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Biomedical subjects

K Glanz

Publications and source records attributed to K Glanz.

89 records · Page 5Linked to original sources
PubMedDate not supplied

Durability and diffusion of the nutrition intervention in the Working Well Trial.

BACKGROUND: The Working Well Trial (WWT) emphasized employee participation in the planning and implementation of the health promotion intervention. These participatory strategies were intended to promote institutionalization of the health promotion program and thereby encourage maintenance of the intervention activities. We used data from 107 worksites in the WWT to test whether the nutrition intervention activities were maintained after the research program (i.e., durability) or were adopted by control sites (i.e., diffusion). METHODS: At baseline, upon the completion of the 2-year intervention, and 2 years later, we conducted organization surveys regarding worksite health promotion activities. A nutrition activity score from 0 to 3 was calculated based on availability of nutrition-related programs, self-help manuals or guides, and videos, tapes, brochures, or posters. RESULTS: From baseline to the end of the intervention, there was a significant increase in the nutrition activity score in intervention worksites compared with the controls (P < 0.001). However, 2 years later, there was no difference between intervention and control worksites. In addition, there was no significant increase in the nutrition activity score in control site 2 years after they received the intervention protocols and materials. CONCLUSIONS: Research is needed to develop and test worksite-based interventions to promote institutionalization, durability, and diffusion.

Adult↗
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Initial knowledge and attitudes as predictors of intervention effects: the individual management plan.

This paper addresses questions concerning the effects of patient education strategies to increase adherence to antihypertensive medical regimens. It endeavors to fill gaps in our knowledge about intervention effects that may link research findings with health care applications. Data from a community intervention study of 432 hypertensives are used to address two broad questions relating research on patient education to health care practice: Do interventions have different effects on individuals who differ with respect to initial attitudes or knowledge, and to what extent do interventions produce changes in the factors thought to mediate their effects on behavior? This investigation tests a client-oriented approach to the delivery of interventions, the Individual Management Plan (IMP). The IMP approach is based on the hypothesis that interventions will be differentially effective for individuals with varying levels of initial attitudes and knowledge thought to mediate the effects of the interventions on behavior. Analysis of variance, correlational analyses, and analysis of covariance models are used to test various aspects of this hypothesis. Analyses are performed for adherence to medication regimens, dietary sodium restrictions, and weight-loss recommendations. The results of analyses offer only minimal support for the IMP hypothesis. The state of the art and constraining factors in the study are examined to guide future applications of the IMP approach.

Humans↗
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Resident education in transfusion medicine: a multi-institutional needs assessment.

A survey was conducted among resident physicians at nine academic medical centers to assess their perceptions of their knowledge of transfusion medicine (TM), their confidence in using various blood bank resources, and their ratings of the contribution of various learning resources to their knowledge of TM. A total of 320 residents completed the survey; nearly 90 percent were in an internal medicine, surgery, or anesthesiology residency. Respondents placed a high value on the relevance of TM to patient care, although they rated their knowledge and learning opportunities as only moderate. They rated senior residents as the most useful educational resource, with undergraduate medical school education, formal conferences, and journals and library resources being the three next most useful. Residents had the greatest confidence in using packed red cells, platelets, and fresh-frozen plasma. Surgery and anesthesiology residents generally had greater confidence in using blood bank resources than internal medicine residents. The findings of the survey can be used, along with the results of medical care evaluations of transfusion practice and opinions of education experts, to create an optimally relevant and effective curriculum for resident education in transfusion medicine.

Academic Medical Centers↗
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Participatory learning in continuing nursing education: Soviet edition of a public health and medicine trivia game.

The challenge in designing professional continuing education programs lies in balancing the need to provide a new knowledge base with the need to engage the interest of the adult learner. This article reports on the use and evaluation of an experiential and innovative educational approach using adult learning techniques in a continuing education program for nurses in a cross-cultural setting.

