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PubMed2004

Changes in health indicators related to health promotion and microcredit programs in the Dominican Republic.

OBJECTIVE: To assess the impact of health promotion programs and microcredit programs on three communities in the Dominican Republic. One community had only the health promotion program, one community had only the microcredit program, and one community had both a health promotion program and a microcredit program. This pilot project examined the hypothesis that the largest changes in 11 health indicators that were studied would be in the community with both a health promotion program and a microcredit program, that there would be intermediate changes in the community with only a health promotion program, and that the smallest changes would be in the community with only a microcredit program. METHODS: The health promotion programs used community volunteers to address two major concerns: (1) the prevalent causes of mortality among children under 5 years of age and (2) women's health (specifically breast and cervical cancer screening). The microcredit program made small loans to individuals to start or expand small businesses. Outcome measures were based on comparisons for 11 health indicators from baseline community surveys (27 households surveyed in each of the three communities, done in December 2000 and January 2001) and from follow-up surveys (also 27 households surveyed in each of the three communities, in June and July 2002, after the health promotion program had been operating for about 13 months). Households were randomly chosen during both the baseline and follow-up surveys, without regard to their involvement in the microcredit or health promotion programs. RESULTS: The health indicators improved in all three communities. However, the degree of change was different among the communities (P < 0.001). The community with parallel microcredit and health promotion programs had the largest changes for 10 of the 11 health indicators. CONCLUSIONS: Multisector development is known to be important on a macroeconomic scale. The results of this pilot project support the view that multisector development is also important on a microeconomic level, given that the parallel microcredit and health promotion programs resulted in greater change in the measured health indicators than either program alone. As far as we authors know, this is the first published study to quantify changes in health indicators related to parallel health promotion and microcredit programs as compared to control communities with only a health promotion program or a microcredit program.

Dominican Republic↗
PubMed1999

Health literacy: report of the Council on Scientific Affairs. Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association.

CONTEXT: Patients with the greatest health care needs may have the least ability to read and comprehend information needed to function successfully as patients. OBJECTIVE: To examine the scope and consequences of poor health literacy in the United States, characterize its implications for patients and physicians, and identify policy and research issues. PARTICIPANTS: The 12 members of the Ad Hoc Committee on Health Literacy, American Medical Association Council on Scientific Affairs, were selected by a key informant process as experts in the field of health literacy from a variety of backgrounds in clinical medicine, medical and health services research, medical education, psychology, adult literacy, nursing, and health education. EVIDENCE: Literature review using the MEDLINE database for January 1966 through October 1, 1996, searching Medical Subject Heading (MeSH) reading combined with text words health or literacy in the title, abstract, or MeSH. A subsequent search using reading as a search term identified articles published between 1993 and August 1998. Authors of relevant published abstracts were asked to provide manuscripts. Experts in health services research, health education, and medical law identified proprietary and other unpublished references. CONSENSUS PROCESS: Consensus among committee members was reached through review of 216 published articles and additional unpublished manuscripts and telephone and Internet conferencing. All committee members approved the final report. CONCLUSIONS: Patients with inadequate health literacy have a complex array of communications difficulties, which may interact to influence health outcome. These patients report worse health status and have less understanding about their medical conditions and treatment. Preliminary studies indicate inadequate health literacy may increase the risk of hospitalization. Professional and public awareness of the health literacy issue must be increased, beginning with education of medical students and physicians and improved patient-physician communication skills. Future research should focus on optimal methods of screening patients to identify those with poor health literacy, effective health education techniques, outcomes and costs associated with poor health literacy, and the causal pathway of how poor health literacy influences health.

American Medical Association↗
PubMed2003

HIPAA privacy rule and public health. Guidance from CDC and the U.S. Department of Health and Human Services.

