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Biomedical subjects

D Nutbeam

Publications and source records attributed to D Nutbeam.

At least 19 recordsLinked to original sources
PubMed2003

Soup kitchen consumer perspectives on the quality and frequency of health service interactions.

OBJECTIVE: Whilst previous research has repeatedly documented premature mortality and high morbidity among seriously disadvantaged and homeless populations, far less is known of the extent and nature of their interactions with health services. DESIGN AND SETTING: This cross-sectional case study describes health service utilization patterns and explores participant-reported difficulties in accessing health care, adhering to prescribed treatment and maintaining continuity of care amongst 100 users of a charity-run soup kitchen in urban Sydney. Participants and results. The study describes a largely welfare-dependent population sample with poor health who are frequent users of the health system (85% had seen a general practitioner in the preceding 6 months). The homeless were more likely to report difficulties accessing health care when needed [odds-ratio 3.15; 95% confidence interval (CI) 1.04-9.62]. One in three respondents reported difficulty adhering to prescribed treatment following their last health care visit. Affordability (P < 0.0001), not understanding instructions (P = 0.007), and not agreeing with advice (P < 0.0001) were the main factors associated with adherence difficulties. One in four failed to return for follow-up visits as advised, largely associated with attitudinal barriers such as a history of not believing problems would be addressed (P = 0.05), not trusting health professionals (P = 0.04), and not knowing where to get help in the past (P = 0.05). CONCLUSION: These results reinforce the important role of free primary care in reducing access barriers for the disadvantaged, but also highlight possible reasons for service interactions being ineffective in a substantial proportion of cases.

Adolescent↗
PubMed2001

The importance of the social environment for physically active lifestyle--results from an international study.

Physically active lifestyles are regularly associated with improved health and quality of life. Differences in lifestyles in society can partly be understood through the differences in the social and physical environment. This study examines the relationships between reported physical activity, and the extent of perceived support for physical activity in the physical and policy environment (e.g. facilities, programmes and other opportunities), and in the social environment. The data for the study come from a cross-cultural health policy study called MAREPS. In total, 3342 adults, 18 years or older, from six countries (Belgium, Finland, Germany, The Netherlands, Spain, Switzerland) were interviewed via telephone. Respondents were categorised as active or inactive according to self-reported physical activity. Social environmental factors and physical and policy environmental factors were also assessed. The analysis of the data was informed by social cognitive theory, although the study was not originally designed for this purpose. Sixty-eight percent of females and 70% of males were active. The proportions of active and inactive varied by countries to a great extent. The strongest independent predictor of being physically active was social environment. Those who perceived low social support from their personal environment (i.e. family, friends, school and workplace) were more than twice as likely to be sedentary compared to those who reported high social support from their personal environment. Specific knowledge of the programmes and actions for physical activity and sport was also a strong predictor of being active. A supportive physical and policy environment was not associated with participation in physical activity as strongly as had been anticipated. The variation between countries was stronger predictor of being active than the physical and policy environment variables. This study generates the hypotheses and raises the questions that in a preliminary way, there appears to be some relationships between aspects of physical and social environment and physical activity participation. However, future research is needed to refine and clarify this.

Adolescent↗
PubMed2001

Opportunities to improve maternal health literacy through antenatal education: an exploratory study.

This paper examines the concept of maternal health literacy, defined as the cognitive and social skills that determine the motivation and ability of women to gain access to, understand, and use information in ways that promote and maintain their health and that of their children. Specifically, it investigates the feasibility of using the concept of health literacy to guide the content and process of antenatal classes. The paper reports on the results of focus groups and interviews conducted with a range of health care providers, pregnant women and new mothers to obtain different perspectives on the issues surrounding antenatal education and parenting. The results give us a realistic look at what women are learning from existing antenatal education and how it can be improved. Comparing the results from the educators and the women, the same basic issues surface. Both recognize that there are serious time limitations in antenatal classes. These limitations, combined with natural anxiety and curiosity about childbirth, generally ensure that the content of classes is confined to pregnancy and childbirth. The limitations of time are also cited as a reason for the teaching methods being heavily weighted towards the transfer of factual information, as distinct from the development of decision-making skills, and practical skills for childbirth and parenting The results indicate clearly that antenatal classes cannot possibly cover all there is to know about pregnancy, childbirth and parenting. If the purpose of antenatal classes is to improve maternal health literacy, then women need to leave a class with the skills and confidence to take a range of actions that contribute to a successful pregnancy, childbirth and early parenting. This includes knowing where to go for further information, and the ability to analyse information critically. The authors conclude that this would represent a very challenging change in orientation for both the educators and pregnant women included in this study. Work continues on the development of the tools that will be needed to support this change.

