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The 1983 OSHA Hazard Communication Standard requires training of employees exposed to hazardous chemicals. The authors provide a detailed look at the successes and failures of a joint labor-management training program that was designed to bring a firm with more than 50 manufacturing facilities into compliance with the standard.
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BACKGROUND: Interactive health communication technologies have the potential to eliminate or greatly reduce many of the barriers to delivery of preventive services. This paper describes the process of developing and evaluating interactive health communication programs for primary care settings. We present as examples the Patient-centered Assessment and Counseling for Exercise plus Nutrition (PACE+) programs, designed to promote physical activity and healthy nutrition with adolescents and adults. METHODS: The PACE+ programs use interactive communication technology to screen multiple behaviors, prioritize areas for intervention, and initiate intervention. Patient information is synthesized for ease of use by clinicians. The patient completes the program on a computer in the clinic waiting room before the provider encounter. Acceptability of the program was evaluated with adolescents (n=252), adults (n=285), and their health care providers. RESULTS: The PACE+ programs were developed, evaluated, modified, and re-evaluated. Feasibility testing indicated that a diverse group of adolescents and adults found the PACE+ computer programs acceptable. Modifications to shorten and refine the programs were identified. CONCLUSIONS: Development of interactive health technologies is an iterative process dependent on feedback from intended users and systems of care. Interactive health communication technologies can be incorporated into clinical settings.
The Program for S. mansoni Control (PCE) has been developed in some areas of the State of Bahia by the Fundação Nacional de Saúde (FNS). In 1989, activities on Information, Education, Communication and Community Mobilization (IEC/MC) were initiated. This study evaluates the epidemiological impact of the IEC/MC, using a quasi-experimental study design strategy, comparing the prevalences of infection for S. mansoni in areas of IEC/MC and estimates of other areas. The data used were routinely collected by the local staff of the FNS. A decrease on the prevalence of S. mansoni infection was found in all study areas, specially in those of IEC/MC activities. Findings indicate that PCE activities are more effective among school-age individuals and male adults, although IEC/MC allows for higher epidemiological impact among women, reflecting the differences among the strategies. These findings point out the need for qualitative evaluation research, as well as cost benefit and cost effectiveness analyses, that are more appropriate for decision making processes.
Patients may be rendered speechless because of many conditions, including cancer surgery, stroke, cerebral palsy, cervical cord and head trauma, neuromuscular paralysis, and intubation for respiratory failure. These same conditions may also be associated with decreased use of the hands, so that writing and other nonverbal forms of communication are also impaired. Lack of communication can frustrate the patient, the family, and health care personnel; increase the patient's isolation; and lead to poor patient cooperation, thus impeding progress in therapy and producing secondary psychiatric disturbances. Two communication programs that use a Commodore 64 computer are described in this paper. One communication program uses the alphabet and the other is based on the international Morse code. These programs are easy to use and inexpensive to establish, and they accommodate any switching device.
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Organ and tissue donation and transplantation have a role in public health programs as organizational projects designed by public health departments to increase the quality and number of donations and transplantations. These programs serve as communication projects to inform public opinion on cerebral death, organ and tissue shortages, procurement and allocation rules, and the quality of life of transplanted patients. The health department of Emilia-Romagna created a regional law and a multimedia communication program for these purposes, resulting in a 95% increase of cadaver donor in 4 years. In 1995, regional activity reached the European mean level and afterwards surpassed it. In 1997, the bone bank was activated, followed in 1998 by the heart valve and vascular segment bank. The regional health department now considers transplant activities a primary goal; human and professional relations between intensive care units and the transplant reference center are considered crucial; cooperation among health departments, medical teams involved in organ procurement and transplant activities has been fostered, and the local coordination network has been active and efficient. The public information campaign has proven important in providing information both to professionals and citizens.
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An alternating treatment comparison was conducted of the relative effectiveness of oral and total communication training models for teaching expressive labeling skills to three echolalic autistic children. The results of this comparison demonstrated that total communication proved to be the most successful approach with each of the subjects. In addition, the replication of these findings both within and across subjects suggest that total communication may be, in general, the most effective of these two training models for teaching basic vocal language skills to echolalic children. A number of hypotheses are presented that may provide a basis for the demonstrated effect.
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Administrative communication is increasingly challenging for residency programs as the number of training sites expands. The Internet provides a cost-effective opportunity to address these needs. Using the World Wide Web, we developed a single, reliable, accurate, and accessible source of administrative information for residents, faculty, and staff in a multisite internal medicine residency at reduced costs. Evaluation of the effectiveness of the website was determined by tracking website use, materials and personnel costs, and resident, staff, and faculty satisfaction. Office supply and personnel costs were reduced by 89% and personnel effort by 85%. All users were highly satisfied with the web communication tool and all reported increased knowledge of program information and a greater sense of "connectedness." We conclude that an internet-based communication system that provides a single, reliable, accurate, and accessible source of information for residents, faculty, and staff can be developed with minimum resources and reduced costs.
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The Sisters Together, Move More Eat Better pilot communication program focuses on young Black women in three inner-city communities to encourage improved nutrition and increased physical activity. The design for Sisters Together is based on an expansion of a public health campaign that combines social marketing with community building efforts. The pilot program design comprises five phases: design, promotion, demonstration, transfer, and sustained activity. The proposed five-stage model holds potential for increasing the life span of a campaign and contributing to community building. Partnerships and coalition development promise to maintain the campaign beyond the limited budget period. This descriptive article illustrates the elements of a hybrid model for the design of a communication program with examples from Sisters Together, Move More Eat Better, a pilot program currently in the last year of implementation.
The Cancer Information Service (CIS) of the National Cancer Institute (NCI) is a health communications program that disseminates information through two channels: to individuals through a toll-free telephone service and to organizations (serving primarily underserved populations) through an outreach program. People call the 1-800-4-CANCER line to meet a variety of information needs. The information specialists who respond to these calls are prepared to answer questions ranging from cancer prevention to early detection, treatment, and survivorship. In a 1996 random sample survey, 2,489 callers were asked why they called, how they valued the information, and what health-related actions they took or decisions they made since their call. Results show the CIS is highly valued by its users, with satisfaction high across gender, age, education, and racial/ethnic groups. While differences in satisfaction were observed by caller type and subject of inquiry, nearly all respondents reported that contact with the CIS increased knowledge, provided reassurance, and influenced decisionmaking and health behavior. Overall, 95% were satisfied with CIS information, 98% trusted the information, 92% reported an increase in knowledge, 69% felt reassured, and 73% said the information helped them to better cope with their concerns. Eight out of 10 callers reported the information they received had a positive impact, with 56% reporting taking a positive health action. Results demonstrate that health communications programs like the CIS can fill information gaps consumers must bridge to make informed health care decisions and can play an important public health role in motivating people to take actions to reduce risks and/or make decisions that lead to improved health status.
The need for harnessing the achievements of communication technology to the burgeoning mass of biomedical information is critical. Recognizing this problem and aware of the short supply of professionals with the skills necessary for the job, a group of leaders from the fields of medicine and communications formed a consortium in 1967 and have developed a twelve month graduate program in biomedical communication. Designed to ground the advanced student in the development and administration of biomedical communication programs, the curriculum focuses on the principles and practice of communication and the development of communications media. Courses are given in the control and communication of information; the printed and spoken word; visual media of photographic arts, television, and motion pictures; computer science; and administration and systems analysis.