New national health information privacy standards have been issued by the U.S. Department of Health and Human Services (DHHS), pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The new regulations provide protection for the privacy of certain individually identifiable health data, referred to as protected health information (PHI). Balancing the protection of individual health information with the need to protect public health, the Privacy Rule expressly permits disclosures without individual authorization to public health authorities authorized by law to collect or receive the information for the purpose of preventing or controlling disease, injury or disability including but not limited to public health surveillance, investigation, and intervention. Public health practice often requires the acquisition, use, and exchange of PHI to perform public health activities (e.g., public health surveillance, program evaluation, terrorism preparedness, outbreak investigations, direct health services, and public health research). Such information enables public health authorities to implement mandated activities (e.g., identifying, monitoring, and responding to death, disease, and disability among populations) and accomplish public health objectives. Public health authorities have a long history of respecting the confidentiality of PHI, and the majority of states as well as the federal government have laws that govern the use of, and serve to protect, identifiable information collected by public health authorities. The purpose of this report is to help public health agencies and others understand and interpret their responsibilities under the Privacy Rule. Elsewhere, comprehensive DHHS guidance is located at the HIPAA website of the Office for Civil Rights (http://www. hhs.gov/ocr/hipaa/).

Confidentiality↗
PubMed2000

Ageing in Portugal: regional iniquities in health and health care.

The health of the Portuguese has improved considerably in the last twenty years. Economic and social transformations that have contributed to the progressive amelioration of problems of feeding, sanitation, hygiene, housing and social conditions in general, as well as health services, have had decisive effect on this phenomenon. The spectacular regression of the indicators related to transmitted diseases, infant, perinatal (more than 50% between 1985 and 1994) and maternal mortality, and the mortality of children 1 to 4 yr old, also reflects this impact. The positive changes that took place in health indicators were reflected in the growth of life expectancy at birth (2.2 yr more for male and 2.3 more for women between 1985 and 1994) in spite of the fact that the difference in life expectancy in relation to EU countries has grown. Improvement in life expectancy, especially in the older age groups, is not normally associated with significant reductions in morbidity. In fact, increased longevity has become more generally associated with chronic illness or other disabilities requiring more medical services and other forms of personal care. This paper reviews some of the evidence for regional differences in the health status of elderly people in Portugal and considers how health services have reacted to these differences. A preliminary study of health status and patterns of utilisation of elderly people was undertaken. After 30 yr of a National Health Service (NHS) in Portugal we may ask why do inequities in health and access to health care of the elderly population persist? Proactive policies to prevent illness and promote health are still relatively underdeveloped in the Portuguese NHS, and the factors that influence health, such as housing, diet and occupational health hazards, remain largely absent from health and welfare policies. Poor accessibility to health services is the most serious barrier consumers have to face in order to get a medical appointment, and this is more relevant to the oldest part of the population. Geographical location of health care facilities unequally affects the ease of access of different groups of consumers and influences utilisation patterns. Examining the distribution of health services resources is an important way to understand the inequities of access to health and to health care.

Aged↗
PubMed2002

Assessing the quality of preschool child health surveillance in primary care: a pilot study in one health district.

OBJECTIVE: To develop a framework for measuring the quality of preschool child health surveillance acceptable to primary health care teams and measurable at individual primary health care team level. DESIGN: Published research evidence was identified and criteria developed by a local multidisciplinary expert group. The criteria were discussed with primary health care teams. How well they were achieved was assessed. SETTING: Twenty-eight general practices in one health authority area. METHODS: Data collection included observation of baby clinics, interviews with health visitors and general practitioners (GPs), questionnaires to parents, collation of child health surveillance reviews recorded in personal child health records and immunization rates. RESULTS: The criteria for assessing preschool child health surveillance were thought to be acceptable and achievable by primary health care teams. Fifteen of the 22 criteria used to assess baby clinics were met by over 90 of practices. Almost all practices completed child health surveillance reviews within a standard time and achieved 90 coverage for primary immunizations. At many practices, less than 90 of parents felt welcome at the baby clinic, usually had enough time to talk to their health visitor or had the purpose or results of the 6 to 8 week child health surveillance review explained to them. GPs were less likely than health visitors to discuss health promotion at child health surveillance reviews (chi(2) 11.52, P = 0.0007). Few practices had a call-up and recall system for all reviews. CONCLUSION: The framework that we developed for assessing preschool child health surveillance was acceptable and achievable by primary health care teams.

