Communications from the N.I.H. Status of new extramural programs.
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Communication↗
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Less paperwork and more communication aids South Carolina's EPSDT program.
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Child↗
Educating the community about violence through a gun turn-in program.
The Ceasefire Oregon gun turn in program was initiated to educate the community regarding violence through a gun turn-in program with voluntary surrender of firearms, educational efforts about violence, and institution of public safety policies. The community board of directors was composed of multiple community leadership organizations. A multi-intervention education, outreach and media program consisting of distribution of brochures, presentations, school education programs, and workshops was implemented throughout the year in addition to the gun turn-in program held in May for two days. A survey was administered to participants in the program at the turn-in sites. The cumulative total for guns turned in years 1994 to 1999 was 4,345. Half of the respondents reported possession of a gun at home. The most common reasons for participating in the gun turn in were obtaining gift certificates and not wanting the gun any more. A successful community grassroots program, Ceasefire Oregon has shown sustainability over six years with increased participation secondary to education, advertising and incentives. Community and statewide efforts can assist with building the infrastructure for programs, however more tools for quantitative performance program evaluation would facilitate measuring the impact on the community.
Community Health Planning↗
Mass casualty alert program.
The occupational health nurse has professional responsibility to be prepared to provide proper reaction if a major crisis should occur. A mass casualty alert program enables the nurse to meet that responsibility. But the nurse cannot do this all alone. There must be a comprehensive, cooperative plan which involves the entire plant. All interested groups, of course, should have individual plans. However, they should all be interrelated as a part of a totally coordinated plan. The mass casualty alert program should clearly indicate who is in charge, with alternates designating who is responsible for what. Things to remember in maintaining the program include: 1. There must be an up-to-date mass casualty alert program. 2. There must be total involvement. a. Ambulance--list should be up-to-date. b. Hospitals--list and capabilities should be up-to-date. c. Other Community Emergency Facilities--e.g., helicopter ambulance list should be up-to-date. d. Plant Management--fully informed and supportive of program. e. Communication--everyone involved should know what to do in-plant. f. Equipment and supplies should be ready at all times. There must also be disaster drills with simulated casualties. There should also be formal critiques of the drills to point out the weak points as well as the strong. This program will be very effective if planned ahead and carried out in this manner, either in a small plant with a small number of employees or a large complex with many employees, such as ours.
Emergency Medical Services↗
Family communication about sex: what are parents saying and are their adolescents listening?
CONTEXT: Communication between parents and adolescents about sex, particularly in minority families, has been understudied; more information is needed both on which sex-related topics are discussed and on how their content is transmitted. METHODS: Parent-adolescent communication about 10 sex-related topics was examined in a sample of 907 Hispanic and black 14-16-year-olds. Chi-square analyses were performed to test for significant differences across the 10 topics in discussions reported by the adolescents (with either parent) and by the mothers. The openness of communication, parent-adolescent agreement about communication of topics and differences by gender and ethnicity were also examined. RESULTS: Significantly higher proportions of mothers and adolescents reported discussions of HIV or AIDS (92% by mothers and 71% by adolescents, respectively) and STDs (85% and 70%, respectively) than of issues surrounding sexual behavior, contraceptive use and physical development (27-74% for these other eight topics as reported by mothers vs. 15-66% as reported by adolescents). The gender of the adolescent and of the parent holding the discussion, but not the family's ethnicity, significantly influenced findings, with adolescents of both sexes more likely to report discussions with mothers than with fathers, and with parents more likely to discuss any of the 10 topics with an adolescent of the same gender than of the opposite gender. The likelihood of a topic being discussed and of mother-adolescent agreement that a topic was discussed both increased with an increasing degree of openness in the communication process. CONCLUSIONS: Consistent with research among white samples, mothers of black and Hispanic adolescents are the primary parental communicators about sexual topics. To facilitate communication, educational programs for parents should cover not only what is discussed, but how the information is conveyed.
Adolescent↗
Corporate social marketing: message design to recruit program participants.