Cross-Cultural Comparison↗
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The health impact of worksite nutrition and cholesterol intervention programs.

PURPOSE: To summarize and provide a critical review of worksite health promotion program evaluations published between 1980 and 1995 that address nutrition and hypercholesterolemia. The article discusses and critiques both intervention methods and research methodologies to identify the most effective strategies. METHODS: Core articles are 26 original, data-based studies that report on measures of health status, behavior, attitudes, and knowledge as outcomes of worksite nutrition and cholesterol interventions. Only work published since 1980 that clearly describes nutrition or cholesterol interventions and that includes identifiable nutrition-related outcomes is reviewed. The main search method was the same one used for this special issue; supplementary sources included those found in earlier reviews or identified through backward searches or expert contact. SUMMARY OF IMPORTANT FINDINGS: Ten worksite nutrition education programs were reviewed and were categorized as group education, group education plus individual counseling/instruction, cafeteria-based programs, and group education plus cafeteria-based programs. Four of these were randomized studies, and one used the worksite as the unit of randomization and analysis. Sixteen worksite cholesterol programs were reviewed, in five categories: monitoring; individual counseling; group sessions or classes; mediated methods using print, audiovisual, telephone, and self-help kits; and combination approaches. Of these, eight were randomized controlled trials; most tested interventions for persons with elevated cholesterol levels, although four studies reported cholesterol education programs for the general employee population. Six large controlled trials of worksite nutrition and cholesterol interventions in progress are also described. MAJOR CONCLUSIONS: The conclusions that can be drawn from this review are limited by the study designs used, which often lacked control groups, used nonrandomized designs, or relied on self-selected high-risk or volunteer participants. Our rating for the quality of the evidence in the literature as a whole lies between suggestive and indicative. It is clear that worksite nutrition and cholesterol programs are feasible and that participants benefit in the short-term. Conclusive evidence about a causal relationship between worksite nutrition and cholesterol programs and improved behavior or health is not yet available, although studies currently underway hold promise for providing more solid evidence about the potential efficacy of these interventions.

Health Knowledge, Attitudes, Practice↗
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The relationship between self-efficacy, attitudes, intake compared to others, consumption, and stages of change related to fruit and vegetables.

PURPOSE: This study examined whether eating practices and psychosocial factors differed across stages of change for fruit and vegetables. DESIGN: Data were collected using a self-administered written survey among a convenience sample of 739 Dutch adults. Response rate was 92%. SETTING: Data were collected as part of the baseline assessment for a nutrition intervention study. MEASURES: Fruit and vegetable intake was measured as self-reported consumption with a validated eight-item food frequency questionnaire. Psychosocial variables were measured with six items on bipolar seven-point scales and stage-of-change classifications were based on separate four-item algorithms for fruits and vegetables. Differences in psychosocial factors and consumption were analyzed using one-way analysis of variance with Scheffé's multiple-comparison test. RESULTS: Significant differences were found between stages of change in dietary intake, attitudes, self-efficacy, and judgment of one's own intake compared to others. Attitudes were most positive in preparation and action and least positive in precontemplation. Intake and self-efficacy were more positive in action/maintenance than in pre-action stages. CONCLUSIONS: The findings suggest that nutrition education aimed at encouraging higher intake of fruits and vegetables might be most effective if it is stage-tailored. Messages to influence attitudes about fruits and vegetables are likely to affect people in precontemplation, and self-efficacy information to increase confidence in overcoming barriers to consumption is likely to be effective with persons in contemplation and preparation stages.

Adult↗
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Progress in dietary behavior change.

Nutrition has important influences on health and mortality. Public response to current dietary guidance is indicated by positive movement on some indicators, notably reductions in calories from fat and in blood cholesterol levels. Downstream case finding and intensive educational and behavioral interventions are often effective for high risk and motivated subjects and for persons with diet-related disease. Midstream environmental changes (e.g., in grocery stores, schools) proffer improved nutritional choices and supports. Individualized dietary counseling has yet to become the norm. Despite recent upstream success in developing broad dietary guidance and improving nutrition labeling policies, numerous avenues remain open for aggressive national policy developments. Emerging studies and continuing improvement in intervention methods, measurement, and research design will help realize the preventive effects of healthful diets.