Child Health Services↗
PubMed2004

Awakening consumer stewardship of health benefits: prevalence and differentiation of new health plan models.

CONTEXT: Despite widespread publicity of consumer-directed health plans, little is known about their prevalence and the extent to which their designs adequately reflect and support consumerism. OBJECTIVE: We examined three types of consumer-directed health plans: health reimbursement accounts (HRAs), premium-tiered, and point-of-care tiered benefit plans. We sought to measure the extent to which these plans had diffused, as well as to provide a critical look at the ways in which these plans support consumerism. Consumerism in this context refers to efforts to enable informed consumer choice and consumers' involvement in managing their health. We also wished to determine whether mainstream health plans-health maintenance organization (HMO), point of service (POS), and preferred provider organization (PPO) models-were being influenced by consumerism. DATA SOURCES/STUDY SETTING: Our study uses national survey data collected by Mercer Human Resource Consulting from 680 national and regional commercial health benefit plans on HMO, PPO, POS, and consumer-directed products. STUDY DESIGN: We defined consumer-directed products as health benefit plans that provided (1) consumer incentives to select more economical health care options, including self-care and no care, and (2) information and support to inform such selections. We asked health plans that offered consumer-directed products about 2003 enrollment, basic design features, and the availability of decision support. We also asked mainstream health plans about their activities that supported consumerism (e.g., proactive outreach to inform or influence enrollee behavior, such as self-management or preventive care, reminders sent to patients with identified medical conditions.) DATA COLLECTION/EXTRACTION METHODS: We analyzed survey responses for all four product lines in order to identify those plans that offer health reimbursement accounts (HRAs), premium-tiered, or point-of-care tiered models as well as efforts of mainstream health plans to engage informed consumer decision making. PRINCIPAL FINDINGS: The majority of enrollees in consumer-directed health plans are in tiered models (primarily point-of-care tiered networks) rather than HRAs. Tiers are predominantly determined based on both cost and quality criteria. Enrollment in HRAs has grown substantially, in part because of the entry of mainstream managed care plans into the consumer-directed market. Health reimbursement accounts, tiered networks, and traditional managed care plans vary in their capacity to support consumers in managing their health risks and selection of provider and treatment options, with HRAs providing the most and mainstream plans the least. CONCLUSIONS: While enrollment in consumer-directed health plans continues to grow steadily, it remains a tiny fraction of all employer-sponsored coverage. Decision support in these plans, a critical link to help consumers make more informed choices, is also still limited. This lack may be of concern in light of the fact that only a minority of such plans report that they monitor claims to protect against underuse. Tiered benefit models appear to be more readily accepted by the market than HRAs. If they are to succeed in optimizing consumers' utility from health benefit spending, careful attention needs to be paid to how well these models inform consumers about the consequences of their selections.

Consumer Behavior↗
PubMed2006

The concept of positive health: a review and commentary on its application in oral health research.

Although the concept of positive health has been around for more than 60 years, acceptable measures of this construct have yet to emerge. Potential explanations are that there is no consensus on how it is to be defined and its ambiguous status with respect to medical and socioenvironmental models of health. In this paper we review definitions of positive health, the origins of these definitions, the way the concept of positive outcomes has been used in research on the outcomes of oral and orofacial conditions and assess whether the concept of positive health has any merit in terms of applied oral health research. This literature reveals many competing and imprecise definitions, many of which are similar to other constructs, such as well-being. Most are lacking empirical referents or indicators. In examining the literature on oral health we found five distinct, although overlapping, ways in which the concept of positive health has been framed: (i) positive health as the absence of negative health states; (ii) positive health as positively worded items; (iii) the positive outcomes of oral health; (iv) positive oral health as a set of psychological and social attributes, and (v) the positive outcomes of chronic conditions such as oro- and craniofacial differences. Each of these ways can be challenged on conceptual or methodological grounds. For example, the states that comprise the upper end of the negative-positive health continuum have not been defined and health states and determinants of health are often confused. Moreover, the meaning of responses to health status questionnaires and the interpretation of accounts of the illness experience is often unclear. Nevertheless, the notion of positive health, irrespective of its merits and public policy implications, provides a context for methodological and theoretical debate that can only serve to enrich theory and practice with respect to measures of health and quality of life and therapeutic interventions at the individual and population.

