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PubMed1995

Caregiver discourse: perceptions of illness-related dialogue.

Interacting with terminally-ill patients is significantly stressful for caregiving families. To date, few studies have examined how caregivers perceive their communication with dying family members. As such, the present investigation was undertaken. A sample of 10 family caregivers was utilized for the study; informants had to be the spouse or child of the patient, having provided the majority of care during the illness period. Semi-structured interviews were employed by the investigator to collect data on the communicative experiences of these caregivers; they were asked to describe their thoughts and interactional experiences with specific reference to the following: (1) the inevitability of the patient's death, (2) the patient's preferred courses of action, (3) levels of family interaction, (4) patient denial, (5) previous patterns of discourse, and (6) bereavement. All interviews were audio-recorded, transcribed verbatim, and analyzed using a two-tier system incorporating aspects of content analysis methodology. Results indicate that caregivers experience difficulty communicating with their patients and with other family members. Suggestions for developing effective, appropriate, and sensitive communication training programs for terminally-ill patients and their caregiving families are provided.

Aged↗
PubMed1999

Effects of an entertainment-education radio soap opera on family planning behavior in Tanzania.

An entertainment-education radio soap opera introduced in Tanzania in 1993 was evaluated by means of a field experimental design in which the radio program was broadcast by seven mainland stations of Radio Tanzania. An eighth station broadcast alternative programming from 1993 to 1995, its listenership serving as a comparison area in which contemporaneous changes in family planning adoption were measured. The soap opera was subsequently broadcast nationwide from 1995 to 1997. Data about the effects of the radio soap opera were gathered in five annual surveys of about 2,750 households in the comparison and the treatment areas and from a sample of new family planning adopters in 79 health clinics. The soap opera had strong behavioral effects on family planning adoption; it increased listeners' self-efficacy regarding family planning adoption and influenced listeners to talk with their spouses and peers about contraception.

Adult↗
PubMedDate not supplied

Analyzing organizational practices in local health departments.

Few researchers have examined the problem of comparing the performances of local health departments. A contributing factor is the lack of a uniform method for describing the range of public health activities. The Centers for Disease Control and Prevention's Public Health Practice Program Office has identified 10 organizational practices that may be used to assure that the core functions of public health are being carried out at a local health department. The researchers determined the percentage of time devoted to each of the 10 practices by individual employees at a local public health unit in Tampa, FL. They identified the manpower expenditures and hours allocated to each of the 10 practices within the major program divisions of the unit. They found that the largest portion of manpower resources was allocated to implementing programs. A much smaller fraction of agency resources was devoted to analysis of the health needs of the community and to the development of plans and policies. Together, primary care and communicable disease programs accounted for fully three-quarters of the resources, environmental health for 11 percent, and administrative support services for 13 percent. With continuing refinement and modification, the methodology could provide a highly effective basis for describing and analyzing the activities and performances of local health departments.

Florida↗
PubMed2001

Comparing student attitudes to different models of the same virtual patient.

AIMS: Two types of virtual patient designs can be distinguished - a 'narrative' structure and a 'problem-solving' structure (1). This study assesses attitudes of students with respect to learning communication skills via a virtual patient; and compares acceptability of the two different types of virtual patient designs. METHODS: Two virtual patients were constructed around the same case, each emphasising a narrative or problem-solving model. Undergraduate medical students used the simulations as part of a communication skills program. A computer-based survey was used to assess attitude. RESULTS: There was general acceptance of the use of the computer-based simulated patient. Students who generally performed better at communication skills, were more positive towards the virtual patient. There was no quantitative difference in acceptability between the two designs, but there were clear qualitative differences. CONCLUSIONS: While students were moderately positive about both simulations, qualitative data indicated that their were clear differences in attitude between the two different designs.

Attitude to Computers↗
PubMed1990

Changes in knowledge, attitudes, and behavior as a result of a community-based AIDS prevention program.

