Local Health Education Research Articles

Public knowledge, attitudes and behaviour regarding antibiotics: does five years make a difference?

Abstract Objective To compare patient knowledge, attitudes and behaviour regarding antibiotic use between 2000 and 2005. Method Postal survey to 400 patients in March-April 2005. Setting Two general medical practices in Grampian, UK. Key findings There was a 64% response rate; 90% had experience of antibiotic use and 96% were happy to take antibiotics when necessary; 75% felt we should be more careful about how we use antibiotics. Compared to 2000, fewer patients indicated that most infections clear up by themselves without the need for antibiotics (48% versus 59%, P = 0.031). Fewer of those who experienced at least one respiratory tract infection (RTI) in the review period had consulted a doctor (2005, 14% versus 2000, 23%), and fewer consultations resulted in an antibiotic being prescribed (55% versus 75%). Fewer patients now agreed that telephone helplines for advice on RTIs are a good idea (42% versus 54%, P = 0.009), while more felt that people should make more use of their local pharmacist for advice on treatments for RTI and that they, themselves, would consult a pharmacist. On advice (from doctors, pharmacists or advertisements) on the management of RTI, fewer patients now cited: drink fluids (48% versus 68%, P = 0.023); rest (35% versus 54%, P = 0.012); take paracetamol (35% versus 50% P = 0.028); while more cited: self-medicate (non-paracetamol) (32% versus 15%, P = 0.004); let infection run its course (11% versus 5%, P = 0.027). Conclusions Antibiotic use remains a concern for many patients; however, almost all would take antibiotics when necessary. Fewer patients now consult a doctor about a RTI, and fewer consultations lead to an antibiotic being prescribed. Patients are increasingly positive about pharmacist advice but less keen on telephone helplines. A further local health education initiative should be considered to remind patients of strategies for the self-management of RTI.

Sex education for local tourism/hospitality employees: Addressing a local health need

Health concerns arising from sexual relationships between tourists and locals usually focus on the travelling public. The local sex partners' health, and their impact on their communities' health, seem far less acknowledged. This paper describes a local health education session which implemented recommendations based on a study in Cuzco/Peru on tourists' and locals' views, knowledge, attitudes and experiences relating to sexual relationships between them. On location, fifteen discotheque employees received a health education session at the establishment's owner's request. Concluding from the positive experience, it is argued that researchers should, where possible, respond to requests to deliver ad hoc health education sessions while on location to address an identified local health need.

The experiences of adults with intellectual disabilities and their carers in general hospitals: a focus group study

People with intellectual disabilities (ID) have higher levels of health needs compared with the general population, many of which are unrecognised and unmet. While there has been interest and research into the primary health provision for this group, there has been a more limited focus on addressing their care received in general hospitals. Access to health care has predominated in the literature, with less attention being paid to the experiences of people with ID as users of general hospital care. A qualitative focus group methodology was used. Eleven adults with ID, nine parents and five paid carers of adults with ID participated. The focus groups were audiotaped and transcriptions were analysed using principles of grounded theory. The analysed data highlighted key themes identified from the experiences of participants. These were the interrelated issues of feelings, particularly anxiety and fear, communication and behaviour problems; the practicalities of being in or attending hospitals, including the role played by carers; and issues around perceived discrimination and negative comments. The experiences of participants in this study concur with and add to concern expressed in recent reports and published research. Wide ranging implications are discussed for further research, wider policy development, clinical practice, local health service provision and education of health professionals.

Expérimentation d'une démarche participative sur le dépistage des cancers auprès de femmes en situation de précarité

An induction of organised breast and cervical cancer screening is underway in France. Nevertheless, communication around this issue has not been sufficient enough to be effective in mobilising women to participate, especially among those who are underprivileged. In fact, there are many constraints and obstacles, including women's opinions, beliefs and perspectives about these types of cancer and their screening. How can communication be designed in order to better respond to their specific concerns? How can one facilitate a greater understanding and awareness of the need and utility for gynaecological regular follow-up and early screening? It is through attempting to answer these questions that a research project was established to develop specific communications activities through a participatory peer-education process. Two groups of disadvantaged women participated in the development and management of a community-based communication programme. The programme's effectiveness is demonstrated. For 9 out of 10 women participating in the programme acknowledged a real awareness of the need for gynaecological follow-up and the usefulness of early screening, and 20% of them had a gynaecological visit with a practitioner as a result. Furthermore, we were able to highlight the impact of the participatory approach on the development of the psychosocial skills of the women involved as partners and volunteers in the programme. Today, the use of this model is being implemented as the participatory method to build a network of health mediators in the Lorraine region where they are responsible for developing local communication and health education at the grass roots level.

