]. Health informatics has been developing solutions for intra-organizational information systems for many decades now. Recently, with the emergence of inter-organi zational (or trans-institutional) information systems [1, 4], the term “eHealth” has been shaped to describe “an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies” [5]. Generally speaking, the term eHealth encompasses more traditional concepts such as telemedicine and tele monitoring [6] as well as newer concepts such as shared electronic health records [7] or pervasive health care systems [8]. eHealth applications offer the potential for large benefits for health care, such as improved quality of care, patient empowerment, health promotion, and cost savings [9 –11]. However, a lot of challenges need to be overcome to exploit these potential benefits, such as semantic and technical integration and human-computer interaction [12], but also social, cultural, eco nomical and organizational challenges [10, 13], as eHealth will have an impact on the way health care is delivered in the future. This special issue presents the best three contributions from the eHealth2009 conference in Vienna, highlighting recent challenges and achievements in the area of eHealth. The eHealth-conference series is an annual series of scientific events dealing with health informatics methods and their applications to eHealth [14]. The paper by Christoph Rinner and coauthors [15] tackles the problem of semantic interoperability. At the moment, XML-based document standards such as Clinical Document Architecture (CDA) or ISO/EN 13606 are being developed to support semantic interoperability within inter-organizational information systems. The authors present an approach to automatically validate EHR documents, to assess whether they are conformant to the described standards. Their approach allows EHR documents to be validated for conformance with the underlying reference models and archetypes of the mentioned standards by means of XML schema, without requiring an additional validation language. This will allow simplifying the overall validation process in the future. The paper by Tuncay Namli and Asuman Dogac [16] addresses the technical interoperability of EHR systems. There are many standards and initiatives (such as HL7 v3 or IHE) that support the exchange of data. To allow interoperability based on these standards, application systems need to prove that they are conformant to these standards. The authors present an automated, modular and scenario-based testing framework that allows testing conformMethods Inf Med 2010; 49: 269–270