Implications For Health Education Research Articles

Elementary School Teachers' Perspectives on Health Instruction: Implications for Health Education

Limited literature is available on the barriers and enablers of elementary school health instruction, and even less is known about teachers' experiences that influence their decision to teach health. The purpose of this research was to obtain information to assist public health educators in creating an infrastructure to support school health education instruction. The question guiding the research was, “From the perspective of elementary school teachers' experience, what are the barriers and enablers to teaching health in the classroom?” During January-March 2000, qualitative research methods, including 56 one-on-one interviews and 9 focus groups with 51 elementary school teachers, were conducted. Findings relate to three general thematic areas: existing policies or guidelines for instruction, limited instruction time, and teacher preferences. Recommendations are provided for creating a partnership between public health educators and school health educators to establish an educational environment that supports classroom health instruction, as well as recommendations for enhancing teacher capacity to teach health.

Developmental concepts of asthma: Reasoning about illness and strategies for prevention

Management of asthma requires not only an understanding of the causes and consequences of asthma episodes, but effective use of preventive techniques. The present study investigated asthma knowledge, causal reasoning (“concepts of illness”) regarding episodes of asthma and headache, and strategies for prevention in a sample of 104 children with persistent asthma and 90 parents. Causal reasoning regarding asthma was associated with child age ( τ=.25 and .29, p<.01), as was factual asthma knowledge ( r=.45, p<.001). Parents and children demonstrated higher concepts of illness for episodes of asthma compared to headache (all ps<.001), suggesting that more education and experience may facilitate reasoning regarding disease. Mentioning medication use for prevention was associated with higher causal reasoning regarding illness. Of note, this strategy was mentioned by fewer than 65% of parents and children in the study, although all of the children had been prescribed such medication. Implications for health education across child development are discussed.

The Activated Health Education model: refinement and implications for school health education.

A behaviorally based, health education instructional model was developed from a review of successful health education interventions. The analysis identified three principles common to improvement of health behavior among program participants: 1) active involvement in the intervention process, 2) awareness of the positive and negative influences of the behavior on health, and 3) personal responsibility for managing health behavior. These principles and several theoretical premises then were organized into a structural framework for the model. Next, studies were conducted to validate applications of these conditions and refine strategic components. The model then was formatted into a curricular design to achieve optimum behavior and provide ease of replication. Research related to developing and field testing the model are included. The model's limitations and strengths, implications for school health education, and plans for the future are presented.

HIV/AIDS knowledge, attitudes, beliefs and behaviours among rural South African youth: Implications for health education

