Health and Behavior The Interplay of Biological, Behavioral, and Societal Influences (2001) / Chapter Skim
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Pages 274-330
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From page 274... ...
The efficacy of interven' tions can only be determined by appropriately designed empirical studies. Randomized clinical trials provide the most convincing evidence, but may not be suitable for examining all of the factors and interactions addressed in this report.
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From page 275... ...
As more trials clocumentec3 effects on total mortality, some surprising results emerged. For example, studies commonly report that, compared with placebo, lipicllowering agents reduce total cholesterol anc3 low-clensity lipoprotein cholesterol, anc3 might increase high-clensity lipoprotein cholesterol, thereby reducing the risk of death from coronary heart disease (Frick et al., 1987; Lipid Research Clinics Program, 1984~.
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From page 276... ...
(1999) clemonstratec3 that intake of cli' etary sodium in overweight people was not related to the incidence of coronary heart disease but was associated with mortality form coronary heart disease.
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From page 277... ...
Recently, research by economists has attempted to integrate studies from cognitive science, while psychologists have begun investigations of choice anc3 clecision-making (Tversky and Shafir, 19921. A significant body of studies demonstrates that cliEer
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From page 278... ...
Programs that prevent the decline of health status or programs that pre' vent deterioration anc3 functioning among the clisablec3 JO perform well in QALY outcome analysis. It is likely that QALYs will not reveal benefits for heroic care at the very end of life.
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From page 279... ...
Some provide knowledge or persuasive informal tion; others involve incliviclual, family, group, or community programs to change or support changes in health behaviors (such as in tobacco use, physical activity, or diet) ; still others involve patient or health care pro' viper education to stimulate behavior change or risk~avoiciance.
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From page 280... ...
Olclenburg anc3 colleagues (1999) reviewed all papers published in 1994 in 12 selected journals on public health, preventive medicine, health behavior, anc3 health promotion anc3 education.
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From page 281... ...
Sev' eral health~relatec3 behavior change interventions meeting those criteria have been iclentifiec3, including interventions for management of chronic pain, smoking cessation, adaptation to cancer, anc3 treatment of eating c3 isorc3 ers (Compaq et al., 1 998 ~ . An intervention that has failed to meet the criteria still has potential value anc3 might represent important or even landmark progress in the field of health~relatec3 behavior change.
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From page 282... ...
Review criteria of community interventions have been suggested by Hancock anc3 colleagues (Hancock et al., 19971. Their criteria for rigor' ous scientific evaluation of community intervention trials include four domains: (1)
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From page 283... ...
Mediating mechanisms are pathways, such as social support, by which the intervention induces the outcomes; mollifying conditions, such as social class, are not affected by the intervention but can influence outcomes inclepenclently. Such an approach offers numerous aclvantages, including the ability to identify pertinent variables and how, when, anc3 in whom they should be measured; the ability to evaluate anc3 control for sources of extraneous variance; anc3 the ability to develop a cumulative knowledge base about how anc3 when programs work (Bickman, 1987; Donaldson et al., 1994; Lipsey, 1993; Lipsey and Polarcl, 19891.
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From page 284... ...
Each principle constitutes a continuum anc3 represents a goal, for example, equitable participation anc3 shared control over all phases of the research process (Cornwall, 1996; Dockery, 1996; Green et al., 19951. Although the principles are presented here as distinct items, community-basec3 participatory research integrates them.
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From page 285... ...
EVALUATING AND DISSEMINATING INTERVENTION RESEARCH TABLE 7 2 Rationale for Community-Basec3 Participatory Research Rationale Reference 285 Enhances the relevance and usefulness of research data for all partners involved Joins partners with diverse skills, knowledge, expertise, and sensitivities to address complex problems Improves quality and validity of research by engaging local knowledge and local theory based on experience of people involved Recognizes limitations of concept of "value-free" science (Denzin 1994) and encourages self-reflexive, engaged, and self-critical role of researchers Acknowledges that knowledge is power, thus knowledge gained can be used by all partners involved to direct resources and influence policies that will benefit community Strengthens research and program development capacity of partners Creates theory grounded in social experience and creates better informed and more effective practice guided by such theories Increases possibility of overcoming understandable distrust of research on part of communities that have historically been subjects of such research Has potential to "bridge the cultural gaps that may exist" (Brown, 1995, p.
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From page 286... ...
