Individual Health Beliefs Research Articles

Impact of clinician and patient attitudes on clinical decision making for the symptomatic menopausal woman with or without comorbidity

Culture, individual health beliefs and distressing symptoms frequently determine women’s perceptions of their menopausal transitions. Women’s perceptions of mental health problems and the acceptability of different interventions greatly affect if and what a woman is willing to try as a treatment option and whether or not she will accept the possibility that her menopausal symptoms represent a comorbidity with a diagnosis, such as depression or anxiety. These perceptions have a significant impact on women’s choices with regard to health practices, as well as on whether or not they will seek out medical care for their distressing symptom(s). Working with a woman’s beliefs, sharing decision making, and empowering her through health education are all critical aspects of the treatment of the patient with comorbid perimenopausal symptoms, regardless of their etiology.

Consistent Condom Use Among Juvenile Detainees: The Role of Individual Differences, Social Bonding, and Health Beliefs

This study takes the perspective that condom use may be a non-continuous variable, and that the endpoint of consistent condom use is an important focus of study both in terms of public health considerations and theoretically. As consistent condom use is the ultimate goal for prevention of the spread of HIV and STDs among those who are sexually active, special attention needs to be paid to those who have accomplished that goal, especially among high-risk populations. Guided by theories of resiliency, and using consistent condom use as a marker of the broader sexual health resiliency construct, condom promotive factors are used to predict consistent condom use among detained adolescents. Consistent condom users appear to be a distinct sub-population. Likely to be male, they are also likely to have higher self-esteem, higher optimism, and lower sensation seeking and impulsive decision making. They are likely to be in school and to live with both biological parents. Finally, they are likely to have positive attitudes towards condoms and report having friends and peers who feel the same way.

Racial‐Ethnic Differences in Genetic Amniocentesis Uptake

The objective of this study was to determine the role of health beliefs in genetic amniocentesis acceptance in a diverse racial-ethnic population. Participants completed a previously-validated questionnaire consisting of three sections: (1) demographics, (2) amniocentesis knowledge, and (3) health beliefs, which assessed perceived susceptibility, seriousness of potential impact, benefits of testing, and barriers to testing. The results showed that Hispanic women were less likely to accept amniocentesis (51.5% vs. Caucasian 82.8%, African American 82.9%, Asian 82.8%). Education level was the only demographic factor higher among acceptors. Women who accepted amniocentesis had higher perceived seriousness, susceptibility, and benefits HBM scores and higher knowledge scores than women who declined. HBM scores and knowledge predicted the amniocentesis decision correctly 91.5% of the time. Individual health beliefs and knowledge play a greater role in genetic amniocentesis acceptance than do demographic factors such as race-ethnicity.

How can adherence with multi-drug therapy in leprosy be improved?

Leprosy remains a major public health problem in many developing countries. Multidrug therapy (MDT) is effective, but adherence varies from 70% to 90%. Poor adherence has detrimental consequences including incomplete cure, persisting infectious sources and multidrug resistance. Many factors determine adherence, including health beliefs of individuals and societies, the quality of the doctor-patient relationship and characteristics of the regimen. Thus multiple initiatives are required to improve adherance. Ley’s cognitive model highlights three potential targets: understanding, memory and satisfaction. Proschaska and DiClemente identified that patients are at different stages in their readiness to change, so each requires different interventions. Health education decreases the stigma of leprosy. Early signs and curability should be emphasized as self-referred patients are more likely to adhere. Advertising leprosy as disfiguring and disabling merely enhances stigma. Advertising should be tailored to populations using locally revered members of the community, politicians and actors. Targeting young adults who are more literate and amenable to change can influence their elders to seek treatment. The ideal treatment involves a cure with the lowest dose of a drug with minimal sideeffects for the shortest length of time. Changes to medication to increase adherence include sustained release drugs, more convenient doses, blister packs and regimens tailored to individuals. Monetary incentives to improve adherence are controversial. They were successful in anti-tuberculosis programs among homeless populations. However, the financial costs may make this impossible in developing countries and it sets a dangerous precedent for other treatments. Direct observed treatment (DOT) increases adherence and decreases drug resistance to anti-tuberculosis treatment. However, this may be due to accessibility, drug availability, patient incentives, tracing defaulters and outreach efforts. Disadvantages of DOT include financial costs and the time and stigma associated with clinic attendance. Patients weigh the benefits of treatment against costs such as price, side-effects, time off work, loss of privacy, loss of autonomy, stigma of clinic attendance and the effort of travelling to clinics. Social marketing can decrease these perceived costs. Countries where

How do people with Type 2 diabetes perceive and respond to cardiovascular risk?