The study evaluates the outcome of a California-based AIDS prevention program, "Stop AIDS." Community discussion groups focusing on information, attitudes, and behavior associated with HIV infection and transmission were conducted in one-time, 3 1/2-hour sessions. Participants completed different versions of the AIDS Prevention Test before and after the discussion group. Significant positive shifts in information, attitudes, and behavior were observed as a function of the discussion group participation. Whereas pretest knowledge correlated with pretest behavior and posttest knowledge, only pretest behavior correlated with the crucial variable of posttest intended behavior. When changes from pretest to posttest were analyzed, both information and attitude change correlated to changes in behavior. The intervention and evaluation procedures are proposed as a replicable national model for community-based AIDS prevention programs.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

The integration of family planning and childhood immunization services in Togo.

Improvements in the constellation of services in the African context are largely addressed through attaining better measures of service integration, which can be achieved through improved referral across categories of health programs. The use of an unobtrusive referral message that linked family planning and the Expanded Program of Immunizations (EPI) services was tested in an operations research study in Togo. The introduction of the referral message was accompanied by an 18-percent increase in awareness of available family planning services and an increase in the average monthly number of new family planning clients of 54 percent. These positive results indicate that the use of referral can have a significant and dramatic impact on family planning services in a relatively short time. In Togo, no evidence existed of a negative impact on EPI services, and a majority of the EPI providers reported satisfaction with the effect of the referral message at the close of the study.

Child Health Services↗
PubMed2000

MedEthEx Online: a computer-based learning program in medical ethics and communication skills.

BACKGROUND: Bioethics education often focuses on lectures and discussions to set a foundation for ethical decision making. Our goal was to bridge the gap between classroom learning and bedside competence through computer-assisted instruction. This article assesses the efficacy of MedEthEx Online, a computer-based learning program as part of a required Bioethics course. DESCRIPTION: Of 173 American medical students, 89 in Section 1 attended 8 bioethics lectures and 8 small-group discussions. Eighty-four in Section 2 had a similar course, although two group discussions were replaced with computerized learning. We compared (a) final exam scores, (b) topic-specific question scores, (c) performance with standardized patients, (d) self-assessments, and (e) course evaluations. EVALUATION: Exam scores were comparable, although computerized-learning students scored higher in specific exam areas, felt somewhat more clinically prepared, and rated the course slightly better. Standardized patient interactions differed, although they were comparable overall. CONCLUSION: MedEthEx Online is a viable option for fostering effective communication and problem resolution skills.

Bioethics↗
PubMed1984

Communicating hospitals' concerns to legislators and the community.

The time is past when voluntary hospitals could afford to be uninformed and inactive in public affairs. As decisions in the public sector increasingly threaten not-for-profit institutions, Catholic hospitals particularly must pursue an action-oriented program of communication with legislators and the community. At Carney Hospital, Boston, an especially effective forum for the past eight years has been buffet dinners held on a quarterly basis with state and congressional legislators and representatives of the hospital's management team, board of trustees, associate board, and medical staff. These dinner meetings provide a singular opportunity for law-makers to learn hospitals' perspective on key issues such as the effect of tightened reimbursement on care of the poor. The dinners not only have enhanced relations with legislators but also raised the consciousness of the business community, consumers, and the general public. Frequent mailings to legislators and members of the board of trustees and the associate board also have beeN helpful. The associate board was formed to augment the expertise of the board to trustees and to increase lay participation in the hospital's affairs. Composed of 20 lay leaders representing a diversity of disciplines, the associate board provides a strong base for influencing public policy and community action. Moreover, the hospital's various constituencies--physicians, employees, volunteers, and auxilians-are recruited as appropriate to contact legislators, write letters to the editor, and give media interviews. Also important in the facility's public affairs efforts have been timely responses to requests for action from The Catholic Health Association, the American Hospital Association, and the state hospital association.

Boston↗
PubMed2006

Managing external risks to health technology assessment programs.

OBJECTIVES: The aim of this study was to develop a guide to identifying and managing risks for health technology assessment (HTA) programs and to obtain opinions on this topic from HTA agencies. METHODS: The risks and approaches to their management were compiled, drawing on experiences from HTA programs and the risk assessment literature. Opinion on this classification was obtained from members of the International Network of Agencies for Health Technology Assessment (INAHTA). RESULTS: Twenty-one risks for HTA programs were identified under the categories Formulation of HTA Questions, Preparation of the HTA Product, Dissemination, and Contracting. For each risk area, potential consequences and suggested management approaches were outlined. Responses from ten HTA programs indicated substantial agreement regarding the risks that had been identified and on the importance of risk management for their own operations. CONCLUSIONS: Prudent management of HTA programs should take into account the risks related to external factors.

