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Biomedical subjects

N K Janz

Publications and source records attributed to N K Janz.

31 records · Page 2Linked to original sources
PubMed1992

Self-regulation of health behavior: the "take PRIDE" program.

Social cognitive theory, in particular, the construct of self-regulation was the basis for developing an educational program for older adults with heart disease. This paper discusses the theoretical principles utilized and describes the program activities based on them. Data from an evaluation conducted with 246 older heart patients who took part in the education are used to illustrate how social cognitive theory constructs operated empirically.

Cognition↗
PubMed1991

Differences in the impact and management of heart disease between older women and men.

Findings are presented from an exploratory study of differences in the impact and management of heart disease between men and women aged 60 and over (N = 323). The sample consisted of ambulatory, non-institutionalized, cardiac patients who had agreed to participate in a self-management intervention study. Differences between men and women were found regarding symptom experience, physical functioning, exercise compliance, use of prescribed drugs, and physician/clinic visits. Differences in emotional well-being and psychosocial functioning were not found; however, women reported more stress and limitation in the area of household management. Implications for future research and practice are discussed.

Activities of Daily Living↗
PubMed1990

Noncompliance with Universal Precautions Policy: why do physicians and nurses recap needles?

In 1987 the Centers for Disease Control published a Universal Precautions Policy establishing blood and body fluid procedures to be used consistently with all patients. An important and unequivocal Universal Precautions Policy recommendation with regard to avoidance of needlestick injuries is that needles should never be recapped. We examined the recapping-related attitudes and behaviors of physicians and nurses at four large teaching hospitals with patients with acquired immunodeficiency syndrome and with Universal Precautions Policy in-service training programs. Compliance was found to be considerably less than optimal. According to unannounced needle counts in disposal boxes, the percentage of recapped needles was always greater than 25% and exceeded 50% in four instances. Recapping was related to inadequate knowledge, concerns about personal risk, forgetfulness, being "too busy" to follow the Universal Precautions Policy, and the misperception that recapping is a way to avoid needlestick injury. Strategies are suggested to improve and supplement traditional in-service education.

Communicable Disease Control↗
PubMed1987

Beliefs about control of smoking and smoking behavior: a comparison of different measures in different groups.

This study investigated several measures of beliefs about controlling smoking as predictors of cessation and reduction at one and six months after a medically-based control program. Smokers (n = 250 total) attending general medicine clinics at University and Veterans Administration facilities received advice to quit from both physicians and nurses. Beliefs about difficulty resisting urges to smoke in 15 situations, their frequency of occurrence, and general level of difficulty were assessed at baseline. For the University group of patients, significant relationships were found between both general and specific indexes and both cessation and reduction at one month. Although a greater change in smoking was seen at six months, few belief measures remained predictive. At one month, global measures were as useful as specific ones, although difficulty in situations of negative emotion was a consistent and strong predictor. Marked differences between the two sites were found; virtually no measure of difficulty proved predictive for the VA group.

Attitude↗
PubMed1987

Evaluation of a minimal-contact smoking cessation intervention in an outpatient setting.

We examined the ability of a provider-initiated, minimal-contact intervention to modify the smoking behavior of ambulatory clinic patients. Smokers at two outpatient sites were assigned to one of three groups: provider intervention only (PI); provider intervention plus self-help manual (PI/M); and usual care (control) group (C). The physician message emphasized the patient's personal susceptibility, the physician's concern, and the patient's ability to quit (self-efficacy). The nurse consultation concentrated on benefits and barriers associated with stopping, and on strategies for cessation. Telephone interviews were conducted with the 250 participants within a few days of their clinic visit and again at one and six months. Both PI and PI/M proved to be superior to usual care in motivating attempts to quit at both one-month and six-month follow-ups, and logistic regression analyses indicated that participants receiving the self-help manual in addition to the health provider message were between two and three times more likely to quit smoking during the study period than were participants in either of the other study groups.

Adult↗
PubMed1987

Behavioral science perspectives on health hazard/health risk appraisal.

Health-promotion efforts often employ HRA as a device for providing an individual with quantitative information about the consequences of personal health-related behaviors and as an attempt to motivate the client to adopt recommendations directed at establishing a healthier lifestyle. From a behavioral science perspective, the HRA approach and process contain elements that (at least in retrospective analysis) appear to be founded in relevant bodies of theory. First, HRA seems to be a reasonably efficient mechanism for transmitting information relative to associations between personal health behaviors and mortality risks. Moreover, while general knowledge and advice about the untoward consequences of risk factors (such as smoking, obesity, high blood pressure, etc.) are currently widespread, HRA provides new and specific information: the client's own relative risks. Some individuals who voluntarily participate in HRA bring to the experience an already high level of readiness to take action; for them, the technique may constitute the final necessary stimulus or "cue to action" [12]. Referring to a "borrowing from the future" phenomenon, Green points out that "some educational efforts are really only triggers to behavior that would have changed eventually anyway" [44, p. 159]. Thus, where motivation is sufficiently high, receipt of HRA feedback information may by itself be capable of inducing behavior change. Second, the focus on awareness and personalization of mortality risk fits well with most theoretical formulations concerning attitudes and beliefs involved in health-related decision making. Although the emphasis on mortality and often distant negative outcomes is problematic, increasing the client's perception of personal vulnerability is a psychologically defensible approach, and fear arousal can generate attitude change (although questions of appropriate level, duration of effects obtained, acceptability, etc. still need to be resolved). Third, HRA might be expected to enhance the client's perception of the benefits associated with lifestyle modifications and may even increase personal belief in his or her ability to undertake such changes in behavior. However, in light of the fact that the behaviors to be altered are complex, usually well-established and repetitive, and require different skills to extinguish, the provision of typical HRA feedback should not (on a theoretical basis) ordinarily be expected to accomplish much beyond information transmission, belief or attitude change, and the induction of some level of motivation.(ABSTRACT TRUNCATED AT 400 WORDS)