保健師の情報ニーズと医療系大学図書館の役割

A public health nurse, who gives local residents health service such as health consultation and health education offers health information to them who are health consumers. So, we made a survey for 211 public health nurses in Hokkaido about the present information environment, acquisition course of information and degree of their satisfaction with it. As a result, we found that their main acquisition course was “book magazine” and they seldom used database to obtain information. In addition, they felt lack of information to give local residents health education and to meet the residents' needs of health information enough. Further, they used public library mainly and felt dissatisfaction with the library of medical science university for the reason of “not being able to use it easily”, “taking long time to get document copy”, etc. It is thought that the nursing association which is one of the occupational associations, public library, hospital library and the library of medical science university have to cooperate from now on in order to offer information to public health nurses.

Guinea worm disease – the final chapter?

The global campaign for the eradication of dracunculiasis has succeeded in reducing the incidence of guinea worm disease by >99% in the past 20 years. This has been accomplished by the provision of safe drinking water supplies, filtration of drinking water, chemical control of intermediate hosts, case containment and, crucially, local health-education initiatives.

Epidemic and Spatial Dynamics of Lyme Disease in New York State, 1990–2000

Lyme disease (LD) occurrence in New York State (NYS) has not only increased over time but also spread throughout the state from the original disease focus in southeastern NYS. Few studies have investigated this epidemic and spatial dynamic in great detail. Using data from the NYS Department of Health Lyme Registry Surveillance System, we summarized epidemic and spatial characteristics of LD in NYS for the 11-yr time period from 1990 through 2000. New epidemiological trends associated with age, sex, and residential influences on LD over time were found. An empirical Bayes approach was used to produce maps of smoothed incidence at different time points to give a foundation for future state and local health funding plans and education programs.

Epidemic and Spatial Dynamics of Lyme Disease in New York State, 1990–2000

Lyme disease (LD) occurrence in New York State (NYS) has not only increased over time but also spread throughout the state from the original disease focus in southeastern NYS. Few studies have investigated this epidemic and spatial dynamic in great detail. Using data from the NYS Department of Health Lyme Registry Surveillance System, we summarized epidemic and spatial characteristics of LD in NYS for the 11-yr time period from 1990 through 2000. New epidemiological trends associated with age, sex, and residential influences on LD over time were found. An empirical Bayes approach was used to produce maps of smoothed incidence at different time points to give a foundation for future state and local health funding plans and education programs.

Smoking in Northern Ireland: A Case Study in Local Health Education, 1950-1973

Although tobacco smoking and its medical effects have both been widely studied, there have been few historical studies of how the evidence of a link between cigarettes and cancer, which began to impinge on the public consciousness from the 1950s, was translated into action at the local level in the United Kingdom. There is strong circumstantial evidence to show that, as elsewhere, the reluctance of Northern Ireland's central government to respond positively to the growing medical evidence was driven by economic motives, although the key consideration was employment rather than revenue. At municipal level, the effectiveness of health education was consistently undermined, not only, as in Britain, by ideological and medical conservatism, but also by a parsimony deriving from an outmoded rating system and a restricted local government franchise. Predictably, County Medical Officers of Health were generally gloomy about the likely benefits of health education campaigns based in the localities, and while the long-term persistence of smoking rates higher than the UK average may reflect a different class structure in the region, the study strongly suggests that without effective central backing, their pessimism was well-founded.

Multidisciplinary intervention for reducing malnutrition among children in the Islamic Republic of Iran

A multidisciplinary intervention to reduce protein-energy malnutrition among children in rural areas was piloted in 3 provinces of the Islamic Republic of Iran. Based on an initial situation analysis, a range of interventions were implemented through local nongovernmental organizations, including nutrition, health and literacy education for mothers, improved growth monitoring and fostering rural cooperatives and income generation schemes. Malnutrition before and after the intervention (in 1996 and 1999) was assessed using anthropometric measurements of random samples of children aged 6-35 months in control and intervention areas. Three years into the intervention, all indicators of malnutrition had consistently decreased in all intervention areas and the prevalence of underweight and stunting was significantly lower. Control areas showed a mixed pattern of small increases and decreases in malnutrition indicators.