Health Policy↗
PubMed2000

Human rights and religious backlash: the experience of a Bangladeshi NGO.

As part of a human rights education campaign, the Bangladesh Rural Advancement Committee fixed 700,000 posters throughout Bangladesh. This met with opposition from the religious organizations. This paper investigates the nature and cause of the backlash and sets out strategies for how development organizations can achieve their objectives in the face of opposition. The opposition was found to be in response to interpretations of the posters based on the Holy Koran and Islamic practices, and a perceived intrusion into the professional territory of religious organizations, which affected the socioeconomic interests of these organizations' representatives. It was therefore concluded that development organizations should pre-empt such opposition by spelling out their objectives to potential critics, and formulating programs that do not provide scope for opponents to undermine their development activities.

Asia↗
PubMed1991

Minnesota workplace drug testing. Analysis of policy and procedures.

1. An employer's decision whether to drug test or not was found to correlate with the size of the company and how extensively the employer perceives a drug abuse problem exists among its work force. 2. A company's drug testing program must be designed, implemented, and evaluated within a medical-legal framework. This includes issues of: confidentiality, employee actions that trigger a drug test, the presence of a drug and alcohol policy, communicating the program to employees and unions, the employee's rights, the consequences of an employee's positive drug test, and the procedures to be followed when collecting a specimen. 3. Future studies need to explore the issue of dealing with job performance problems; in particular, the cost and effectiveness of employee drug testing vs. the use of discipline alone.

Data Collection↗
PubMedDate not supplied

Indirect exposure to a family planning mass media campaign in Nepal.

It is often noted that some individuals become aware of a mass media program's messages through discussions with other individuals. However, the extent to which indirect exposure occurs, and its influence on behavior, are somewhat unclear. This study examines the role of indirect exposure in extending the reach of a family planning mass media campaign in Nepal. Sociometric data, gathered from nearly all women between the ages of 15 and 49 years living in six villages in Dang District, Nepal (N = 667), assessed indirect exposure to the radio program. Indirect exposure was extensive; half of all respondents were indirectly exposed to the program's messages and the overall reach of the program increased from 50% to 75% when indirect exposure was considered. Members of community groups had higher levels of direct exposure to the radio program and more extensive and diverse social networks, allowing them to serve as a conduit for these messages into the wider community. While direct exposure to the radio program appeared to influence family planning knowledge, indirect exposure was more strongly associated with contraceptive use. These findings suggest that program evaluations that ignore indirect exposure underestimate the impact of a mass media program on behavior.

Adolescent↗
PubMed1995

In-home communication intervention training for parents of multiply handicapped children.

Two major questions derived from social-interactional theory were addressed: What are the effects of an in-home communication training program for parents on (1) the acquisition of child-training skills (imitating/animating and expectant waiting) by parents of developmentally delayed children who have severe language impairments and autistic features and (2) the acquisition of communication behaviors in the children themselves? Questions regarding the social value of the intervention and effects on parent-child interactions were also addressed. Four mothers were taught two parent-training skills (imitating/animating and expectant waiting) during two in-home training sessions. Following the parent training, the mothers conducted training sessions in their homes with their children for 10 minutes, three times per week for 8-12 weeks. All sessions were videotaped and frequency counts taken of the target parent skills and child target behaviors. A single subject experimental research design was used incorporating a multiple baseline across two parental child-training skills (i.e., imitating/animating, expectant waiting). Data were analyzed visually as is customary in single subject experimentation, and direct behavioral counts showed that all four mothers demonstrated increases in the frequency with which they used the child-training skills following treatment. Increases in four child behavior frequencies (i.e., vocal utterances, social responding, social initiating, and intelligible words spoken) were also noted. The ECO Scales Interaction Profile results supported direct behavioral count data, showing significantly improved parent-child interactions for the subject dyads over three conditions (p < .034). Additionally, Parental Consumer Satisfaction Questionnaire results indicated that the intervention was positively perceived by the parents. Furthermore, the utility of single subject experimentation procedures in clinical nursing practice was clearly demonstrated in this research, and the findings support nurse-conducted, in-home parent training as a practical and socially valid means of addressing the complex needs of chronically disabled children and their families.