Attitude to Health↗
PubMedDate not supplied

Urban elementary school personnel's perceptions of student health and student health needs.

OBJECTIVE: To determine the perceptions of school personnel with regard to urban students' health and health needs as part of a planning process for development and implementation of school-linked health services. METHODS: A self-administered, close-ended questionnaire was given to 294 schoolteachers and school staff to assess school personnel perceptions of 1) health needs of students, 2) priority of need for health services or programs delivered on-site or off-site, and 3) selected factors suspected to affect implementation of new school health services. RESULTS: A total of 72% of teachers and 77% of staff completed the survey. The most highly ranked need by school personnel was mental health, followed by violence and anger management and physical abuse and domestic violence. The most commonly requested services on-site and off-site were for physical abuse or domestic violence, mental health, and drug or other substance abuse. Only 40% of teachers and staff rated current health services as excellent or good. A total of 72% of teachers and staff had some level of discomfort with their current responsibilities regarding the health of students. Parental involvement was reported to be quite low, with only 9% of teachers and staff rating it as excellent or good. CONCLUSIONS: he greatest health care need identified by these elementary school personnel was not for management of chronic or acute physical health conditions, but for mental health services and programs to meet the emotional and psychosocial needs of students. When implementing school-linked or school-based mental health services, focus needs to be placed on 3 areas: 1) education of school health and educational personnel regarding common mental health issues, 2) development of systems that improve knowledge of and connection with mental health resources inside and outside the school, and 3) development of systems that improve communication within the school and between the school and parents regarding health services.

Attitude to Health↗
PubMed1996

Inequalities in health: what health systems can and cannot do.

Health promotion activities are actively encouraged in most countries, including the UK. Meanwhile many health care providers and health experts are becoming increasingly concerned about the growing evidence of significant health inequalities between social groups in the UK, and in particular the strong association between relative deprivation and poor health. In 1995, a report for the British government entitled 'Variations in health: what can the Department of Health and the NHS do?', identified the need for the Department of Health and the NHS to play a key role in coordinating and implementing public health programmes intended to reduce inequalities in health. Examination of existing evidence on the effectiveness of health promotion and prevention programmes designed to improve the health status of the most vulnerable groups in society reveals very little evidence to support current enthusiasm for adopting public health strategies in order to reduce variations in health status between the affluent and the poor. Alternative and potentially more effective health care responses to inequalities in health status need to be considered.

Health Policy↗
PubMed2004

[Evaluation of quality and accessibility of health education materials. I. The opinion of health personnel].

The study concerning quality and accessibility of educational materials for health workers was taken up in 2003 in Health Promotion Department of the National Institute of Hygiene and Mazovian Centre of Public Health. Two questionnaires were elaborated: a) for physicians, b) for social-and-familial nurses. The questionnaire for physicians contains demographic data and questions about health education materials (accessibility, sufficiency, themes of received materials, and expectations concerning themes and forms). The questionnaire for social-and-familial nurses consists of demographic data and questions about health education materials (sources of materials, patients' concern with materials, adequacy for patients' interest, and needs concerning themes and forms). Data were obtained from 112 nurses (110 females and 2 males) working in Warsaw hospitals (37.6%), regional dispensaries (33.0%), specific dispensaries (11.9%) and other health services (19.5%). Majority of physicians (82.7%) answered that they received health education materials, but only 32.9% assessed the number as sufficient. More then seventy percents of physicians assessed, that materials in high degree concern advertising of pharmaceutical drugs and other commercial products, while only 11.3%--health promotion and healthy lifestyle, and 5%--disease prevention. One from three physicians needed educational materials for patients to give them during visits in high degree. As regards to themes, physicians most frequently mentioned disease prevention (41.1%), health promotion and healthy lifestyle (37.7%), treatment (34.9%), diet and nutrition (20.7%). Booklets, leaflets and posters were the forms of health education materials, which physicians noticed most frequently. Regarding social-and-familial nurses, almost all (95%) received health materials from pharmaceutical and other commercial institutions, 68.5% from public institutions and 26.6% from foundations. Only one from five of the nurses assessed, that materials captured high interest of the patients, and 13.6% of the nurses stated, that received health education materials were adequate to health information needs of patients in high degree. Nearly the same percentage of nurses as physicians (41.4%) mentioned disease prevention as most desirable theme of health education materials, lower percentage mentioned treatment (29.5%) and health promotion and healthy lifestyle (19.8%). Our findings showed that most of health materials were received from pharmaceutical and other commercial institutions. Moreover, the interest to have educational materials concerning health promotion and healthy lifestyle is low, especially among social-and-familial nurses.