Public knowledge, attitudes and behaviour regarding antibiotics

Objective: To assess public knowledge, attitudes and behaviour regarding antibiotics to provide information for a local health education policy.Design: Postal survey to 605 patients registered with two general medical practices in Grampian, NorthEast Scotland (351 respondents, 59.3%) in February/ March 2000. Questionnaire topics covered attitudes, knowledge and behaviour towards antibiotic use.Results: 326 (93%) bad experience of antibiotic use and 319 (81%) were happy to take antibiotics when necessary. 158 (45%) were concerned about antibiotic resistance. Few would expect antibiotics to treat a slight cold or heavy cold, but around half would expect antibiotics for very sore throats and influenza. 262 (75%) indicated they would ask a pharmacist for advice about the treatment of RTI. Most respondents experienced at least one episode of RTI during the review period. 280 (80%) provided details of their most recent episode; most self-treated, 57 consulted a doctor of whom 43 (75%) were prescribed antibiotics.Conclusions: Antibiotic resistance is a matter of concern for the public. Mixed opinions about the use of antibiotics for common respiratory tract infection were heard. Encouragingly the majority of people suffering an RTI during the review period treated themselves with paracetamol-based products for symptom relief. Those who consulted a doctor were in the minority but were likely to be prescribed antibiotics. Future local health education initiatives should target antibiotic use for sore throats as well as colds and flu.

Maternal perception of pneumonia in children: a health facility survey in Enugu, eastern Nigeria.

In a health facility-based study to determine the knowledge of mothers regarding recognition of pneumonia in their pre-school children, 400 women were interviewed using a pre-tested structured questionnaire. Sixty-one per cent of them would recognise pneumonia by difficult breathing, 42% by fast breathing and 26.5% by severe cough. Few of the mothers mentioned signs suggestive of 'chest indrawing' (8.5%) and 'central cyanosis' (1%). The maternal knowledge score on pneumonia signs increased significantly with educational status and social class (p < 0.05). While a substantial number of mothers (51%) perceived fast breathing to be an indication of severe pneumonia, a sizeable number (87.5%) were unsure if late signs such as chest indrawing and central cyanosis suggested severe disease. On the basis of the WHO criteria, it is concluded that maternal recognition of pneumonia in children is at best modest while knowledge of signs indicating severe disease is poor. These findings underscore the need to modify the WHO criteria to include difficult breathing and to highlight during local ARI health education campaigns that late signs such as chest indrawing and central cyanosis indicate severe and potentially fatal pneumonia.

Cutaneous leishmaniasis in Hormozgan, Iran.

Epidemiology of Cutaneous Leishmaniasis in Hormozgan province during April 1994 to March 1998 was studied. Data were collected from the Health service Centres throughout the province as well as from dermatologists. The patients were diagnosed clinically or paraclinically and all important details were recorded on specially designed forms. A total of 4094 patients with 7255 lesions were diagnosed. 42.24% of the sufferers were under 20 years and 6.47% were over 40 years old. 52.10% of the patients had one lesion and 33.98% had two lesions. Most of the cases were seen during January to March. The incidence rate per 10000 ranged from 5.90 in 1998 to 16.98 in 1996. A decreasing trend in the number of cases after 1996 may be due to the awareness of local health authorities, preventative activities and education.

Impact of a rural domestic violence prevention campaign.

Domestic violence is a prevalent health problem that in rural areas is further complicated by limited services, social isolation and the lack of privacy. Little is known about the impact of public health education on awareness, attitudes and behavior of the general public regarding domestic violence. This study sought to measure change in societal attitudes and behavioral intention in response to a seven-month public health education campaign targeting domestic violence in a rural county. From October 1998 to April 1999, the campaign used radio advertisements, posters, mailings to libraries and clergy, printed media articles, printed advertisements and health facility modifications. A random-digit-dialing telephone survey was used to evaluate attitudinal and behavioral changes in the intervention and comparison counties before and after the campaign. The response rates for the pre- (n =378) and postcampaign (n=633) surveys were 73 percent and 65 percent, respectively. Statistically significant increases in slogan and advertising recognition occurred in the intervention county (P=0.03), particularly among men recalling the campaign slogan (P=0.006). In a vignette regarding actions to be taken if the neighbor next door was abusing a partner, significant increases occurred in the intervention county in the percentage of respondents who thought that most people would talk to the victim (P=0.04), consult with friends (P=0.002) or talk to a doctor (P=0.004). Domestic violence agency hotline calls in the intervention county doubled following the campaign. Local public health education campaigns in a rural setting may be a valuable adjunct to national efforts, especially in reaching men.