Child↗
PubMed1990

A component analysis of functional communication training across three topographies of severe behavior problems.

We evaluated the separate treatment components of a functional communication training program for 3 severely handicapped persons who each displayed different topographies of aberrant behavior. Following a functional analysis of maintaining conditions for inappropriate behavior (self-injury, stereotypy, aggression), each participant was trained to emit a communicative response that functioned to solicit reinforcement. For 2 participants, consequences (time-out or graduated guidance) for inappropriate behavior were also included. Treatment continued until the participants emitted the communicative response independently and no occurrences of inappropriate behavior were observed for at least two sessions. Following treatment, the separate contributions of the treatment components for communicative responding and for inappropriate behavior were evaluated with a reversal design. The results indicated that both sets of treatment components were necessary for maximal control over aberrant behavior. These results are discussed in relation to the efficiency, history, and control over reinforcement of both appropriate and inappropriate responses.

Behavior Therapy↗
PubMed1995

Meeting the needs of young adults.

As they mature and become sexually active, more young people face serious health risks. Most face these risks with too little factual information, too little guidance about sexual responsibility, and too little access to health care. Meeting young adults' diverse needs challenges parents, communities, health care providers, and educators. Despite urgent needs, program efforts have been slight and slowed by controversy.

Adolescent↗
PubMed1997

A Multisectoral Approach to Prevention of Lead Poisoning in Hungary: Lessons Learned and Potential for Replicability Elsewhere.

Hungarian and American occupational and environmental health professionals are collaborating in a research and demonstration project designed to prevent lead poisoning in Hungary. Using a multisectoral approach, the project has three phases: data collection and review, risk communication, and facilitation of program and policy development. First, the project team reviewed relevant data of many types through a workshop at which commissioned papers were presented, key-informant interviews, and a survey of knowledge, attitudes, and practices. The team then conducted a multifaceted risk-communication program to disseminate information about lead hazards in general and what had been learned about lead exposures and lead poisoning in Hungary. It presented training workshops for workers exposed to lead at work and for groups serving as "mediators" who could affect others' behavior, such as nongovernmental organizations, labor unions, public health nurses, pediatricians, teachers and students, and coordinators of the Hungarian Healthy Cities Project. It also conducted a campaign of "concentrated action," using a variety of communication approaches directed to car owners, pregnant women, mothers of small children, and others, in order to convey knowledge and change attitudes, emphasizing emotional appeals. Project leaders will organize a multisectoral working group to develop, coordinate, and implement an overall activity plan aiming to reduce lead pollution. The approach developed and used in this project provides a model for preventing lead poisoning that may be transferrable or adaptable for use for preventing lead poisoning and other environmental health problems elsewhere.

Journal Article↗
PubMed1994

Evaluation of a targeted AIDS prevention intervention to increase condom use among prostitutes in Ghana.

OBJECTIVE: To assess the short- and long-term impact of a 6-month pilot intervention program on condom use among prostitutes in Accra, Ghana. DESIGN: The 4-year prospective study follows-up cohorts enrolled in the intervention in 1987 and 1988, comparing condom use in 1991 with that among a comparison group not enrolled in the intervention. SETTING: The community-based intervention was initiated in Accra, Ghana in 1987. PARTICIPANTS: Self-identified female prostitutes who volunteered participation. INTERVENTION: The educational intervention used local health workers to train and support selected prostitutes to be health educators and condom distributors to their peers. OUTCOME MEASURES: Self-reported condom use with clients. RESULTS: Reported condom use increased dramatically between 1987 and 1988 during the first 6 months of the intervention. In 1991, after 3 years of program relapse, 107 (43%) of the 248 women who had enrolled in 1987 or 1988 were still in prostitution and located for interview. Their level of condom use in 1991 was higher than pre-enrollment but similar to use among prostitutes never enrolled. Sixty-four per cent of those followed-up reported always using condoms with clients in 1991. These 'always users' were more likely to have maintained informal contact with project staff, know that HIV can be transmitted by healthy clients, and report that clients frequently initiate condom use. CONCLUSIONS: Findings support the development of long-range educational strategies that recognize the career longevity of prostitutes, available channels for informal program diffusion, individual changes in condom use over time, and the role of clients in condom negotiation.

Acquired Immunodeficiency Syndrome↗