Adult↗
PubMed1996

Assessing the health of the nation. The predictive validity of a preference-based measure and self-rated health.

Health-related quality-of-life (HRQOL) measures are becoming increasingly important for evaluating the effectiveness of medical interventions and assessing the health of populations. Preference-based instruments, a subset of HRQOL measures, allow comparisons of overall health status in populations and in clinical settings, and are suitable for economic analyses; but validity studies have used selected samples, mostly examining morbidity. This study compared the performance of a preference-based instrument with self-rated health in predicting subsequent self-rated health, hospitalization, and mortality in a national cohort. A version of the Health Utility Index (HUI), constructed from questions in the 1982 to 1984 National Health and Examination Survey I Epidemiologic Follow-up Study (NHEFS), was used to develop scores for the 1982 to 1984 survey sample. The relationship between both the NHEFS-HUI and self-rated health in 1982 to 1984, and subsequent decline in self-rated health, hospitalizations, and mortality experienced by 1987 were examined using survival analyses. The analyses adjusted for sociodemographic variables (age, sex, race, education, and income), medical conditions, and smoking status reported at the 1982 to 1984 NHEFS interview. Results indicated that NHEFS-HUI and self-rated health scores were worse in older persons, persons with one or more medical conditions, African Americans, and those with less education and lower incomes. The effects of all 19 chronic conditions and smoking were reflected in lower self-rated health scores, whereas the NHEFS-HUI did not capture the effects of two of the conditions or smoking status. Both measures made independent contributions to predicting hospitalizations and mortality by 1987; in addition, the NHEFS-HUI predicted decline in subsequent self-rated health. The NHEFS-HUI also predicted health outcomes in the subgroup of those in initial excellent or very good self-rated health. A preference-based instrument demonstrated predictive validity in three relevant domains of health status outcomes across all sociodemographic groups examined in this cohort. Self-rated health was better able to capture concurrent decrements in health associated with certain chronic illnesses and smoking. It is concluded that preference-based measures capturing both functional status and health perceptions should be incorporated explicitly into national surveys to assess the health of populations.

Adult↗
PubMed1975

Educational program n dental public health at schools of public health as of fall 1973.

A letter of inquiry from a fictious dentist, requesting applications and information regarding training in dental public health, was sent to each of the 19 accredited Schools of Public Health. The purpose of the survey was to determine the manner in which the schools respond to a letter of inquiry from a dentist and to determine, from the material included in the response, what type of program in dental public health, if any, each school had. All 19 schools responded, but the type and quality of the responses varied greatly. Some schools answered the questions fully and others ignored them. From the bulletins of the schools and other material contained in the responses, seven schools were determined to have what could be termed viable programs in dental public health. Two of the seven programs are administratively independent with full-time faculty as directors of their programs; three of the programs receive their major input in dental public health from an affiliated dental school; one program's input of dental public health is provided by the school of public health; and one program has an affiliation with a dental school, but the major portion of the input for dental public health during the year of preparation for the degree of MPH is provided in the school of public health. There are seven schools of public health with eight full-time faculty who are public health dentists, although only three of the faculty spend a substantial portion of their time in activities related to dental public health. Five schoolshave no public health dentist on the faculty and they have a total of 33 part-time faculty at the rank of assistant professor or higher and a total of 36 part-time faculty with a rank lower than instructor. Twelve of the schools of public health still require only a minimum of an academic year for a dentist to receive the degree of MPH and only one school requires more than a calendar year. Only five schools require field-experience in order for a dentist to receive his degree of MPH. Most schools, it appears, do not provide a program for dentists which meets the standards established by the American Public Health Association or the American Board of Dental Public Health. It is time to question the blanket acceptance by the Council on Dental Education of the American Public Health Association's accreditation of Schools of Public Health for meeting the academic requirements in the specialty of dental public health.