OBJECTIVE: To identify variables for a corporate social marketing (SM) health message based on the 4 Ps of SM in order to recruit future participants to an existing national, commercial, self-administered weight-loss program. METHOD: A systematically evaluated, author-developed, 310-response survey was administered to a random sample of 270 respondents. RESULTS: A previously established research plan was used to empirically identify the audience segments and the "marketing mix" appropriate for the total sample and each segment. CONCLUSIONS: Tangible product, pertaining to the unique program features, should be emphasized rather than positive core product and outcome expectation related to use of the program.
Adult↗
HIV-positive black women with histories of childhood sexual abuse: patterns of substance use and barriers to health care.
A constellation of factors contributes to Black women's health including stressors and traumatic experiences. Their psychological adjustment and substance use can further affect their health status. The purpose of this study was to examine patterns of substance abuse and barriers to health care among HIV-positive Black women with histories of childhood sexual abuse (CSA). Baseline data on a community sample of 75 Black HIV-positive women were analyzed to assess and identify drug use, alcohol use, participation in an alcohol or drug treatment program, and communication skills with providers, all of which may act as barriers to health care. Findings indicate that substance use is a significant health problem, with 83% of the participants having used at least one substance regularly and 28% having engaged in regular injection drug use. Barriers to health care included confidentiality issues, poor financial resources, difficulty getting an appointment, excessive waiting to see a health care provider and obligation to care for others. Contrary to past research, poor communication between the participants and the providers did not seem to be a barrier to health care utilization for these women. Early traumatic experiences, including CSA, regardless of whether incidents involved penetration, may exacerbate the problems faced by HIV-positive Black women. Implications for future research and culturally relevant prevention and intervention programs are discussed.
Adult↗
Measuring creativity through computer graphics of hearing-impaired children.
The purpose of this study was to investigate variables affecting visual creativity of 31 hearing-impaired children through the medium of computer graphics. These children ranged in age from 8.0 to 15.9 yr. 16 subjects attended total-communication educational programs and 15 subjects attended aural/oral classes. Each subject worked independently at a computer terminal equipped with a graphics menu developed for a subject's use. Hardcopy printouts of four images per subject were evaluated for creativity, aesthetics, and imagery. Analysis suggested that creativity among hearing-impaired children is influenced by age and communication mode used in the educational setting.
Adolescent↗
The recruitment triangle: reasons why African Americans enroll, refuse to enroll, or voluntarily withdraw from a clinical trial. An interim report from the African-American Antiplatelet Stroke Prevention Study (AAASPS).
Recruitment and retention of study subjects are key to the success of a clinical trial. In the case of minority patients, this may be challenging as minority patients have been underserved by the medical health-care system. Furthermore, minority patients are more likely to experience barriers to entry into a clinical trial such as mistrust of the medical system, economic disadvantages, lack of awareness of study programs, and communication barriers. An open-ended questionnaire was used to determine reasons why subjects in the African-American Antiplatelet Stroke Prevention Study (AAASPS) remained in the study or voluntarily withdrew in the absence of an adverse event. Potential enrollees who refused to participate in the AAASPS also were queried. Enrollees who remained in the program consistently stated that they participated to reduce the risk of stroke recurrence and to help others by finding a "cure" for stroke. Those who withdrew or refused to participate consistently stated that they were afraid of being used as "guinea pigs." A "recruitment triangle" emerged that might predict a patient's likelihood of participation in a clinical trial. The sides of the triangle include the patient, key family members and friends, and the primary medical doctor and other medical personnel. The organizers of a clinical trial need to be aware of the "recruitment triangle" and establish strategies to heighten and maintain its integrity.
Black or African American↗
Assessing clinical pathways use in a community hospital: it depends on what "use" means.