Behavior Therapy↗
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Randomized trial of a "talking computer" to improve adults' eating habits.

PURPOSE: To assess efficacy of an intervention delivered by an interactive, computer-controlled telephone system to improve individuals' diets. DESIGN: Randomized controlled trial. SETTING: Large multispecialty group practice. SUBJECTS: Two hundred ninety-eight adults who were both sedentary and had suboptimal diet quality. INTERVENTION: Weekly communication for 6 months via a totally automated, computer-based voice system. Among intervention group subjects, the system monitored dietary habits and provided educational feedback, advice, and behavioral counseling. Control group subjects received physical activity promotion counseling. MEASURES: Daily intake of fruits, vegetables, red and processed meats, whole fat dairy foods, and whole grain foods estimated from a food frequency questionnaire. RESULTS: Mean age 45.9 years, 72% women, 45% white, and 45% African-American. Among participants who completed diet assessments, compared with the control group, the intervention raised fruit intake a mean of 1.1 servings per day (95% confidence interval [CI] .4, 1.7). On a 0 to 100 global diet quality score combining all five food groups, intervention participants improved their mean score 9 (95% CI 4, 13) points more than in the control group. The intervention also raised dietary fiber intake 4.0 g/d (95% CI .1, 7.8) and decreased saturated fat, as a proportion of energy intake, by 1.7% (95% CI -2.7, -.7). CONCLUSIONS: This computer-based telecommunications dietary behavior intervention helped improve participants' overall diet.

Adult↗
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Association of awareness, intrapersonal and interpersonal factors, and stage of dietary change with fruit and vegetable consumption: a national survey.

PURPOSE: To examine associations of awareness, intrapersonal and interpersonal factors, and stage of change with consumption of fruits and vegetables. DESIGN: Nationally representative, random digit dial survey conducted in 1997 with a response rate of 44.5%. Psychosocial correlates of fruit and vegetable consumption were assessed using regression analyses. SETTING: United States. SUBJECTS: A total of 2605 adults who were 18 years and older. MEASURES: Awareness of the "5 A Day for Better Health" program and its message, along with stage of change; taste preferences; self-efficacy; and perceived benefits, barriers, threats, social support, and norms related to fruit and vegetable consumption. RESULTS: Awareness and intrapersonal and interpersonal factors explained 24% of the variance in fruit and vegetable consumption beyond the 9% explained by demographic characteristics. Knowledge of the 5 A Day message was associated with a 22% increase in fruit and vegetable consumption. Self-efficacy for eating fruits and vegetables and taste preferences (affect) were the factors most consistently and strongly associated with both higher consumption and higher likelihood of being in action or maintenance stages of change. Affect and perceived barriers were more strongly associated with increased vegetables and salad than fruit. CONCLUSIONS: Dietary intervention programs to increase fruit and vegetable consumption should emphasize the 5 A Day message, increased self-efficacy, and ways to make vegetables more palatable and easily accessible. Understanding the factors that influence dietary choices should be used when designing dietary interventions.

Adolescent↗
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Factors influencing acceptance of mammography: implications for enhancing worksite cancer control.