Accreditation↗
PubMed2005

Health programmes for school employees: improving quality of life, health and productivity.

School health programmes in the 21st century could include eight components: 1) health services; 2) health education; 3) healthy physical and psychosocial environments; 4) psychological, counselling, and social services; 5) physical education and other physical activities; 6) healthy food services; and 7) integrated efforts of schools, families, and communities to improve the health of school students and employees. The eighth component of modern school health programmes, health programmes for school employees, is the focus of this article. Health programmes for school employees could be designed to increase the recruitment, retention, and productivity of school employees by partially focusing each of the preceding seven components of the school health programme on improving the health and quality of life of school employees as well as students. Thus, efforts to improve the quality of life, health, and productivity of school employees may be distinct from, but integrated with, efforts to improve the quality of life, health, and education of students. School employee health programmes can improve employee: 1) recruitment; 2) morale; 3) retention; and 4) productivity. They can reduce employee: 5) risk behaviours (e.g., physical inactivity); 6) risk factors (e.g., stress, obesity, high blood pressure); (7) illnesses; 8) work-related injuries; 9) absentee days; 10) worker compensation and disability claims; and 11) health care and health insurance costs. Further, if we hope to improve our schools' performance and raise student achievement levels, developing effective school employee health programmes can increase the likelihood that employees will: 12) serve as healthy role models for students; 13) implement effective school health programmes for students; and 14) present a positive image of the school to the community. If we are to improve the quality of life, health, and productivity of school employees in the 21st century: school administrators, employees, and policymakers must be informed about the need and the means to do so; school employee health programmes must become part of the culture of education and the expectation of educators; and colleges that prepare school administrators and other school employees must provide the pre-service and in-service training, research, development, and leadership to make it happen. This article outlines ten actions that can be taken by school districts to build or improve school employee health programmes, and a list of websites that provides more detailed information about such programmes.

Health Promotion↗
PubMed1997

[Evaluating quality and effectiveness in the promotion of health: approaches and methods of public health and social sciences].

Health promotion and health education have often been limited to evaluation of the effectiveness of actions and programmes. However, since 1996 with the Third European Conference on Health Promotion and Education Effectiveness, many researchers have become interested in "quality assessment" and new ways of thinking have emerged. Quality assurance is a concept and activity developed in industry with the objective of increasing production efficiency. There are two distinct approaches: External Standard Inspection (ESI) and Continuous Quality Improvement (CQI). ESI involves establishing criteria of quality, evaluating them and improving whatever needs improvement. CQI views the activity or service as a process and includes the quality assessment as part of the process. This article attempts to answer the questions of whether these methods are sufficient and suitable for operationalising the concepts of evaluation, effectiveness and quality in health promotion and education, whether it is necessary to complement them with other methods, and whether the ESI approach is appropriate. The first section of the article explains that health promotion is based on various paradigms from epidemiology to psychology and anthropology. Many authors warn against the exclusive use of public health disciplines for understanding, implementing and evaluating health promotion. The author argues that in practice, health promotion: -integrates preventive actions with those aiming to maintain and improve health, a characteristic which widens the actions of health promotion from those of classic public health which include essentially an epidemiological or "risk" focus; -aims to replace vertical approaches to prevention with a global approach based on educational sciences; -involves a community approach which includes the individual in a "central position of power" as much in the definition of needs as in the evaluation of services; -includes the participation and socio-political actions which necessitate the use of varied and specific instruments for action and evaluation. With the choice of health promotion ideology, there exist corresponding theories, concepts of quality, and therefore methods and techniques that differ from those used until now. The educational sciences have led to a widening of the definition of process to include both "throughput and input", which has meant that the methods of needs analysis, objective and priority setting and project development in health promotion have become objects of quality assessment. Also, the modes of action and interaction among actors are included, which has led to evaluation of ethical and ideological aspects of projects. The second section of the article discusses quality assessment versus evaluation of effectiveness. Different paradigms of evaluation such as the public health approach based on the measurement of (epidemiological) effectiveness, social marketing and communication, and the anthropological approach are briefly discussed, pointing out that there are many approaches which can both complement and contradict one another. The author explains the difference between impact (the intermediate effects, direct or indirect, planned or not planned, changes in practical or theoretical knowledge, perceptions, and attitudes) and results (final effects of mid to long term changes such as changes in morbidity, mortality, or access to services or cost of health care). He argues that by being too concerned with results of programmes, we have often ignored the issue of impact. Also, by limiting ourselves to evaluating effectiveness (i.e. that the expected effects were obtained), we ignore other possible unexpected, unplanned and positive and negative secondary effects. There are therefore many reasons to: -evaluate all possible effects rather than only those lined to objectives; -evaluate the entire process rather than only the resources, procedures and costs; -evaluate the impact rather than results; -evalu

