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Biomedical subjects

D E Morisky

Publications and source records attributed to D E Morisky.

32 records · Page 2Linked to original sources
PubMed1983

A small group strategy for improving compliance behavior and blood pressure control.

A brief small group structured approach to improving compliance behavior and blood pressure control is described. The group intervention is based on the results of a diagnostic baseline survey of ambulatory hypertensive patients receiving care in an inner-city hospital. It was tailored to meet the expressed needs of that population group. Three main steps characterize the intervention: examining health behaviors and compliance issues with the patients using rehearsal of specific coping skills in problem solving activity; using Locus of Control concepts to facilitate process; and encouraging the patient to practice and apply the coping skills in stressful situations. Major themes within the group sessions and general outcomes are examined.

Blood Pressure↗
PubMed1983

Five-year blood pressure control and mortality following health education for hypertensive patients.

Three health education interventions for urban poor hypertensive patients were introduced sequentially in a randomized factorial design: 1) an exit interview to increase understanding of and compliance with the prescribed regimen; 2) a home visit to encourage a family member to provide support for the patient's regimen; and 3) invitations to small group sessions to increase the patient's confidence and ability to manage his/her problem. Previous evaluation of the initial two-year experience demonstrated a positive effect of the educational program on compliance with the medical treatment and blood pressure control. Data accumulated over an additional three years, including mortality analysis, are now presented. The study group consisted of the same cohort of 400 ambulatory hypertensive outpatients in the eight experimental and control groups. The five-year analysis shows a continuing positive effect on appointment keeping, weight control, and blood pressure control. All-cause life table mortality rate was 57.3 per cent less for the experimental group compared to the control group (12.9/100 vs 30.2/100, p less than .05), while the hypertension-related mortality rate was 53.2 per cent less (8.9/100 vs 19.0/100, p less than .01). The results from this longitudinal study provide evidence to encourage health practitioners to utilize such educational programs in the long-term management and control of high blood pressure.

Behavior↗
PubMed1982

An educational and behavioral approach toward increasing patient activation in hypertension management.

The shift in patterns of disease toward chronic illness necessitates greater patient participation in its management and their own rehabilitation, and they require greater social support over longer periods. Patient activation, or the enhancement of patient and support group involvement in personal health care through teaching management techniques and problem-solving skills, has emerged in healthy education in response to this need. This paper will examine combined educational and behavioral approaches to increasing social support and patient activation in hypertension management. Activation in this study involves increased feelings of personal control over the contingencies surrounding the management of medical regimens. Both family support intervention and small group sessions oriented to changing compliance behavior by changing expectancy frames were offered to a randomized sample of 200 inner city, black, hypertensive patients who were part of a larger study. Patients were examined within a pretest-posttest randomized factorial design on measures of locus of control, belief in seriousness, efficacy of treatment, medication compliance, and blood pressure control. This combined approach showed small differences on the attitude and behavioral measures but displayed a significant effect on the program outcome variable blood pressure control (62% in control among intervention groups versus 46% in nonintervention groups).

Black or African American↗
PubMed1982

Health education program effects on the management of hypertension in the elderly.

Because the elderly are viewed as having more difficulty in complying with therapy, this analysis was directed at the effects of a health education program on their control of primary hypertension when compared with a younger population. The program consisted of three sequential interventions introduced in a randomized factorial design. Depsite the fact that elderly patients had more chronic disease, more complications from hypertension, and were receiving more complex drug therapies than younger patients exposed to the same experimental interventions, they demonstrated significantly higher levels of compliance with drug therapy, significantly higher levels of appointment keeping, and no difference in the proportion having their BP under control at two-year-follow-up. Longitudinal data collected at five-year follow-up indicate no decay effect. These results indicate such programs can be successfully implemented and equally effective for an elderly population.

Aged↗
PubMed1978

A test of the construct validity of health locus of control: effects on self-reported compliance for hypertensive patients.

A test of the construct validity of the Health Locus of Control (HLC) scale is presented within the larger framework of Rotter's social learning theory. Self-reported compliance behavior was predicted to relate to the subject's HLC orientation, value toward health, and level of perceived home assistance. In a sample of ambulatory hypertensive patients, a significant two-way interaction effect was calculated between the perceived level of home assistance and the patient's HLC orientation (p = .02). The more internally oriented the patient and the higher the level of perceived home assistance in complying with the prescribed medical regimen, the greater the level of self-reported compliance behavior.

Attitude to Health↗
PubMedDate not supplied

Patterns of adolescent alcohol, cigarette, and marijuana use over a 6-month period.