BACKGROUND: Many benefits have been associated with the use of clinical pathways, yet developing them can be costly, and implementing them is not always successful. A 300-bed Midwestern community hospital began a clinical pathways program in 1995, and by fall 1998, 15 pathways were in various stages of implementation, with 3 under development. Many challenges had been encountered, but hospital leaders were eager to find ways to increase pathway use. METHODS: A qualitative case study design was used to investigate four clinical pathways, two perceived as being "used" and two that were perceived as "not used". Each pathway was analyzed as a separate case, followed by cross-case analysis. Qualitative data were collected in 65 semistructured interviews with administrators, physicians, physicians' office staff, nurses, and allied health professionals at the hospital. Data were also collected through observation and document analysis. RESULTS: The two used pathways had been introduced as part of a larger change in care, whereas the two pathways not used had been introduced as stand-alone innovations. Confusing and inadequately developed aspects of the hospital's clinical pathways program included its purposes, the definition of pathway use, pathway procedures, accountability, education, and incentives. A new case management department, ongoing administrative support, and a sophisticated medical information system were viewed as supports for continued growth in the program. CONCLUSIONS: Implementation of clinical pathways was delayed and complicated by the varied perceptions of the program among stakeholders. Lack of clarity and consistency in how information about the program was communicated made it difficult for clinicians to develop a shared understanding of clinical pathways.
Attitude of Health Personnel↗
Evaluating the program effects of a radio drama about AIDS in Zambia.
This study describes an approach to the analysis of data that is designed to isolate program effects for evaluations and applies that approach to a program in Zambia designed to disseminate AIDS information. Evidence is considered that a radio drama broadcast for nine months had an impact on knowledge and behavior related to AIDS among Bemba speakers in northern Zambia. Using results from large sample surveys (1,600 men and women), conducted before and after the drama was broadcast, the analyses compare changes in knowledge and behavior in those most likely and least likely to have listened to the broadcast. While the population as a whole had improved its knowledge substantially, and some people reported having reduced risky behavior, attributing these changes to the program itself was not possible.
Acquired Immunodeficiency Syndrome↗
Texas Tobacco Prevention Pilot Initiative: processes and effects.
The study was designed to examine how intensity of anti-smoking media campaigns and differing types of anti-smoking community-based programs influence young adolescents' tobacco use and related psychosocial variables. Sixth grade students attending 11 middle schools in eight study communities assigned to varying intervention conditions were assessed by a pre-intervention survey conducted in spring 2000. The assessment was followed by summer and fall 2000 media and community interventions that were evaluated by post-intervention data collection taking place with a new cohort of sixth graders in the same 11 schools in late fall 2000. In analyses conducted at the school level, the enhanced school and comprehensive community program conditions outperformed the no intervention program condition to reduce tobacco use and intentions to use tobacco. Combining the intensive or low media campaign with the comprehensive community program was most effective in suppressing positive attitudes toward smoking, while the enhanced school program alone was less effective in influencing attitudes. The most consistent changes, at least short-term, to reduce teen tobacco use, susceptibility to smoking and pro-smoking attitudes were achieved by combining the intensive media campaign with the comprehensive community program condition.
Attitude to Health↗
Innovation in HIV prevention: organizational and intervention characteristics affecting program adoption.
A multiple case study design was used to explore the organizational characteristics of community-based organizations that provide HIV prevention programs and the criteria these organizations employ when judging the merits of externally-developed HIV prevention programs. In-depth interviews were conducted with organizational representatives of 38 randomly-selected HIV prevention providers throughout Illinois. Results indicated that there were three main types of adopting organizations: adopters of entire programs, adopters of program components and practices, and adopters of common ideas. These three types of organizations were distinguished by their level of organizational commitment to HIV prevention, organizational resources, and level of organizational maturity. Narrative data from the interviews are used to describe the dimensions that underlie the organizations' program adoption criteria. The criteria of merit used by these organizations to evaluate prevention programs provide partial empirical support for existing theories of technology transfer. Implications for designing and disseminating HIV prevention programs are discussed.
Adolescent↗
Spreading the word by radio.
