Biomedical subjects

G Kok

Publications and source records attributed to G Kok.

At least 19 recordsLinked to original sources

PubMed2003

Designing a quality improvement intervention: a systematic approach.

Most quality improvement or change management interventions are currently designed intuitively and their results are often disappointing. While improving the effectiveness of interventions requires systematic development, no specific methodology for composing intervention strategies and programmes is available. This paper describes the methodology of systematically designing quality of care improvement interventions, including problem analysis, intervention design and pretests. Several theories on quality improvement and change management are integrated and valuable materials from health promotion are added. One method of health promotion-intervention mapping-is introduced and applied. It describes the translation of knowledge about barriers to and facilitators of change into a concrete intervention programme. Systematic development of interventions, although time consuming, appears to be worthwhile. Decisions that have to be made during the design process of a quality improvement intervention are visualised, allowing them to serve as a starting point for a systematic evaluation of the intervention.

Decision Making, Organizational↗

PubMed2001

The additional value of anticipated regret and psychopathology in explaining intended condom use among drug users.

Abstract In this study we examine determinants of intended condom use with casual and steady sex partners among drug users. Our aim was to find out whether anticipated regret and psychopathology represent additional factors in explaining condom use behaviour, on top of the constructs defined in traditional psychosocial models of behaviour. A questionnaire measuring intentions, attitude, beliefs, personal norm, subjective norm, descriptive norm, self-efficacy and anticipated regret toward condom use with steady and casual sex partners, and the Symptom Checklist '90 (to measure dimensions of psychopathology) were handed out to 150 Dutch drug users. The results showed that intended condom use with steady sex partners was mainly predicted by self-efficacy, personal norm and anticipated regret (total R2 = 0.41). Lower feelings of hostility and a more positive personal norm, subjective norm and attitude significantly predicted intended condom use with casual sex partners (total R2 = 0.24). The results also showed that intended condom use with steady sex partners seems to result from anticipating possible barriers, whereas condom use with casual sex partners is largely a matter of having safe sex norms. Practical implications of this study for Aids-preventive campaigns are also discussed.

Condoms↗

PubMed2001

Predicting condom use with casual and steady sex partners among drug users.

In many Western societies, drug users are accountable for heterosexual transmission of HIV. Although various studies have shown that safe sex is not a common practice among drug users, we still have little understanding of the factors that determine their use of condoms in their sexual relationships with steady or casual partners. The objective of this study is to gain more insight into the determinants of drug users' condom use with steady and casual sex partners. In a study conducted among 103 Dutch drug users, the participants indicated their intentions, vulnerability, attitude, personal norms, subjective norms, descriptive norms, self-efficacy and response efficacy regarding condom use with steady and casual partners. The results showed that some drug users had borrowed used syringes and that most drug users practise unsafe sex, especially with steady partners. Most drug users were hardly motivated to start using condoms. The study further showed that antecedents of condom use differ with regard to steady sex partners and casual sex partners. Self-efficacy and subjective norms were predictors of intentions to use condoms with steady partners; intention to use condoms with casual partners was only predicted by self-efficacy. These differences should be taken into account when designing AIDS prevention interventions to encourage use of condoms.

Adult↗

PubMed2001

Evoked fear and effects of appeals on attitudes to performing breast self-examination: an information-processing perspective.

The effect of fear arousal on attitude toward participating in early detection activities [i.e. breast self-examination (BSE)] was studied from an information-processing perspective. It was hypothesized that fear arousal motivates respondents to more argument-based processing of fear-relevant persuasive information. Respondents first read information about breast cancer in which fear was manipulated. After measuring fear arousal, respondents read a persuasive message about performing BSE. Analyses with reported fear, but not manipulated fear, found support for the hypothesis. Respondents who reported mild fear of breast cancer based their attitude toward BSE more on the arguments provided than respondents who reported low fear of breast cancer. This finding suggests that the use of fear arousal may be an efficient tool in health education practice. However, alternative interpretations are provided, in addition to the suggestion to be careful with using fear arousal in health education messages.

Adult↗

PubMed2001

Public reactions to people with HIV/AIDS in The Netherlands.

A national telephone survey was conducted to (a) assess present-day public reactions to people with HIV/AIDS in the Netherlands, (b) measure how knowledge about highly active antiretroviral therapy (HAART) is related to public reactions to people with HIV/AIDS, and (c) investigate determinants of willingness to have personal contact with people with HIV/AIDS. Dutch adults (N = 751) participated in a telephone interview conducted to measure cognitive, emotional, and behavioral reactions to people with HIV/AIDS. This study has shown that public reactions to people with HIV/AIDS seem to be moderately positive in the Netherlands. Knowledge about HAART is related to lower risk perceptions, a positive attitude toward homosexuals, less fear, and more willingness to have personal contact with people with HIV/AIDS. In particular, cognitive and emotional factors are meaningfully related to willingness to have personal contact with people with HIV/AIDS. Implications for Dutch AIDS educational campaigns aimed at stigma reduction are discussed.