To explore how people with Type 2 diabetes perceive cardiovascular risk, and how those perceptions might affect their motivation to make lifestyle changes. The setting was a diabetes clinic in a UK teaching hospital. A qualitative study was conducted, using semistructured individual interviews and template analysis of content. The participants were 20 Type 2 diabetic patients, aged between 52 and 77 years, half with and half without cardiovascular disease (CVD). Whether they had CVD or not, most people were aware they were at risk of it, of its causative factors, and possible effects. However, they were more likely to attribute it to unchangeable factors like 'stress' and 'heredity', than medical risk factors like cholesterol and smoking. Patients with pre-existing CVD correctly regarded their risk as higher than those without. Few saw any direct link between being diabetic per se and cardiovascular risk. Lifestyle changes were precipitated by major life events and motivated by family support, fear of complications, and a belief that one should follow doctors' advice. A common reaction to CVD and diabetes was stoical acceptance, allowing patients to view their lives positively, whilst living with unpredictable potentially disabling diseases. Patients were unaware how strongly diabetes influences cardiovascular risk. Their ideas about risk were very different from those of conventional medicine, and provided individual rationales for making choices about treatment and risk-influencing behaviour. Contextual factors, such as family milieu, also influenced their behaviour. Clinicians should not assume patients share the same mental model of risk as they, and must be prepared to explore peoples' individual constructs and health beliefs.

USE OF INTERNET MEDICAL WEBSITES AND NHS DIRECT BY NEUROLOGY OUTPATIENTS BEFORE CONSULTATION

SUMMARYWith increasing personal access to the internet, and the mass of medical information available in cyberspace, many patients may access information before an outpatient consultation. Since this information may shape individual health beliefs and expectations, yet is acknowledged to be of very variable quality, it may be important for practitioners to know about their patients' self‐directed findings. Medical information may also be gained from the NHS Direct telephone helpline. This study measured the frequency of use of the internet and of NHS Direct by questioning consecutive new referrals attending general neurology outpatient clinics over a three‐month period. A comparison was made between patients' searches and their final diagnosis. Patients' views on the use of the information received were sought.

Student nurses' breast self-examination health beliefs, attitudes, knowledge, and performance during the first year of a preregistration degree program.

Very little information is available about young women's breast self-examination (BSE) health beliefs and practice. The purpose of this descriptive survey was to determine if changes occurred in young women's BSE health beliefs, attitudes, knowledge, and performance over the first year of a registered nursing degree program. The convenience sample consisted of female students ages 40 years or younger who were surveyed at the beginning (n = 105) and end (n = 71) of the first year of the course. The Health Belief Model was used as the conceptual model in the study to measure the students' health beliefs and to calculate mean health belief scores. Data were collected using self-administered questionnaires and analyzed using descriptive and inferential statistics. Results found students' BSE health belief scores to be high for perceived seriousness and benefits; moderate for susceptibility, control, and health motivation; and low for perceived barriers. These beliefs were not found significantly to predict or increase student's attitudes, knowledge, or performance of BSE, even though significant associations were identified between individual health beliefs. Students consistently reported positive attitudes toward the importance of BSE and in learning more about the procedure. Approximately one-third of students reported performing BSE monthly. No significant differences were identified in their BSE knowledge or performance over the year. Positive correlations were found between students' BSE frequency and their nursing experience as well as BSE instruction gained outside the course. In summary, no statistically significant differences were found between students' pretest and posttest BSE variables.

Health beliefs and the intent to use predictive genetic testing for cystic fibrosis carrier status

The utility of the health belief model (HBM) for predicting intent to use carrier screening for (CF) was considered. Using an analogue survey design, information about health beliefs and demographic variables was collected from a sample of 131 predominantly white men and women, aged 18-45 years. A multiple indicator model of the HBM constructs of perceived severity, beliefs and benefits was designed and tested for efficacy in distinguishing between those who indicated that they would and would not consider carrier screening. In total, 20% of the between groups variability was accounted for by the discriminant function model, with 10% attributed to the combined effects of the HBM, and the remainder attributed to age and marital status. The results of the study suggest that further exploration of individual health beliefs surrounding CF carrier testing may be useful to facilitate effective decision-making in genetic counselling situations.