PURPOSE: The purposes of this article are to review what is known about participation in mammography programs and to propose several elements that warrant consideration in planning mammography screening programs in occupational settings. Breast cancer is the most common female cancer. Regular screening programs including mammography, clinical breast examination, and monthly breast self-examination can reduce breast cancer deaths by as much as 35%. However, mammography is underutilized. This review examines factors affecting acceptance of mammography and possible worksite-based strategies to increase its appropriate use. SEARCH METHODS: We identified the sources cited in this review through a combination of literature searches of computerized data bases, backward searches of reference lists, and contacts with active investigators. The article includes a selected subset of the most recent and relevant references. SUMMARY OF IMPORTANT FINDINGS: A variety of individual factors, environmental influences, health care system factors, and employer factors influence the acceptance of mammography. Workplace mammography programs can be especially important in reducing access barriers. MAJOR CONCLUSIONS: Six program elements which are central to planning successful worksite mammography programs are discussed: location and facilities; health professional involvement; the range of services; education and referral; employer policies, and plans for follow-up and repeat screening.

Adult↗
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Skin cancer prevention in outdoor recreation settings: effects of the Hawaii SunSmart Program.

CONTEXT: Skin cancer is the most common form of cancer in the United States, and it is one of the most preventable. Interventions for young children and their parents can help prevent future cases of skin cancer. OBJECTIVE: To determine whether a skin cancer prevention program implemented at outdoor recreation sites improved children's sun-protection behaviors and site sun-protection policies. DESIGN: Randomized trial of 14 outdoor recreation sites on the island of Oahu, Hawaii. The trial had three arms: control, education only, and education/environment. INTERVENTION: The education arm included staff training, on-site activities, take-home booklets, behavior-monitoring boards, and incentives. The education/environment arm included all education components plus provision of sunscreen and promotion of sun-safe environments. PARTICIPANTS: Children 6 to 8 years of age and their parents. OUTCOME MEASURES: Reports from parents of children's sun-protection behaviors and the sun-protection policies of recreation sites. The cohort for analysis from baseline to 6 weeks after testing had 383 participants; the cohort from 6 weeks after testing to 3 months of follow-up had 285 participants. RESULTS: Program implementation was high in the education only and the education/environment sites. Compared with control sites, children's sun-protection behaviors and, in particular, the use of sunscreen improved significantly at sites where the two interventions were implemented. In addition, sun-protection policies of recreation sites were markedly higher at intervention arm sites. The education/environment intervention was not superior to education alone. Changes were partly maintained at 3 months of follow-up. CONCLUSION: A creative, engaging, multicomponent skin cancer prevention program in outdoor recreation settings can lead to modest improvements in children's sun-protection behaviors.

Adult↗
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A survey of newspaper coverage of HCFA hospital mortality data.

A study that assessed newspaper coverage of the 1986 Hospital Mortality Data for Medicare Patients released by the Health Care Financing Administration (HCFA) of the U.S. Department of Health and Human Services is described. Media interpretation of Federal information about the quality of hospital medical care is also discussed. A sample of 68 articles from newspapers serving urban areas of various sizes in all regions of the United States was analyzed. Articles were coded into classifications according to how the news was played, headline bias (positive-negative-neutral), hospital mentions, quote sources, explanations for excessively high mortality rates, urban area population, and geographic region. The findings indicated that HCFA's release of the 1986 hospital mortality data received heavy news coverage. There were twice as many negative headlines as positive ones, although nearly 95 percent of the hospitals had mortality rates within expected ranges. Quotes from representatives of hospitals predominated in the newspaper articles, and they often blamed some aspect of the HCFA data for higher-than-expected mortality rates. Newspaper attention to the quality of hospital care clearly raised consumer awareness of the idea that health care quality can vary. The newspaper articles, however, provided no guidance on obtaining valid data or on using it to make health care choices.

Centers for Medicare and Medicaid Services, U.S.↗
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Patient reactions to nutrition education for cholesterol reduction.

The purpose of this study was to assess the perceptions of patients with elevated cholesterol who participated in a physicians' office-based cholesterol management program and to compare patient reports with clinic counseling records. We conducted telephone interviews with 94 patients from five family practice clinics participating in the Physician-Based Nutrition Program (PBNP) between January and March 1988. Within two weeks after a cholesterol counseling visit, interviewers asked patients what happened during the cholesterol management process, queried their understanding of their health risk and recommended dietary changes, and assessed their attitudes toward the educational process and recommended nutrition behavior changes. Results indicate that a large majority of patients understood the problem of high cholesterol and the needed behavior changes and were highly satisfied with the cholesterol management process. However, patients' memory of specific facts, such as their cholesterol levels and behavioral goals, was often incorrect. We discuss the implications of these findings for developing and providing patient cholesterol education.