Social environment and substance misuse: A study of ethnic variations among inner London adolescents

Objectives. To explore ethnic variations in drug, tobacco and alcohol use and their correlation with other factors which operate through peer, familial and religious influences. Design. Semi‐structured interviews with 132 12–13‐year‐old young people from four ethnic groups attending secondary schools in two inner London boroughs and a follow‐up interview completed approximately 17 months later. Results. The data was analysed using chi‐square and McNemar tests. Familial, religious and peer influence closely correlated with ethnicity. Bangladeshi young people showed lower levels of peer and higher levels of religious and familial involvement and lower levels of substance use. White young people reported higher levels of peer, lower levels of religious and familial involvement, and a higher level of substance use. Black African and Black Caribbean young people lay between the two extremes. Conclusion. The findings suggest that young people with lower levels of familial and religious influence, or higher levels of peer influence, have higher levels of substance consumption than other young people. Health education initiatives need to promote personal decision‐making skills within the context of the young people's individual culture. Cultural diversity should be recognised within local health education needs assessment.

Health education for a breast and cervical cancer screening program: using the ecological model to assess local initiatives.

This study investigates the development and implementation of health education strategies at the local level for a statewide breast and cervical cancer control program. Baseline data on these initiatives were collected from 88 local screening programs in North Carolina. Using the ecological model as a framework, health education initiatives were assessed and analyzed to determine the level of activity occurring at the local level and the comprehensiveness of programs. Types and levels of interventions used are described and initial analysis is provided of the impact these strategies are having on recruiting women from target populations into these screening programs. Specific examples illustrating the variety of interventions used at the individual, network, organizational and community levels, and the impact of certain variables, such as the use of local health education staff, on the comprehensiveness of interventions utilized, are provided. The importance to practitioners of establishing process indicators in assessing local initiatives and challenges to conducting evaluations of these strategies are also discussed.

Changes in medical education: the community perspective.

The societal and economic forces driving change in medical education are affecting communities as well as universities. Each of the four authors of this paper is deeply involved in one of the components of their locale's well-developed community-based medical educational system, and each describes how change is influencing his role in that system, whether the role be managing a community hospital, directing a local Area Health Education Center, participating as a family medicine faculty member, or being a community preceptor. They agree on some common themes: (1) that it is good that medical students' education is moving into the community (e.g., this validates the importance of the community hospital to medical education, is an acknowledgment of the importance of generalism, and provides students invaluable learning experiences); (2) that educating medical students in the community is expensive, and more funding and resources are needed so that the area's hospitals, community faculty, preceptors, and support services can be fairly compensated for their commitment; and (3) that their community-based education system can no longer absorb the costs of training more medical students. This is not a criticism of academic medical centers, which are under tremendous financial pressures themselves, but is simply to state the community perspective and to urge fairness in the distribution of resources for medical education. Community institutions and academic medical centers will work individually to create their own integrated health care systems but must work together to create a better, more cost-effective system for educating medical students.

Dietary patterns among adolescents in the West of Scotland

Dietary data from 15-year-old adolescents participating in the West of Scotland Twenty-07 study were examined in order to describe current eating patterns and food habits. Comparison of the data with a 'healthy eating' index showed that less than one-third of the sample were eating a diet similar to that promoted by local health education campaigns. Multivariate analysis showed that adolescents from non-manual and wealthier families, non-smokers, and females were more likely to be classified as 'healthy eaters'. Comparison of the data with that collected from a 35-year-old cohort in the same study showed that significantly fewer 15-year-olds were likely to consume diets associated with long-term health.

The value of qualitative research: health education in Nigeria

The experience of the University of Ibadans Ibaraba Community Health Program suggests that qualitative action research is particularly suitable for planning health education programs and encouraging community involvement. In contrast to large-scale survey methods fieldwork research is most often based on the technique of participant observation. In the context of health education such research seeks to identify locally perceived problems and their causes and to use the results to design appropriate programs. Time is taken to establish rapport with the community and more detailed in depth information is generated than is the case with surveys. Through participating in the research community members can have an important input into the research process and develop skills in the areas of program planning and evaluation. At the local level where primary health care programming takes effect there is a need for the flexibility offered by qualitative research methods. The foci of the 3 Ibaraba Community Health Program case studies were: 1) prompt treatment of malaria to prevent febrile convulsions 2) food categories and perceptions for nutrition education and 3) health education for a clinic-based diarrhea control program. These studies provided accurate essential and detailed results for health program planning and demonstrated that operational research using qualitative methods can become a part of regular service delivery. Whereas qualitative methods are generally more appropriate for local health education research quantitative information is needed for regional or national-level policy making.

The certificate in health education--a continuing experience in the development and training of health educators.

This paper describes key developments in the national validation of certificate courses, and the setting up of a network of co-operative curriculum development projects between the Health Education Council, local health education services and their officers, and colleges and their tutors. These developments are encompassed in a centre-periphery interactional model which, when projected into the future, displays continued active development. This model for the training and role development of health educators has considerable adaptability for use in other situations.