The aim of the study was to evaluate data on behavioural indicators in relation to the Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS)/Sexually Transmitted Diseases (STD) prevention and occurrence in a rural youth population in South Africa. A representative community sample of youth using a three-stage cluster sampling method was chosen for a household survey, and qualitative data were obtained from the youths using ten focus group discussions. The survey sample included 421 youths: 189 (44.9%) male, and 232 (55.1%) female, whose ages ranged from 15 to 24 years (M=20.8 years, SD=3.6). The questionnaire included 71 items on HIV/AIDS/STD related knowledge, attitudes, beliefs and behaviours. Results indicated a mean HIV/AIDS knowledge score of 7.11 (range 0-9) indicating a moderately adequate knowledge. HIV/AIDS knowledge was associated with more consistent condom use, and with a more supportive attitude towards persons with HIV or AIDS. At first sexual intercourse, 19.4% of the sexually active youth had used a condom, whereas 80.6% had not, 41.4% men and 25.3% women admitted they had more than one sexual partner other than commercial partner (partner with whom you had sex in exchange for money) in the last 12 months. A large group of the women (47.6%) and men (32.7%) participants indicated that they never used a condom with their non-commercial partner during the past 12 months. Among the sexually active youth 18% of the men and 13.4% of women had had sex with a commercial partner in the last 12 months. Among female youth 15.2% reported to have become victims of forceful sex during the last 12 months. For youth the major reasons for not using a condom with a non-commercial partner were 'not available', followed by 'did not like them', 'did not think of it', 'other' (mainly trust in partner), and 'partner objected'. There was a high incidence of self-reported genital discharge/ulcer/sore within the last 12 months among sexually active youths (12% in males and 5.2% in females). Findings are discussed in relation to implications for health education. Key words: HIV/AIDS/STD knowledge, attitudes, beliefs, behaviour, rural youth, South Africa. 2. MODIFIABLE RISK FACTORS OF CORONARY HEART DISEASE IN MALE FIRST TIME ENTRANTS TO A HEALTH AND FITNESS CENTRE IN SOUTH AFRICA Marius F. Coetsee The objective of the study was to draw up a profile of modifiable risk factors among male first time entrants to a health and fitness centre. Data for 257 males with mean age of 31 years were documented between 1999 and 2001. All assessments were done at the Empangeni Health and Fitness Centre. The following parameters were recorded: personal details, health status, smoking habits, mass, height, body composition, blood pressure, total cholesterol, physical working capacity and predicted aerobic capacity. The majority of subjects (50.9 %) displayed two or more, 27.3 % three or more and 8.2 % four or more, risk factors for coronary heart disease (CHD). Of the 253 subjects tested 43.2 % were inactive before they joined the health and fitness centre. Smoking ³ 10 cigarettes per day was prevalent in 19.2 % of subjects. At risk due to obesity (body fat >20 %) was prevalent in 45.9 % of subjects and 36.2 % had a BMI of >27.8 kg.m-2. Elevated cholesterol (>5.2 mmol.l-1) was found in 51.1 % of the subjects. Hypertension (systolic >140 mmHg and/or diastolic >90 mmHg) were prevalent in 16.1 % of subjects. It is clear that much room for improvement in the modifiable risk factors exists in the subjects. The findings have important implications for health and fitness providers in planning preventive strategies. Key words: Modifiable CHD risk factors, exercise, health and fitness, males. 3. EFFECTS OF 8 WEEKS JOGGING PROGRAMME ON BODY FAT IN UNTRAINED WOMEN Danladi I. Musa. This study was designed to measure the effects of 8 weeks continuous jogging programme on abdominal fat and total adiposity in 27 untrained female undergraduate students aged 21- 39 years. Subjects were randomly assigned to a control group (n = 13) and a continuous jogging group (n = 14). Subjects in the experimental group jogged 3.2 km three times a week for 8 weeks at an intensity of 80% of their age predicted maximal heart rate. Abdominal fat and total fat mass (TFM) were estimated before and after the training programme. Results indicated no significant (p > 0.05) training effect on abdominal fat but a significant (p (Af. J. Physical, Health Education, Recreation and Dance: 2002 8(1): 1-25)

Coverage of Adolescent Substance Use Prevention in State Frameworks for Health Education

Ten secondary health education state curriculum frameworks were reviewed for their inclusion of 12 mediators commonly used to prevent adolescent substance use. Specific aims of the investigation were: a) to identify the extent to which the 12 mediators were found in each framework; and b) to identify those frameworks that included Alcohol, Tobacco, and Other Drugs (ATOD) sections and determine to what extent the 12 mediators were found in those sections. A panel of three researchers independently reviewed each framework. Beliefs about consequences, decision-making skills, and stress management skills were identified most often while commitment, lifestyle incongruence, and normative beliefs were identified least often. Among states that included ATOD sections, beliefs about consequences and resistance skills were the most commonly identified mediators. Commitment, goal setting, and normative beliefs were not identified in any ATOD sections. Research in prevention and implications for health education are discussed.

Help-seeking behaviour for cancer symptoms: perceptions of patients and general practitioners.

The aim of this study is to increase our understanding of the relationship between knowledge and interpretation of symptoms, fear and trust on the one hand, and the decision to consult a general practitioner (GP) for cancer symptoms on the other. Qualitative interviews were used to evaluate the various factors. Twenty-three patients and ten GPs were interviewed. A number of factors were found to play different roles for different patients groups, i.e. patients that consult their doctor prematurely, at the right time, or those that delay. A lot of the findings can be tested using various concepts of socio-psychological theory. Further research should provide an improved understanding of the way these models can be applied to help-seeking behaviour. In terms of implications for health education, we conclude that each patient group has different needs and requires different information.

A Study of Suicide-Related Behaviors among Colombian Youth: Reflections on Prevention and Implications for Health Education

This study examined risk behaviors related to depression and suicide among adolescent students enrolled in public schools in Bogota, Colombia. Data were collected from 1,692 respondents who completed a modified version of the CDC Youth Risk Behavior Survey. Measures of central tendency, chi-square, and analysis of variance tests were used to analyze the data. Findings from this study revealed that 21% of the participants expressed suicidal ideation; fantasizing about suicide transcended to an actual plan in 19% of the cases; and 16% reported at least one attempt in the 30 days preceding the study. This article presents selected literature on the relationship between culture and suicidal risk behavior, methodological considerations in cross-cultural research, and implications for suicide prevention for Colombian adolescents and U.S. health educators.