Attitude to Health↗
PubMed1984

Contingency contracting to enhance patient compliance: a review.

Researchers and practitioners have expressed considerable interest in contingency contracting as a promising intervention strategy for enlisting patient cooperation, particularly with regard to long-term treatment regimens. After brief examination of the theoretical background, the authors summarize advantages of contracting, describe elements essential to the development of a contract, and enumerate those ingredients in the contracting process thought to be critical for achieving optimal results. They review relevant research efforts in terms of their designs, methods, target and contracted health-related behaviors, contingencies employed, and initial and follow-up results. On the basis of this review, current issues regarding contingency contracting are raised, and practical considerations for large-scale application are noted along with recommendations for future research.

Diet, Reducing↗
PubMed1984

The Health Belief Model: a decade later.

Since the last comprehensive review in 1974, the Health Belief Model (HBM) has continued to be the focus of considerable theoretical and research attention. This article presents a critical review of 29 HBM-related investigations published during the period of 1974-1984, tabulates the findings from 17 studies conducted prior to 1974, and provides a summary of the total 46 HBM studies (18 prospective, 28 retrospective). Twenty-four studies examined preventive-health behaviors (PHB), 19 explored sick-role behaviors (SRB), and three addressed clinic utilization. A "significance ratio" was constructed which divides the number of positive, statistically-significant findings for an HBM dimension by the total number of studies reporting significance levels for that dimension. Summary results provide substantial empirical support for the HBM, with findings from prospective studies at least as favorable as those obtained from retrospective research. "Perceived barriers" proved to be the most powerful of the HBM dimensions across the various study designs and behaviors. While both were important overall, "perceived susceptibility" was a stronger contributor to understanding PHB than SRB, while the reverse was true for "perceived benefits." "Perceived severity" produced the lowest overall significance ratios; however, while only weakly associated with PHB, this dimension was strongly related to SRB. On the basis of the evidence compiled, it is recommended that consideration of HBM dimensions be a part of health education programming. Suggestions are offered for further research.

Adolescent↗
PubMedDate not supplied

Determinants of breast self-examination after a benign biopsy.

Although breast self-examination (BSE) continues to be recommended as an adjunct to clinical screening techniques for the early detection of breast cancer, little is known about events that might negatively influence long-term adherence. The primary aim of this investigation was to determine if regularity of BSE would decline after a benign breast biopsy. Analyses are based on 655 women: 83 women who self-discovered the breast problem by BSE, 179 women in whom the problem was discovered by the health care system, and a control group of 393 women who had no history of breast problems. Frequency of BSE was assessed over two six-month periods and collapsed into three categories--nonpractitioner, irregular practitioner, and regular practitioner. Results indicated that the percentage of women in the self-discovered group who reported decreased regularity of BSE was over three times higher than that found in the control group. The largest percentage increase in BSE frequency was evidenced by the health care-discovered group. Logistic regressions revealed that the biopsy experience was a more powerful indicator of subsequent BSE practice than either sociodemographic characteristics or whether one engaged in other preventive health behaviors. The data provide substantial evidence that a benign biopsy can affect BSE practice, with the direction and magnitude of the change influenced by mode of discovery of the breast problem, perceived degree of confidence in ability to perform BSE, and level of practice before the biopsy. Postbiopsy educational strategies incorporating these findings and targeted at specific subgroups are outlined.

Adult↗
PubMedDate not supplied

Interventions to enhance breast self-examination practice: a review.

Breast self-examination (BSE) is an important component of any program for the early detection of breast cancer. Compared to clinical breast examination and mammography, BSE is relatively safe, low cost, offers monthly assessment, and does not require overcoming barriers associated with access to the medical care system (unless an abnormality is discovered). Over the past decade, considerable research has been directed at encouraging women to perform BSE. This paper reviews 33 intervention studies that vary in the type and intensity of strategies employed, and in the BSE behaviors assessed. In general, more-intensive interventions result in better outcomes. With regard to BSE frequency, the provision of information seems sufficient to obtain BSE initiation but not necessarily adequate to maintain practice or to establish proficiency. The addition of skills training and corrective feedback leads to significantly improved BSE proficiency. Prompts and reminder aids seem also to contribute to long-term frequency. The search should continue for motivational mechanisms regarding BSE frequency, and for creative approaches to teaching and maintaining proficiency.

Breast Neoplasms↗