Australia↗
PubMed2001

Asking the right questions of disadvantaged and homeless communities: the role of housing, patterns of illness and reporting behaviours in the measurement of health status.

OBJECTIVE: To assess the self-reported health status and its relationship to key demographic variables among patrons of a charity-run meals service at The Exodus Foundation, in urban Sydney, Australia. METHOD: Random-sample cross-sectional study of 100 face-to-face interviews (79% recruitment rate). Self-reported health status was measured by subjective rating scale, open-ended and checklist questions about presence and type of acute and chronic disease. Anaysis by logistic regression of fair-poor health status on demographic variables in Exodus patrons and genera Sydney population adjusted for age and sex using the 1995 National Health Survey. RESULTS: Compared to housed but poor counterparts within the Exodus sample, homeless people were significantly more likely to report fair-poor health status (age-adjusted OR-3.0, 95% CI 1.3-7.1). Exodus patrons, as a whole, were much more likely than Sydney's general population to report fair-poor health status, after adjusting for age and sex (OR-4.5, 95% CI 2.9-7.0) and had a more serious pattern of illness (diseases of the digestive system; depression; common cold; bronchitis; refractive errors; drug and alcohol dependence; diabetes mellitus Type II). Exodus patrons reported fewer acute and chronic illnesses with open-ended questions than with a checklist (p<0.001). CONCLUSION: In this population there was a strong relationship between poor health and homelessness. When patterns of illness and injury were measured within this disadvantaged group, they showed more serious illness types than in the general population. Such patterns may not be identified by methods often used in traditional population health surveys.

Adolescent↗
PubMed2000

A model for mapping linkages between health and education agencies to improve school health.

Efforts to develop effective and sustainable school health programs evolved in sophistication the past 20 years through research and practical experience. This paper reviews these developments, arguing they were significantly driven by public health priorities, and have not adequately accounted for educational perspectives and priorities. To better understand the differences in perspective, a model is presented which illustrates linkages between different school-based inputs and strategies, and long-term health and educational outcomes. The model describes similarities and differences between the two perspectives. A significant coincidence exists in factors that determine educational attainment and improved health outcomes for students. A more holistic and integrated approach to school health is emerging, and at these interfaces our implementation and research efforts for the 21st century should be concentrated.

Education↗
PubMed1998

Effects of the Heartbeat Wales programme over five years on behavioural risks for cardiovascular disease: quasi-experimental comparison of results from Wales and a matched reference area.

OBJECTIVE: To assess the net 5 year effects of intervention of a community based demonstration project, the Heartbeat Wales programme, on modifiable behavioural risks for prevention of cardiovascular disease. DESIGN AND SETTING: Quasi-experimental design comparing results from two independent cross sectional population surveys conducted in 1985 and 1990 in Wales and a matched reference area in north east England. SUBJECTS: Random, stratified samples of people aged 18-64 years (18,538 in 1985 and 13,045 in 1990) in Wales and in north east England (1483 and 4534, respectively). INTERVENTION: A coordinated range of activities for heart health promotion in Wales entailing public education campaigns along with supportive policy and infrastructure change. In the reference area no additional community heart health promotion was planned, though considerable activity did take place, "contaminating" the reference area. MAIN OUTCOME MEASURES: Fifteen self reported behavioural indicators relating to dietary choice, smoking, frequency of exercise, and weight. RESULTS: Positive changes (for health) in behavioural outcomes were observed among the population in Wales, including a reduction in reported smoking prevalence and improvements in dietary choice. There was no net intervention effect for the programme over and above observed change in the reference area. CONCLUSIONS: No definite conclusions can be drawn concerning the efficacy of the programme in terms of behavioural outcomes. With hindsight, the difficulties of evaluating such a complex multifaceted intervention were underestimated. Further debate on the most appropriate methods for assessing the effectiveness of community based health promotion programmes is called for.

Adolescent↗
PubMed1997

Promoting health and preventing disease: an international perspective on youth health promotion.

PURPOSE: To advocate strategies to promote the health of young people that include action to create supportive social and economic conditions, alongside more traditional actions to strengthen individual capacity to protect health. METHODS: Analysis of different strategies for youth health promotion from different countries, including education, public policies, laws, and regulations that protect young people from exploitation and physical harm, and enhance their capacity to make healthy lifestyle choices. RESULTS: Access to education and the promotion of basic literacy are, in their own right, important public health goals. Beyond this, efforts to promote health through schools should focus on the creation of an integrated and mutually reinforcing set of experiences for young people, including classroom health education, the creation of a safe and healthy physical environment, and provision of appropriate school health services. The creation of supportive social and economic conditions are also essential, and require political action through the development of public policy. Such policies include restricting access to tobacco, alcohol, and illicit drugs, improving access to essential health services; and regulation of economic exploitation of young people. CONCLUSIONS: Health promotion is inherently political. Health professionals have to find ways to become more effective political advocates for young people. This should be reflected in the education of health professionals and educators, and in the work of agencies and professional associations.