. s consistent With Implications or principles of practice that emanate from conceptual framework of stress process, for example, context-specific, comprehensive approach, and multiple outcomes Provides additional funds and possible employment opportunities for community partners Aims to improve health and well-being of communities involved, both directly through examining and addressing identified needs and indirectly through increasing power and control over research process Involves communities that have been marginalized on basis of race, ethnicity, class, gender, sexual orientation in .
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From page 287... ...
EVALUATING AND DISSEMINATING INTERVENTION RESEARCH TABLE 7 3 Principles of Community-Basec3 Participatory Research and Evaluation 287 Principle Recognizes community as unit of identity Builds on strengths and resources within community Facilitates collaborative partnerships in all phases of research Integrates knowledge and action for benefit of all partners Promotes a colearning and empowering process that attends to social inequalities Reference Hatch et al. 1993; Israel et al.
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From page 288... ...
288 TABLE 7 3 Continued HEALTH AND BEHAVIOR Principle Reference Involves cyclic and iterative process Addresses health from both positive and ecological perspectives Disseminates findings and knowledge gained to all partners Involves long-term commitment of all partners Altman 1995; Cornwall and Jewkes 1995; Fawcett et al. 1996; Hatch et al.
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From page 289... ...
They sometimes assess cholesterol anc3 blood pres' sure, but they JO not usually measure heart disease because that would not be expected to occur for many years. Given the aims anc3 the dynamic context within which community' based participatory research anc3 evaluation are concluctec3, methoclologic flexibility is essential.
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In particular, policymakers need to know whether legal interventions achieve their intenclec3 goals (e.g., reducing risk behavior)
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From page 291... ...
Ethical concerns accompany the use of legal interventions to mandate behavior change anc3 must be part of the deliberation process. COST EFFECTIVENESS EVALUATION It is not enough to demonstrate that a treatment benefits some pa' tients or community members.
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From page 292... ...
SOURCES, in order from top: Edelson et al., 1990; Office of Technology Assessment, 1981; Balestra and Littenberg, 1993; Eddy, 1990; Danese et al., 1996; Goldman et al., 1991; Cromwell et al., 1997. programs, but only 2 life-years if used to supply Lovastatin to men aged 35-44 who have high total cholesterol but no heart disease and no other risk factors for heart disease.
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From page 293... ...
However, comparing behavioral and psychosocial interventions with other ways of promoting health on the basis of cost-effectiveness requires additional research. Currently there are too few studies that meet this stanciarc3 to support such recommendations.
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From page 294... ...
, half the women overestimatec3 their risk of death from breast cancer by a factor of 8. This clic3 not appear to be because the subjects thought that they were more at risk than other women; only 10% reported that they were at higher risk than the average woman of their age.
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From page 295... ...
EVALUATING AND DISSEMINATING INTERVENTION RESEARCH 295 provide guidance for reducing misunclerstancling (Fischhoff anc3 Downs, 19971. Formal normative analysis of decisions involves the creation of decision trees, showing the available options anc3 the probabilities of various outcomes of each, whose relative attractiveness (or aversiveness)
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From page 296... ...
The electromagnetic field brochure is an example of a general approach in cognitive psychology, in which communications are clesignec3 to create coherent mental models of the domain being consiclerec3 (Ericsson anc3 Simon, 1994; Fischhoff,1999b; Gentner anc3 Stevens, 1983; Johnson' Lairc3,1980~. The bases of these communications are formal models of the domain.
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From page 297... ...
The reciprocal of 0.004 is 250. In this case, 250 people would have to be treated for 6 years to avoid 1 death from coronary heart disease.
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From page 298... ...
Thiazide medications can be effective at controlling blood press sure, they also can be associated with increased serum cholesterol; the benefit of blood pressure reduction must be balanced against such side effects as dizziness and impotence. Factors that affect patient decision making and use of health services are not well understood.
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From page 299... ...
Systematic clinical trials have shown that the probability of surviving breast cancer is about equal after mastectomy anc3 after lumpectomy fol' lowed by radiation (Lichter et al., 19921. But in some areas of the United States, nearly half of women with breast cancer have mastectomies (for example, Provo, Utah)
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From page 300... ...
Not all evaluations of decision aids have been positive. In one evaluation of an impartial video for patients with ischemic heart disease, (Liao et al., 1996)
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From page 301... ...
Although different researchers have offered a variety of approaches, there is consensus on the importance of at least four stages (Goodman et al., 19971: · dissemination, during which organizations are made aware of the programs and their benefits; · adoption, during which the organization commits to initiating the program; · implementation, during which the organization offers the program or services; · maintenance or institutionalization, during which the organization makes the program part of its routines and standard offerings. Research investigating the diffusion of health behavior change programs to new organizations can be seen, for example, in adoption of prevention curricula by schools and of preventive services by medical care practices.