A reporter for Japan Broadcasting Corporation (NHK) interviews a woman from the Miao ethnic minority in China working as a midwife for a worldwide radio program to be aired on NHK's Radio Japan. The program, for broadcast in August [1994], is one of a five-part series on population issues and the family to be broadcast worldwide from August to December. Made with collaboration from JOICFP, the series features activities of JOICFP's Integrated Project in China in the first program and in Tanzania in the third program. The series, entitled 5.7 Billion Population Challenge--A Family Point of View, was planned to mark the UN International Conference on Population and Development to be held in Cairo, Egypt, in September, and the International Year of the Family.
Asia↗
Designing interventions to prevent HIV-1 infection by promoting use of condoms and spermicides among intravenous drug abusers and their sexual partners.
This paper summarizes the results of a 2-day workshop to identify the most effective educational strategies to promote use of condoms and spermicides for preventing heterosexual transmission of HIV-1 virus from intravenous drug abusers (IVDA) to their steady, nonintravenous drug abusing (NIVDA) sexual partners. Representatives from health departments, drug abuse treatment centers, academic institutions, service organizations, and the community discussed issues relating to population characteristics, educational strategies and recruitment techniques. A consensus document that identifies the most effective recruitment and intervention strategies was developed. Recruitment issues include locations, recruitment targets, anticipated difficulties, and ethical considerations. The majority of workshop participants agreed that an intervention should target the couple (both IVDA and NIVDA). Intervention concerns encompass obtaining trust, maintaining participation, and identifying guidelines to maximize program impact.
Acquired Immunodeficiency Syndrome↗
Designing effective nutrition interventions for adolescents.
By altering dietary behaviors, nutrition interventions during adolescence have the potential of affecting children at that time and later in life. The majority of interventions implemented in the teen years have occurred in schools, but other intervention sites have included after-school programs, summer camps, community centers, libraries, and grocery stores. Programs with successful outcomes have tended to be behaviorally based, using theories for the developmental framework; included an environmental component; delivered an adequate number of lessons; and emphasized developmentally appropriate strategies. One planning method that can be used in the development of nutrition interventions is Intervention Mapping. The steps of Intervention Mapping include conducting a needs assessment, developing proximal program objectives, mapping appropriate strategies and methods to address the objectives, planning the program design, planning program adoption and implementation, and evaluation. The use of intervention-planning techniques, coordination of nutrition and physical education interventions, using technological advances such as CD-ROMs, incorporation of policy changes into intervention efforts, and dissemination of effective programs are all trends that will influence the future development of effective nutrition programs for adolescents.
Adolescent↗
A training program for elementary school teachers. Optometrist-teacher communications.
Communication between optometrists and teachers is critical to optometric involvement in interdisciplinary team approaches to learning disabilities. The classroom teacher may be a prime source of referrals to the general optometrist as well as the vision development specialist. Optometry's contribution to classroom learning cannot be fully realized without sound optometrist-teacher communication. The basic design of a training program to enhance optometrist-teacher communications is presented in this paper. The individual optometrist may modify and supplement the program to suit the special needs of the teachers involved.
Child↗
Communication in oncology care: the effectiveness of skills training workshops for healthcare providers.
Communication skills are the cornerstone of the patient-provider relationship in cancer care. Lack of these skills can diminish patient disclosure, increase patient anxiety, and decrease satisfaction with care. The purpose of this article is to evaluate the literature regarding the efficacy and outcomes of communication skills training programs for healthcare providers in oncology. Using four databases, the author found 21 research articles about communication skills training programs for healthcare providers in oncology. The majority of published studies involved training programs for experienced clinicians (i.e., physicians, nurses, nurse practitioners, physician assistants) in oncology care. Programs varied in length from 18-105 hours and evaluated communication skills, patient satisfaction and anxiety, and provider confidence and perceived stress. Specific communication skills and provider confidence were statistically improved in 19 of 21 studies. Follow-up data showed maintenance of some skills and attrition of others. Longer programs with consolidation workshops are seen as more effective.
Communication↗