Adolescent↗
PubMed1997

Lessons from a review of publications in three health promotion journals from 1989 to 1994.

A thematic analysis was undertaken of 72 editorials in three leading health promotion journals, Health Education Research: Theory & Practice, Health Education Quarterly and Health Promotion International, from 1989 to 1994. The three main themes which emerged were (1) the need to broaden health promotion interventions, (2) the need to promote rigour and professionalism in the discipline of health promotion, and (3) the need to respond to the information requirements of practitioners. Against this context, we conducted a content analysis of the journals, examining the nature of the 649 peer-reviewed publications in the same time period. Categories from the traditional bio-medical 'stages of research' models had to be adapted before full classification of articles published was feasible. The largest number of articles published could be termed descriptive research, followed by studies developing and validating health promotion measurement tools and health promotion theory. The proportion of program evaluations was small and the proportion of randomized controlled trials ('highest quality evidence' of effectiveness) decreased over time. Dissemination studies were also poorly represented in spite of this being identified in editorials as an important professional need. Ways to redress some of the imbalances observed are discussed.

Bibliometrics↗
PubMed1997

Health risk and behaviour of out-of-school 16-year-olds in New South Wales.

This study describes the health risks and health behaviour of a sample of 283 out-of-school 16-year-olds in New South Wales. We sampled study participants through the Commonwealth Employment Service offices in 1994 using a multistage sampling procedure. Of those surveyed, 129 responded to a letter inviting them to participate and 154 were recruited opportunistically. This paper describes the study methods and results for self-reported binge drinking, weekly use of tobacco and marijuana, sexual abuse, physical abuse, drink-driving, violence, and use of health services, by sex and method of recruitment. High rates of substance use were observed. Reported substance use in the out-of-school group was consistently higher than for 16-year-olds in school, except for binge drinking for girls recruited by letter. Of the out-of-school group, 34 per cent reported weekly use of tobacco, marijuana and also binge drinking. Boys were more likely to report drink-driving than girls (28 per cent and 13 per cent respectively). Having been in trouble with police ranged from 32 per cent for girls recruited by letter to 75 per cent for boys recruited opportunistically. A high proportion of girls reported sexual abuse (34 per cent of the 'letter' group and 41 per cent of the 'opportunistic' group). Overall, 87 per cent of respondents had used health services in the previous year. The results indicate that this is a disadvantaged group of young people who are an important target for health service provision and interventions.

Adolescent↗
PubMed1996

Achieving 'best practice' in health promotion: improving the fit between research and practice.

This paper is based on the proposition that transfer of knowledge between researchers and practitioners concerning effective health promotion interventions is less than optimal. It considers how evidence concerning effectiveness in health promotion is established through research, and how such evidence is applied by practitioners and policy makers in deciding what to do and what to fund when addressing public health problems. From this examination it is concluded that there are too few rewards for researchers which encourage research with potential for widespread application and systematic development of promising interventions to a stage of field dissemination. Alternatively, practitioners often find themselves in the position of tackling a public health problem where evidence of efficacy is either lacking, or has to be considered alongside a desire to respond to expressed community needs, or the need to respond to political imperative. Several different approaches to improving the fit between research and practice are proposed, and they include improved education and training for practitioners, outcomes focussed program planning, and a more structured approach to rewarding research development and dissemination.

Diffusion of Innovation↗
PubMed1996

Asthma, health behaviors, social adjustment, and psychosomatic symptoms in adolescence.

The association of health behaviour, indicators of social adjustment, and psychosomatic symptoms with diagnosed asthma was assessed in a community-based sample of 4550 adolescents in South Western Sydney, Australia. The results of this survey found an asthma prevalence among 11-15-year-olds of 17.5%, being consistent with previous studies. Tobacco use and alcohol consumption were higher among asthmatic compared with nonasthmatic adolescents. Asthmatics reported feeling lonely more often, having a number of negative social perceptions and feelings, and having more frequent psychosomatic symptoms. The findings of the study suggest that adolescents with asthma represent an important vulnerable group of school children. Asthma education may need a greater life-style change focus, besides asthma self-management training.

Adolescent↗