A qualitative study of parents' experiences of providing sex education for their children: The implications for health education

0bjective To explore how parents talk to their children and identify the factors that influence parents talking to their children about sex. In addition, to uncover ways by which this sex education could be enhanced. Design A qualitative study of parents' experiences of providing sex education to their children. Setting Interviews were carried out in the field within parents' homes or workplace. Method Fifty semi-structured interviews were conducted with parents across Leeds. One or both parents were interviewed to gather qualitative data. Results Factors that were found to enhance or limit parent-child communication were dynamically inter-related. These include parents' perceptions of the child, their role as a parent and their perception of sex education from school and health agencies. Gender of the parent and their own experience of sex education clearly influenced provision. Mothers tended to be the main educators although a few fathers shared the role. Uncertainties were experienced, especially about giving sons sex education. Parents also possessed many skills as educators taking opportunities, establishing open communication or responding to ideas progressively and appropriately during their child's development. Participants welcomed access to sources of information, support and good communication within the school and health care settings. Conclusion Parents were found to possess skills as educators, but also experience uncertainty and embarrassment about aspects of their role. The realities of provision were intricate. However, parents' natural role in sex education was evident. Agencies should consider fully integrating parents into their health education strategies.

The Internal Triangle: Self, peers and society in boys' identity formation with implications for sexual health education

Drawing on qualitative data from a research project funded by the Economic and Social Research Council (ESRC), this article investigates boys' own construction of gender identity and the correlation between this and formal Sex and Relationships Education (SRE). It offers a simple but flexible model as a basis for understanding this correlation-or its lack-and for the construction of SRE approaches that the boys might find more relevant to their current priorities. The model takes the form of a triangle whose sides equate with the time and energy that boys are expending on the private, peer and societal aspects of their lives. The shape of the triangle alters according to shifts in this personal expenditure, forcing the individual into different areas within the triangle according to the circumstances they find themselves in at different times. The article also draws some methodological conclusions on the experience of doing qualitative research with young people in sensitive areas.

Prevalence, attitudes and knowledge of high school pupils towards drugs and other addictions: implications for school health education in Israel

One hundred and fifteen high school pupils from Holon (a city in the center of Israel) participated in a study about the prevalence, knowledge and attitudes of these pupils towards drugs and other addictions (cigarettes and alcohol). Their mean age was 16.13 (±1.59) years; 43.9% were boys and 56.1% were girls. A total of 1.6% of the pupils regularly used illicit drugs, and an additional 11.3% were offered drugs. A total of 24% of the pupils smoked regularly (at least during the past year), and 42% consumed alcoholic beverages regularly. Their knowledge concerning illicit drugs was found to be inadequate; they correctly answered only 50% of the total study questions. A more liberal attitude towards illicit drugs was found with increasing age. Pupils who consumed illicit drugs received a higher scoring for their knowledge concerning the characteristics of various illicit drugs, as well as to having a more liberal attitude. The self image of the pupils who had experience with illicit drugs was lower (in two separate tests) in comparison to their peers. As a result of our study, our recommendation is to include the subject of illicit drugs, their dangers and prevention of their use in the official school curriculum from elementary school and during all subsequent school years.

Correlates of knowledge of one's blood pressure and cholesterol levels among older members of a managed care plan.

We examined factors predicting knowledge of one's blood pressure, total cholesterol, and high-density lipoprotein levels (HDL) among older persons who reported a recent blood pressure or cholesterol test. Data come from a self-administered, health risk assessment that was mailed to health plan members, age 55 and older, in a Santa Barbara, California medical group. Despite their universal access to health care and high levels of reported compliance with preventive health care screening practices, 41%, 49%, and 77% of respondents reported that they did not know their blood pressure, cholesterol, or HDL levels, respectively. After controlling for potential confounders, age and low income were inversely associated with the respondents' ability to report each level. In addition, current smoking and obesity were inversely associated with self-reported knowledge of both cholesterol measures. Persons taking medication for hypertension or hypercholesterolemia were much more likely than those not taking medication to be able to report their blood pressure and cholesterol levels. Except for persons currently undergoing treatment for related conditions, these results suggest that a substantial proportion of the older persons at high risk for cardiovascular disease do not know their levels of these important biological risk factors. This lack of knowledge has important implications for public health education, and may hinder risk-reduction efforts among the elderly.