In the current study, alcohol, cigarette, and marijuana use among adolescents (N= 794, 48.6% female) was assessed at two time points, and four patterns of use were identified: (1) abstainers: no lifetime use; (2) new users: no use at baseline but had used by the follow-up period; (3) experimenters: use prior to the baseline but no use in the period up to the follow-up; and (4) consistent users: self-report of use prior to the baseline and the follow-up. Mean levels of psychosocial variables (mastery, self-esteem, and parental social support) were compared across the four patterns of use for each substance. Only analyses including parental social support as the dependent variable were significant. Adolescents with higher levels of social support were more likely to be classified as abstainers or experimenters of alcohol than consistent users. More frequent users of cigarettes at baseline were likely to be classified as frequent users at the follow-up. The discussion focuses on the identification of the situational context of substance use for alcohol, cigarettes, and marijuana.

Adolescent↗
PubMedDate not supplied

Needs assessment strategies in working with compliance issues and blood pressure control.

This paper addresses the development and effect of health education interventions on compliance behavior and blood pressure control of hypertensive patients. The focus is on two main tactics: 1) the use of a baseline questionnaire to determine the patients' needs in the area of medical regimen management and the translation of that information into education intervention; 2) the development of a group method as a form of internality training providing a needs assessment and simultaneously responding to the assessment. The results supported the study's hypotheses with respect to blood pressure control. Both the theoretical and practical aspects of internality training as a needs assessment process and a skill training process are discussed.

Attitude to Health↗
PubMedDate not supplied

Asia--the new epidemic zone for HIV/AIDS.

Two articles that appear in this journal present unique ethnographic assessments of the commercial sex industry in Thailand. They discuss how culture, society, and organizations interact with respect to communication approaches, information dissemination, and organizational-behavior change in preventing the spread of HIV/AIDS. Each of these articles provides important insights into the many factors that have intensified the epidemic as well as those identified opportunities for concerted community organization, behavioral reinforcement, and social structural approaches for HIV/AIDS prevention and control.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Behavioral interventions for the control of tuberculosis among adolescents.

OBJECTIVES: Activation of latent tuberculosis infection into tuberculosis disease (TB), the primary killer among infectious diseases worldwide, can be prevented with six months of anti-TB medication. A large percentage of adolescents started on medication, however, fail to complete their treatment. The authors developed and tested the effects of innovative educational strategies on infected adolescents at two health centers serving ethnically diverse populations. METHODS: The authors used a randomized experimental four-group design to assess the independent and combined effects of peer counseling and a participant-parent contingency contract intervention. RESULTS: A total of 794 adolescents were recruited into the study, for a 79% participation rate. The overall rate of treatment completion was 79.8%. Self-efficacy for medication-taking behavior at post-test correlated strongly with completion of care (R = 0.367, p = 0.002). Participants randomized to the peer counseling groups demonstrated significantly greater improvements in self-efficacy and mastery than the usual care control group. Based on the study results, continuing education seminars and workshops were implemented for TB control staff at the two health clinics and for all TB Control Division staff at the Los Angeles County Health Department. Educational materials and a training manual for enhancing completion of treatment of latent TB infection through tailored educational approaches were developed and disseminated to the clinics. CONCLUSIONS: Health education and incentives are helpful adjuncts to the completion of treatment for latent tuberculosis infection in adolescents.

Adolescent↗
PubMedDate not supplied

Are condom instructions readable? Results of a readability study.

The use of condoms has assumed a central position in the current strategy to prevent sexual transmission of the human immunodeficiency virus. The effectiveness of condoms in disease prophylaxis is dependent, to a degree, on their correct use. Condom manufacturers routinely include information on condom use either printed on the actual package or in an enclosed package insert. With the use of three readability formulas, the reading grade level was determined for 14 different sets of instructions included with 25 brands of condoms manufactured by 7 domestic and 1 overseas manufacturer. The readability formulas, when applied to instructions for condom use, estimated that, conservatively, 8 of the 14 instructions required at least reading at the level of a high school graduate and none required less than a 10th grade level. Clearly written instructions and simple concepts could assist current and future condom users in the correct use of condoms and improve the effectiveness of condoms in the prevention of AIDS and other sexually transmitted diseases.

Achievement↗
PubMedDate not supplied

Data-based planning for educational interventions through hypertension control programs for urban and rural populations in Maryland.

As part of a statewide effort to coordinate existing resources for high blood pressure (HBP) control, a public health HPB control program was planned and implemented in two high-risk communities in Maryland. The selection of the two communities was based on epidemiologic data. The planning of the educational intervention program in these communities (urban and rural) was guided by organizational theory and health education principles. The framework for development, implementation, and evaluation of the program utilizes an educational assessment model which identified factors that predispose, reinforce, and enable individual persons to practice positive health behavior. Multiple data sources were used in assessing the extent of the problem and relevant approaches in the development of the coordinated HPB control program. These include statewide vital statistics and a random statewide household survey to assess the prevalence rates of awareness, treatment, and control of HPB. To supplement these data, telephone surveys were carried out in the two communities to assess knowledge, beliefs, and practices related to HPB control. Medical record reviews provided baseline information on appointment keeping behavior and BP correlates of hypertensive patients. The planning and implementation of the program was carried out under the direction of representatives of the health care systems, community leaders, and residents, and representatives of communitywide organizations involved in HPB control.

Adolescent↗