Anthropology↗
PubMed1998

What do health authorities think of population based health outcome indicators?

OBJECTIVES: To determine the role of population based indicators of health outcome in local health outcome assessments; the constraints of using such indicators; how they could be made more useful; and whether health authorities had developed their own indicators of health outcome. DESIGN: A structured telephone interview with representatives of 91 of the 100 English health authorities. RESULTS: Interviewees, asked to give details on two clinical areas in which population health outcome assessments had been of most value, nominated 147 examples in over 30 clinical areas. They chose 50 (34%) of the examples because of an outlying national indicator, and 20 (14%) because of local variations in a national indicator. The main perceived constraints in the use of population based indicators of health outcome were: data validity and timeliness; the attributability of these health outcomes to the quality of health care; the difficulties of changing clinical behavior; and organisational change within health authorities. To make these indicators more useful interviewees wanted an increased use of process indicators as proxies for health outcome, indicator trend data, and indicator comparisons of districts with similar population structures. Some recent publications have started to consider some of these issues. 27 (30%) health authorities had developed their own indicators, mostly provider based process indicators. 10 of these used their own indicators to manage the performance of local provider units. CONCLUSIONS: Population based indicators of health outcome had an important role in prompting districts to undertake population health outcome assessments. Health authorities also used these indicators to examine local variations in health outcome. They helped to highlight areas for further investigation, initiated data validation, and enabled the monitoring of changes to services. Comparative population based indicators of health outcome may have an increasing part to play in assessing the performance of health authorities.

Community Health Planning↗
PubMedDate not supplied

The role of health consciousness in predicting attention to health warning messages.