The role of behavioral experience in judging risks.

This study used conditional risk assessments to examine the role of behavioral experiences in risk judgments. Adolescents and young adults (ages 10-30; N = 577) were surveyed on their risk judgments for natural hazards and behavior-linked risks, including their personal experiences with these events. Results indicated that participants who had experienced a natural disaster or engaged in a particular risk behavior estimated their chance of experiencing a negative outcome resulting from that event or behavior as less likely than individuals without such experience. These findings challenge the notion that risk judgments motivate behavior and instead suggest that risk judgments may be reflective of behavioral experiences. The results have implications for health education and risk communication.

Differences in sexual risk behaviors between college students with same-sex and opposite-sex experience: results from a national survey.

The goal of this study was to identify differences in the sexual health behaviors (condom use and number of sexual partners) between college students with same-sex sexual experiences and those with only opposite-sex partners. Data from a random sample of American university students were gathered as part of the 1997 College Alcohol Study. Odds ratios were estimated for consistent condom use and multiple sex partners for students with same-sex or both-sex sexual partners compared to those with exclusively heterosexual contacts. Five percent of respondents reported ever having a same-sex partner. Significant differences in safer-sex practices were found between groups. Females with both-sex experience and males with both-sex or only same-sex experiences were more likely to report multiple recent sexual partners than their peers with only opposite-sex partners. Odds ratios of consistent condom use were lower for men with only same-sex experience than among those with only opposite-sex partners. Findings have implications for sexual health education on the college campus. Consistent condom use remains low among college students. Education programs should emphasize the importance of limiting the number of lifetime sex partners, especially among students with same-sex experiences.

Establishing a Relationship between Behavior Change Theory and Social Marketing: Implications for Health Education

Social marketing has been applied in a variety of health education settings and has produced encouraging results. As the awareness and application of social marketing increases among practicing health educators, the link between social marketing and traditional behavior change theory becomes more critical. Because behavior change theory and social marketing are complementary, the challenge facing health education is how to make behavior change theory a useful and essential component of social marketing. This article describes the relationship between behavior change theory and social marketing practice. It is proposed that social marketing is the framework to which theory can be applied, resulting in programs that are theory-driven, consumer-focused, and potentially more effective. This integration of behavior change theory and social marketing can be achieved in four areas: planning, understanding consumer behavior, guiding formative research, and evaluating success. The added value of theory to an already promising framework like social marketing that replaces paternalistic, top-down approaches with consumer-based interventions should be compelling to all health educators.

Attitudes and practices regarding varicella vaccination among physicians in Minnesota: implications for public health and provider education.

This study sought to determine physicians' attitudes and practices regarding varicella vaccine. A sample of Minnesota family physicians and pediatricians was surveyed in January 1997. Of 255 physicians surveyed, 108 (42%) reported routinely offering varicella vaccine. Physicians who perceived their professional organization's recommendations as "very important" were more likely to routinely offer varicella vaccine. Physicians who preferred natural disease over vaccination and those concerned about waning immunity were less likely to routinely offer vaccine. Recommendations of professional organizations have encouraged varicella vaccine use and may further enhance future use. Differences in pediatricians' and family physicians' attitudes and practices regarding this vaccine suggest that education of providers by specialty may be needed to increase acceptance of newly licensed vaccines.

Food beliefs and practices among British Bangladeshis with diabetes: Implications for health education