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From page 302... ...
Initial or traditional efforts to enhance diffusion focused on the characteristics of the intervention program, but more recent studies have focused on the change process itself. Two NCI-funded studies to diffuse tobacco prevention programs throughout schools in North Carolina and Texas targeted the four stages of change and were evaluated through randomized, controlled trials (Goodman et al., 1997; Parcel et al., 1989, 1995; Smith et al., 1995; Steckler et al., 1992~.
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From page 303... ...
Much effort has been invested in the development of effective programs anc3 processes for clinical practices to accomplish health behavior change. However, the diffusion of such programs to medical practices has been slow (e.g., Anderson anc3 May, 1995; Lewis, 19881.
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From page 304... ...
Preventive Services Task Force anc3 is clistributec3 by federal agencies anc3 through professional associations. Using a case study approach, McVea anc3 colleagues (1996)
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From page 305... ...
They include theoretically based behavior change strategies, targeting of multiple levels of influence, anc3 the involvement of empowered community leaclers (Florin anc3 Wanclersman, 1990; Pentz, 1998~. Practitioners need training in specific strategies for the transfer of core elements (Berg et al., 1998; Orlancli, 19861.
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From page 306... ...
In health behavior change, an example of observability might be attention given to a health promotion program by the popular press (Pentz, 1998; Rogers, 1983~. Dissemirlatiorl Research The ability to identify effective interventions anc3 explain the characteristics of communities anc3 organizations that support dissemination of those interventions provides the basic building blocks for dissemination.
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From page 307... ...
for classifying par' ticipatory research projects also could be used. Similarly, based on her research anc3 experience with children anc3 adolescents in school health behavior change programs, Perry (1999)
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From page 308... ...
. Multihospital systems or linkages among managec3-care organizations anc3 local health departments for treating sexually transmitted diseases (Ruth' erforc3, 1998)
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From page 309... ...
Evaluation models, such as the FORECAST model (Goodman anc3 Wanclersman, 1994) anc3 the model proposed by the Work Group on Health Promotion anc3 Community Development at the University of Kansas (Fawcett et al., 1997)
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From page 310... ...
American Journal of Public Health, 85, 840-842. Anderson, N.B.
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From page 311... ...
Cardiovascular risk factor prevention in black school children: The Know Your Body: Evaluation Project. Health Education Quarterly, 16, 215-228.
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From page 312... ...
American Journal of Public Health, 83, 667-674. Deber, R.B.
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From page 313... ...
Health Education Quarterly, 21, 199-220. Erdmann, T.C., Feldman, K.W., Rivara, F.P., Heimbach, D.M., and Wall, H.A.
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From page 314... ...
Safety of treatment, changes in risk factors, and incidence of coronary heart disease. New England Journal of Medicine, 317, 12371245.
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From page 315... ...
American Journal of Health Promotion, 10, 270-281. Greenfield, S., Kaplan, S., and Ware, J.E.
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From page 316... ...
American Journal of Health Promotion, I I, 290-307. Hingson, R
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From page 317... ...
Health Education Quarterly, 22, 364-389. Israel, B.A., Schulz, Ad., Parker, E.A., and Becker, A.B.
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From page 318... ...
Health Education Quarterly, 21, 253-268. Lalonde, M
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From page 319... ...
I Reduction in incidence of coronary heart disease.
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From page 320... ...
(1986~. Dissemination of community health promotion programs: The Fargo-Moorhead Heart Health Program.
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From page 321... ...
Health Education Quarterly, 16, 181-199. Park, P., Brydon-Miller, M., Hall, B., and Jackson, T
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From page 322... ...
Health Education Quarterly, 21, 221-234. Price, R.H.
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From page 323... ...
Health Education Quarterly, 21, 295-312. Rogers, E.M.
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( 1995~. Health Education and Health Promotion, grid Edition.
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American Journal of Health Promotion, 6, 214-224. Steckler, A.B., Dawson, L., Israel, B.A., and Eng, E
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From page 326... ...
(1989~. Primary prevention of chronic disease among children: The schoolbased "Know Your Body Intervention Trials." Health Education Quarterly, 16, 201214.
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From page 327... ...
(1986~. Ottawa Charter for Health Promotion.
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From page 329... ...
~~T THREE if ~d Reco_~"dons
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