Health beliefs and heart disease risk among middle-aged Swedish men Results from screening in an urban primary care district

Objective - To study the relationship between individual health beliefs and risk factors for coronary heart disease.Design - Health beliefs indices, formed by factorial analysis of ratings of statements on health related matters in a questionnaire, were related to risk factors for coronary heart disease, assessed with physical examinations and self reports of medical history and habits.Setting - An urban primary care district in Malmö, Sweden.Subjects - A random sample of middle-aged men, invited to a health check-up.Results - The participation rate was 453/705 (64%). “Perceived threat to health caused by illness” was positively related to previous information on high blood pressure, high plasma cholesterol, and/or diabetes (p=0.01). In a model of logistic regression, adjusted for age, cohabitation, and previous medical history, health belief index on “threat to health” was related to low exercise habits (RR=1.06, CI 1.01, 1.12). “Perceived control over illness” was related to high alcohol consumption (RR=0.86, CI 0.75, 0.97), smoking (RR=0.89, CI 0.79, 0.99), and high diastolic blood pressure (RIU0.84, CI 0.75, 0.95).Conclusion - This cross-sectional study demonstrates relations between health beliefs, previous health-related experiences, and risk behaviour. To explore the causality of the former, longitudinal studies of changes in health beliefs after medical information are required.

Sociodemographic correlates of health beliefs among black and white community dwelling elderly individuals.

This study examined the hypothesis that sociodemographic characteristics such as age, education, race, and gender would be predictive of Multidimensional Health Locus of Control Subscale scores in a population-based sample of 342 community dwelling elderly individuals. Bivariate analysis revealed associations between black race, lower socioeconomic status, and lower education on the Chance and Powerful Others Subscales. While the multivariate analysis revealed no predictors for the Internal Subscale, a higher socioeconomic status, white race, and a higher level of education continued to predict low scores on the Chance Subscale when controlling for all other variables. Scores on the Powerful Others Subscale appeared to be a function of socioeconomic status and gender. Of note, the higher the education level for both men and women, the lower the scores on the Chance and Powerful Others Subscales. This sex by education interaction term reached statistical significance for the Chance Subscale. The results demonstrate the measurable influence of sociodemographic variables on the health beliefs of community dwelling elderly individuals.

The relationship between health beliefs, adherence, and metabolic control of diabetes.

There is evidence that an individual's health beliefs influence performance of health behaviors. The purpose of this study was to determine whether health beliefs in persons with diabetes could be modified during a clinical education program and whether the health beliefs were related to adherence to self-care instructions and metabolic control of diabetes. Health beliefs and HbA1c were measured at baseline in 189 adult outpatients with diabetes. Diabetes educators then attempted to modify health beliefs that were not conducive to positive health behaviors. Following education, some health beliefs were modified in a positive direction. Modest, but statistically significant increases in perceived severity of diabetes, perceived ability to carry out recommended behaviors, and perceived benefits of treatment were observed. Although HbA1c improved significantly in a subgroup of patients, this improvement could not be directly associated with any health belief or with self-reported adherence by the measures used in this study.

Psychosocial predictors of intended condom use among Zimbabwean adolescents

In a test of the predictive capacity of the Health Belief Model the association of perceived susceptibility to HIV severity of HIV infection efficacy of HIV-preventive solutions facilitating cues and barriers to action with intended condom use was examined among 343 male and 220 female Zimbabwean adolescents. Of these 57% of males and 17% of the females were reportedly sexually experienced; among this group 34% of the males and 41% of the females reported consistent condom use. Predictors of intended condom use were examined separately for each sex using bivariate odds ratio analysis of individual health beliefs with significant bivariate associations with intended condom use and simultaneous logistic regression on Health Belief Model subscales comprised of aggregated individual beliefs belonging to each element of the model. These analyses indicated that whereas facilitating cues and barriers to action were the principal determinant of intended condom use among males perceived social support for condom use was the major determinant of intended condom use among females. These results suggest that while HIV-prevention approaches for each sex have much in common somewhat different emphasis for males and females may be appropriate. (authors)

Beliefs, practices, and experiences of Korean women in relation to childbirth

Korean women's health beliefs and childbirth experiences in the United States were examined. A convenience sampling procedure was used, and face-to-face interviews were conducted in Korean. Interviews were audiotaped, typed, and translated from Korean to English. These women had a holistic concept of health. Some practices were influence by ancient Chinese medicine. Childbirth experiences indicated that language is a barrier requiring specific interventions. Recommendations include (a) development of an assessment tool with which health-care professionals can identify individual health beliefs early in pregnancy; (b) development of a bilingual pamphlet about medical terms and the U.S. health-care system; (c) development of a short bilingual dictionary of common foods for use in menu selection during hospitalization; and (d) provision of English practice periods based on anticipatory guidance principles to prepare women to ask for specific assistance.