Acquired Immunodeficiency Syndrome↗

PubMed2000

The determinants of health care seeking behaviour of adolescents attending STD clinics in South Africa.

The study investigated the determinants of delay behaviour in health care seeking in a sample of 292 adolescent patients (20 years and younger) with STD symptoms. Fifty six percent (56%) of the adolescents sought health care within the first 6 days of noticing symptoms, 23% waited between 7 to 10 days and 21% waited longer than 10 days before seeking health care. Early health care seeking was determined by perceived seriousness of STDs, an absence of self treatment prior to seeking care and positive attitudes regarding personal autonomy in condom use behaviour. Facilitation of early health care seeking remain critical in curbing the threat of AIDS among the South African youth.

Adolescent↗

PubMed2000

Determinants of condom-use behaviour among STD clinic attenders in South Africa.

This cross-sectional study analyses determinants of condom-use behaviour among patients attending dedicated STD clinics in South Africa. A structured interviewer-administered survey was conducted among 1473 patients. Patients' beliefs and attitudes towards condom use in general, as well as their personal condom-use behaviour were measured. Their perceptions, regarding the social influence of their partners and friends on their condom use, and of their self-efficacy in using condoms, while infected with an STD were also measured. Condom use, as a dependent variable, was examined and patients were placed in a pre-contemplation stage if they had never used a condom, contemplation if they had seriously thought of using a condom, some action stage if they sometimes used a condom and regular action stage if they used a condom every time. The relationships between the stages of change, as dependent variables, and the independent variables were investigated for both those patients with steady partners and those with outside partners. This was performed by stepwise multiple regression analyses. The variables that significantly explained stages of change were similar for patients with steady partners and those with outside partners. In both partner groups communication was the variable most strongly associated with the use of condoms. General self-efficacy in condom use, self-efficacy in condom use with a partner and attitudes towards the use of condoms played a role in determining patients' different stages of change.

Adult↗

PubMed2000

Impact of HIV-positive speakers in a multicomponent, school-based HIV/STD prevention program for inner-city adolescents.

Qualitative and quantitative data from Safer Choices, a school-based multicomponent HIV prevention program, were examined to determine the impact of HIV-positive speakers on inner-city adolescents' HIV risk perception and empathy for people with HIV or AIDS. Inductive analyses were used to assess student reactions to speakers. Multilevel regression modeling techniques were used to analyze student survey data (n = 1,491) to determine the effect of speakers alone, as well as in combination with the multicomponent intervention, and a knowledge-based curriculum (comparison condition). Results showed that speakers were highly popular with students and teachers, and had a positive short-term impact on students' attitudes. Although not statistically significant, the combination of intervention and speakers had the greatest impact on outcome variables. Integrating HIV-positive speakers into multicomponent programs may have a positive impact on inner-city youth. Utilizing speakers without other educational components may have minimal effects. Strategies for training and utilizing HIV-positive speakers in school settings are included.

Adolescent↗

PubMed1999

Targeted prevention for people with HIV/AIDS: feasible and desirable?

People with HIV/AIDS are rarely chosen as a target group for prevention activities. In this paper we look at empirical and theoretical evidence for the feasibility and desirability of directing preventive interventions at HIV-positives. Research data on the behaviour and motivation of HIV-positives suggests that the differences between HIV-positives and HIV-negatives and those who are unaware of their HIV-status are not large. However, specific determinants of behaviour, such as responsibility for others or the risk of superinfection, have seldom been measured. Effective interventions targeting at HIV-positives and focussing on prevention are lacking. Fear of increased stigmatization has been used as an argument against focussing prevention activities at HIV-positives. Theoretically that argument is probably not correct: positive coping with HIV may invite positive reactions. The conclusion is that HIV-positives should be chosen as a special target group for additional planned preventive interventions. Because people need to be aware of their HIV status, testing and treatment sites are adequate settings. Effective interventions should be developed on the basis of theory and evidence about the specific determinants of risk behaviour of HIV-positives: protecting oneself for superinfection and protecting one's partner.

Adaptation, Psychological↗

PubMed1999

STD-related knowledge, beliefs and attitudes of Xhosa-speaking patients attending STD primary health-care clinics in South Africa.