PURPOSE: Guided by information processing theory and the health belief model, this paper considers the relationship between health consciousness among the general population and attention to environmental health warnings about alcohol consumption. Mechanisms of exposure to three dominant types of impersonal alcohol-related health messages in the environment are explored. DESIGN: Cross-sectional survey using telephone interview data. SUBJECTS: A representative nationwide sample of adults was interviewed in 1993 (n = 1026), with a response rate of 63%. MEASURES: Key variables include exposure to warning labels on alcoholic beverages, to point-of-sale posters, and to advertisements in the media, as well as respondents' alcohol consumption, health problems (indicative of salience of health warnings), and level of health consciousness assessed by items tapping concern with nutrition and seeking information on health topics. RESULTS: In the total sample, over a third had seen a warning label or poster and almost all had seen an advertisement about the risks associated with alcohol consumption in 1993. Survey respondents scored very high on five individual items that make up the health consciousness scale introduced here, with 69% endorsing all items. The scale demonstrated good internal reliability (alpha = .70) and was significantly correlated (p < .01) with not enjoying getting drunk and with usually reading product warning labels, suggesting construct validity. Yet the hypothesized strong relationships between health consciousness and attention to health warnings about drinking were not observed; nor was salience of messages a predictor of recall. Importantly, high proportions of underage drinkers and young adults at elevated risk for drinking problems are reached by container warning label messages. Mechanisms of exposure recall vary based on message source, with "container label recall" associated with heavier drinking, younger age, and purchasing patterns; "poster recall" associated with purchasing and health consciousness; and "advertisement recall" associated with heavy consumption and younger age. CONCLUSIONS: These results are contrary to predictions from skeptics of broad-based informational interventions, who argue that only the already-health conscious are attentive to health warnings about the risks of alcohol consumption. These data suggest that the label is reaching intended target audiences, especially younger people, males, and heavier alcohol consumers. Future research in predicting attention to impersonal health warnings in the environment should continue to improve the assessment of constructs such as salience and health consciousness, and should further test the applicability of available theoretical models. Subsequent research should also consider additional measures to tap mechanisms of exposure to impersonal health messages to enable a better understanding of the population that is not being reached by such public health interventions.

Adolescent↗
PubMed2004

Mental health care system and mental health expenditures in the Czech Republic.

BACKGROUND: Although the mental health care is a substantial component of the health system in the Czech Republic, there is a lack of information and research on mental health expenditures. Determining the level and profile of mental health expenditures is the first step in achieving awareness of the cost of mental illness to society. AIMS OF THE STUDY: To describe the mental health care financing and delivery system in the Czech Republic and to estimate the mental health expenditures in 2001. The paper examines expenditures with regard to structure by type of service, relative share of total health expenditures, and relative share of the gross domestic product. It also makes international comparisons of mental health expenditures between the Czech Republic and other countries. METHODS: The data discussed in this study come from the Institute of Health Information and Statistics of the Czech Republic and from the General Health Insurance Fund of the Czech Republic. Mental health expenditures are defined as expenditures on services for patients with primary or first-listed diagnoses from Chapter V, Mental and Behavioural Disorders (F00-F99), of the Tenth Revision of International Classification of Diseases (ICD-10). Different methods of allocation are used for various types of services. In addition, expenditures of sickness insurance related to mental illness are also estimated. RESULTS: Mental illness is diagnosed and treated in about 4% of the population. The share of mental illness on the total morbidity in the population is approximately 2%. The share of mental health expenditures on both the total health expenditures (3.54%) and the gross domestic product (0.26%) is low when compared to levels in other developed countries. Psychiatric hospitals consume 35.6% of mental health expenditures; prescribed drugs and medical aid consume 33.2%; specialized outpatient services consume 17.4%; and shares of other services are relatively low. IMPLICATIONS FOR HEALTH CARE POLICY FORMULATION: First, if the amount of expenditures allocated to mental health can be interpreted as an indicator of the government's commitment to mental health, then, in comparison to other developed countries, mental health has a low priority in the Czech Republic. Second, the improved availability of data on morbidity and regular analyses of these data are needed and should yield fast and valuable results.

Czech Republic↗
PubMed2004

Health behavior models and oral health: a review.

Dental hygienists help their clients develop health promoting behaviors, by providing essential information about general health, and oral health in particular. Individual health practices such as oral self-care are based on personal choices. The guiding principles found in health behavior models provide useful methods to the oral health care providers in promoting effective individual client behaviors. Theories provide explanations about observable facts in a systematic manner. Research regarding health behavior has explored the effectiveness and applicability of various health models in oral health behavior modification. The Health Belief Model, Transtheoretical Model and Stages of Change, Theory of Reasoned Action, Self-Efficacy, Locus of Control, and Sense of Coherence are examples of models that focus on individuals assuming responsibility for their own health. Understanding the strengths of each and their applicability to health behaviors is critical for oral health care providers who work with patients to adopt methods and modify behaviors that contribute to good oral health. This paper describes health behavior models that have been applied to oral health education, presents a critical analysis of the effectiveness of each model in oral health education, and provides examples of application to oral health education.

Behavior Therapy↗