Adult↗
PubMedDate not supplied

Psychosocial determinants of breast self-examination.

To explore the psychosocial determinants of breast self-examination (BSE) among women, we studied a stratified random sample of 264 women students, faculty, and staff in a university community. The dependent variable of the study was self-reported frequency of BSE, and predictors included measures of general health predispositions, variables of the Health Belief Model, the impact of a woman's social network, a set of secondary non-health-related barriers and benefits, and the woman's evaluation of her personal health care system. Analysis of the data showed strong relationships between most of the predictor variables and BSE. Regression analysis showed that variables measuring a woman's recent experience in the health care system were stronger predictors of BSE practice than intrapersonal "health belief" variables. However, the independent variables included in the regression accounted for almost 35 percent of the total variance in BSE practice.

Attitude to Health↗
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Using data to plan public health programs: experience from state cancer prevention and control programs.

In 1989 the National Cancer Institute funded the second round of Data-Based Intervention Research (DBIR) cooperative agreements with state health agencies to implement a four-phase cancer prevention and control planning model that would establish ongoing cancer prevention and control programs. Activities included identifying and analyzing relevant data to develop a state cancer control plan. The authors reviewed the data analysis and planning activities of five DBIR projects to understand: how states use different types of available data to make public health planning decisions, in what ways available data were sufficient or insufficient for this planning, and perceived costs and benefits of a data-based planning approach. Many of the sources of and ways in which health statistics and behavioral data were used were consistent across states. Sources and use of data on the availability and utilization of health services and on cancer control policies were less consistent. Data were most useful in making decisions to address specific cancers, to target populations or regions, to identify general barriers, and to influence policy makers and the public. Data were less influential in identifying specific barriers within target populations and determining what proven intervention components should be implemented and how. The process of pulling this information together and involving working groups and coalitions was considered very beneficial in establishing the credibility of the state health agency in addressing the state's cancer problem. This process relied on a national infrastructure that provided financial resources, sources of data, and research results.

Data Collection↗
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Components of the working well trial intervention associated with adoption of healthful diets.

INTRODUCTION: This report examines whether variability in the type and amount of the nutrition intervention in a worksite-based intervention could explain dietary outcomes. METHODS: Data are from 55 intervention worksites in the Working Well Trial, a randomized controlled trial of worksite-based health promotion. The components of the nutrition intervention were kickoff event, direct education, interactive activities (e.g., food sampling), contests, printed information picked up by employees, and materials distributed to employees. We measured delivery of the nutrition intervention (i.e., dose) by determining the amount of workforce participation in each intervention component. Diet outcomes were changes in intakes of fat, fiber, and servings of fruits and vegetables (reported on food frequency questionnaires). All variables were aggregated to the worksite level. We correlated the dose variables with indices of receipt of the intervention and with the dietary outcomes. RESULTS: Contests were associated with employee awareness of and participation in the nutrition intervention (r = 0.49 and 0.28, respectively), and interactive activities were associated with intervention participation (r = 0.43). Contests were associated with increased fiber intake and fruit and vegetable consumption (r = 0.36 and 0.31, respectively), and direct education was associated with fruit and vegetable consumption (r = 0.38). All the above correlation coefficients were statistically significant (P < .05). Intervention dose was not associated with changes in fat intake. CONCLUSIONS: It appears that longer, interactive intervention efforts (contests and classes) resulted in more positive outcomes than did one-time activities (such as the kickoffs) or more passive efforts (use of printed materials). There is a need for studies designed to test worksite- and community-based nutrition intervention methods.

Diet↗