The primary aim of this study was to describe patients at sexually transmitted disease (STD) clinics in Cape Town, South Africa, in terms of gender, education and age differences relative to their STD knowledge and beliefs, their condom use, as well as their attitudes towards condom use and their condom-use behaviour. The information was collected with a view to developing a health education intervention. Structured interviews were conducted with 2978 randomly sampled Xhosa-speaking STD clinic attenders about their knowledge, beliefs and practices regarding STDs and related behaviours. More males (75%) than females (25%) presented for STD treatment. The majority of patients (92%) were younger than 35 years. Female patients were found to be more aware than male patients of the sexual nature of STD transmission, valued personal autonomy in sexual behaviour and expressed a greater need to use condoms. Males perceived STD symptoms to be more serious, had more misconceptions about the cause of STDs and also more negative beliefs and attitudes towards condom use. Only 34.9% of the patients reported using condoms in the last 6 months while only 24.5% reported regular use. Those who reported condom use were more knowledgeable about the sexual transmission of STDs and the effects of STDs on the neonate. They also had fewer misconceptions about the causes of STDs and perceived STD symptoms to be more serious, attached greater value to personal autonomy in sexual behaviour and condom use and had more positive outcome expectancies of refusing sex than those who never used condoms. The data suggest that targeted interventions directed at males will have to address their inadequate knowledge regarding STDs in terms of transmission, causes, consequences, prevention and cure. Their negative beliefs and attitudes towards condoms will need special attention, especially in view of their multiple partner behaviour. Interventions directed at females will need to improve their knowledge regarding STD consequences, causes, recognition of symptoms as well as improve their knowledge of aspects of prevention and cure. All interventions must facilitate personal autonomy in decision making about sexual behaviour and condom use for both men and women, through skills development programmes that promote self-efficacy in the individual and instil a culture of mutual respect of such in the community.

Adult↗

PubMed1999

[How effective are smoking cessation campaigns?].

An important risk factor, single as well as combined with other factors, for the development of cancer is tobacco smoking. In the Netherlands 37% of the adult men smoke, and 30% of the women. It is estimated that 20% of the now living population will eventually die from the consequences of smoking. Besides stimulating youngsters not to take up smoking, helping smokers to stop is preventative for the evolution of cancer. However, how effective are the attempts that are currently accomplished in this field? In this contribution, the quit-rates that the different methods produce will be described, over and above the 5% of smokers who yearly succeed in quitting on their own. These rates vary from 5% among the general population resulting from a mass media led campaign. Finally, some critical comments will be given on governmental policies.

Advertising↗

PubMed1998

The learning curve: health education in STI clinics in South Africa.

This qualitative study aims to assess health education practice in sexually transmitted infection (STI) clinics in South Africa with a view to develop improved health education programs in such clinics. Health workers' knowledge of and attitudes towards health education practice, their perceived health education skills, the content of health education in STI clinics and the organizational structure as context for health education were investigated. In-depth interviews were conducted with 18 health care workers practicing in the area of STI control. A lack in knowledge and skills required for effective health education practice was reported. The constraints posed by health workers' current knowledge and skills around health education and the organizational structure in terms of the absence of policy and protocols to govern health education, limited time, space and resources, impede on the actual practice of health education. It seems that these obstacles to health education facilitate a biomedical approach to STI management. This approach is further portrayed in the power dynamics between the health workers as well as between health workers and patients. The data suggest that a health education intervention needs to be directed at an individual level namely at health workers and at the organizational level, i.e. the clinic that provides the context for health education. The newly adopted district health system which equally embraces medical care and health promotion augers well for a holistic management of STIs in South Africa. This would ensure the recognition of all categories of health workers' contributions to health education within their own functions, strengths and time limitations.

Community Health Services↗

PubMed1998

Behavior and behavioral determinants in the management of demented people in residential homes.

The major goal of this Dutch study was to compare the behavior of staff towards demented patients in residential homes with five expert recommendations for dealing with dementia. There were 136 respondents in this postal survey. The results showed that the staff carried out the recommendations of encouraging activity, establishing effective communication, and not changing the routine of the patient's physical environment without good reason. However, the staff tested and corrected the residents too often. This was related to insufficient knowledge and a lack of support from colleagues. It is recommended that staff receive specific training during and after their professional training.

Aged↗

PubMed1998

Associations between work stress, alcohol consumption and sickness absence.