In order successfully to promote 'healthier' food choices, health professionals must first understand how people classify and select the foods they eat. We explored the food beliefs and classification system of British Bangladeshis by means of qualitative interviews with 40 first-generation adult immigrants with diabetes. Methods included audiotaped, unstructured narrative interview in which participants were invited to 'tell the story' of how diabetes affects them, pile sorting of food items, and participant observation of meals. We found considerable heterogeneity of individual food choices against a background of structural and economic factors (i.e. food choices were partly determined by affordability and availability), as well as cultural influences. Important themes included strong religious restrictions on particular food items (chiefly the Islamic prohibition of pork), and widely held ethnic customs based on the availability of foods in rural Bangladesh. Modification of the diet on immigration did not generally incorporate many 'Western' foods but included increased quantities of 'special menu' Bangladeshi foods such as meat and traditional sweets. Foods were not classified or selected according to Western notions of food values (protein, carbohydrate, etc.). Rather, within religious and ethnic patterns, further food choices were determined by two interrelated and intersecting binary classification systems: 'strong'/'weak' and 'digestible'/'indigestible', which appear to replace the 'hot'/'cold' classification prevalent elsewhere in South Asia. Different methods of cooking (especially baking and grilling) were perceived to alter the nature of the food. A desire for dietary balance, and a strong perceived link with health, was apparent. These findings have important implications for the design of health education messages. Dietary advice should reflect religious restrictions, ethnic customs and the different cultural meaning of particular foods, while also acknowledging the ability of the individual to exercise choice within those broad limits.

WOMEN'S KNOWLEDGE AND PRACTICES REGARDING THE PREVENTION AND TREATMENT OF OSTEOPOROSIS

Osteoporosis and related fractures are a major cause of disability, institutionalization, and death among aging women. Unless prevented or actively treated, osteoporosis will continue to limit both the quantity and quality of life for many older women and significantly add to the health care costs of this rapidly growing population group. This study was designed to assess women's knowledge and practices regarding the prevention and treatment of osteoporosis. A descriptive/exploratory design was used to survey a convenience sample of 185 women. Measures of knowledge and practices were obtained with a hand-delivered questionnaire. Data were statistically and thematically described. The results suggest that women are receiving inadequate information about osteoporosis, possess limited knowledge about the disease, and are not taking adequate measures to prevent or treat osteoporosis as they age. Implications for health education on these issues are addressed and plans for future research are briefly discussed.

‘Let Mum have her say’: turntaking in doctor–parent–child communication

Recent legislation in the Netherlands requires that children should play a part in decision making regarding their own health care. So far, however, little attention has been given to the child’s participation in medical interviews. In order to get a grip on aspects of asymmetry and control in doctor–parent–child communication, the present study explores the turntaking patterns in this triad at the general practitioner’s surgery, and makes a comparison over the years. Videotaped observations of 106 medical interviews taken over a period of almost 20 years have been analyzed by means of the Turn Allocation System. The results show that the child’s control in the medical consultation is rather limited, though, over the years, the child participates more actively. The child’s conversational contribution appears to be strongly related to the age of the child. An important finding is the difference in the way GP and parent accommodate their turntaking patterns to the child; parental control appears to be constant over the years, and is not related to the age of the child, whereas the GP is considering the child’s age. The results are discussed in terms of implications for medical practice and health education.

Tobacco growers' knowledge of revenue distribution and foreign prices: implications for health education.

This study examined tobacco growers' knowledge of tobacco economics, particularly their knowledge of how tobacco revenue is distributed and their knowledge of the price of foreign tobacco. Tobacco growers (n = 1236) from 14 tobacco-dependent counties in North Carolina were interviewed by telephone and asked to estimate how much of a hypothetical $2.00 for a pack of cigarettes is received by each of four market segments: tobacco growers, retailers, government and manufacturers. Respondents were also asked to estimate the price of foreign raw tobacco. USDA data were used to assess the accuracy of the respondents' estimates. Respondents were within the 'correct' range as follows: growers 31%, retailers 15%, government 23%, manufacturers 43% and foreign prices 25%. Knowledge was positively related to education and farm size for the growers' share and foreign tobacco prices. Knowledge of the government's and manufacturers' shares was positively associated with younger age. North Carolina growers lacked knowledge of the distribution of the tobacco dollar. This may influence the positions that growers take on health policy and provide significant opportunities for health educators to become involved in grassroots efforts to educate growers.

On-Line Medical Information and Service Delivery: Implications for Health Education

This article provides an overview of on-line medical information and service delivery. It outlines the immediate implications of these advances for health education professionals as well as projects some of their potentials and regulatory repercussions for the future. The article also analyzes the varieties of medical misinformation and rumor that are common on networks, and discusses attempts by health organizations to control them. Many individuals are using the Internet to become more autonomous in their health care activities, but are encountering various hazards. Health educators can be instrumental in empowering individuals to be critical and cautious yet effective in their use of medical applications on the Internet.