AIMS: To test an interactional model on the associations between work stressors, perceived stress, alcohol consumption and sickness absence. DESIGN: Cross-sectional survey. SETTING: The study was part of a Worksite Health Project including an Employee Assistance Programme and a Health Promotion Programme in the Netherlands. PARTICIPANTS: Participants were blue-collar workers from two Municipal Garbage Collecting Departments and white-collar workers from a Pharmaceutical Company (N = 471). MEASUREMENTS: Measurements included socio-demographic characteristics (gender, age, education, marital status), work stressors, perceived stress, alcohol consumption and sickness absence. Type of work-site (blue- or white-collar) and smoking behaviour were used as covariates. FINDINGS: Regression analyses resulted in three major findings. First, in the presence of stress, abstinence increased the risk of sickness absence compared with moderate drinking. We failed to find a significant relationship between excessive drinking and sickness absence. Secondly, stress mediated the associations between stressor and alcohol consumption, and between stressor and sickness absence, although stressors also directly predicted sickness absence. CONCLUSIONS: The association between abstinence and sickness absence could reflect medical problems of abstainers or a lack of skills for coping with stress. The failure to find a significant detrimental effect of excessive drinking may have been due to use of a low threshold for excessive drinking and/or low power. Prospective studies are needed to gain insight in causal relationships between the variables concerned.

Absenteeism↗

PubMed1998

The socio-cultural contexts of sexually transmitted diseases in South Africa: implications for health education programmes.

Sexually transmitted diseases (STDs) are widespread in South Africa and contribute to the growing HIV epidemic. As an important step in curtailing the spread of STDs, this study explores STD patients' illness representations within its socio-cultural context, particularly gender relationships. In-depth interviews were conducted with Xhosa- and Zulu-speaking patients in clinics in Cape Town, Western Cape (N = 67) and in rural areas of Kabokweni, Mpumalanga (N = 21) The findings suggest that STD patients' illness representations are reflections of their socio-cultural understanding of disease and of culturally defined gender relations. This, in turn, impacts on their general perceptions of the cause of STDs, their perceptions of the risk of contracting STDs, them entering and using formal and traditional medical treatment and on their ideas of prevention. Thus, healthy behaviours need to be facilitated through multiple educational strategies focusing on an improved understanding of the cause of the STD in its context of gender relations, the development of interpersonal and technical skills, as well as focusing on cues for action.

Attitude to Health↗

PubMed1998

Health education in television entertainment--Medisch Centrum West: a Dutch drama serial.

World-wide a number of groups have sought ways to incorporate health messages into television entertainment like popular drama and soap serials. In the Netherlands, the Heart Foundation incorporated its cardiovascular health message in several episodes of a popular Dutch hospital serial called Medisch Centrum West. To obtain greater insight into the impact of this so-called 'entertainment-education (E & E) strategy', an evaluation study was carried out. Medisch Centrum West was both entertaining and informative at the same time. Although viewers were well aware that the programme included a health message, they did not find it intrusive to their enjoyment of the storyline. It was interesting to learn that fans were more tolerant and positive towards the E & E strategy than non-fans. Age, sex and education level explained only 5% of the variance.

Adolescent↗

PubMed1998

Effectiveness of a personalized Health Profile for blue-collar workers.

This article describes a study on the effectiveness of a Health Profile that was offered to blue-collar workers. The major goal of the Health Profile was to improve workers' awareness of own health behaviors and their intentions to change unhealthy behaviors. The Health Profile consisted of a booklet in A4-format in which tailored information was given on health behaviors. A pretest and posttest design (no control group) was used. The results showed a significant improvement of awareness of own health behaviors. Significant attitudinal changes were also achieved. There were no changes in social support and self-efficacy nor was there a change in the intention to change behaviors. These results suggest that a personalized Health Profile is a promising means to make workers aware of their personal risk behaviors.

Adult↗

PubMed1998

The impact of computer-tailored feedback and iterative feedback on fat, fruit, and vegetable intake.

A randomized trial was conducted to study the impact of individualized computer-generated nutrition information and additional effects of iterative feedback on changes in intake of fat, fruits, and vegetables. Respondents in the experimental group received computer-generated feedback letters tailored to their dietary intake, intentions, attitudes, self-efficacy expectations, and self-rated behavior. After the first feedback letter, half of the experimental group received additional iterative feedback tailored to changes in behavior and intentions. The control group received a single general nutrition information letter in a format similar to the tailored letters. Computer-tailored feedback had a significantly greater impact on fat reduction and fruit and vegetable intake than did general information. Iterative computer-tailored feedback had an additional impact on fat intake. The results confirm that computer-generated individualized feedback can be effective in inducing recommended dietary changes and that iterative feedback can increase the longer term impact of computer-tailored nutrition education on fat reduction.

Adult↗