Health education monographs最新文献

The purpose of this study was to investigate the effectiveness, dynamics, and consequences of a health education intervention designed to increase patient question asking during the patient's medical visit. Data were collected at a Baltimore family and community health center which provides outpatient services to a low income, predominantly black and female population. The majority of the study participants were, in addition, elderly and chronically ill. A total of 294 patients and 3 providers took part in the study. The study design included random assignment of patients to experimental and placebo groups with two non-equivalent (non-randomized) control groups. Findings included: (1) The experimental group patients asked more direct questions and fewer indirect questions than did placebo group patients. (2) The experimental group patient-provider interaction was characterized by negative affect, anxiety, and anger, while the placebo group patient-provider interaction was characterized as mutually sympathetic. (3) The experimental group patients were less satisfied with care received in the clinic on the day of their visit than were placebo patients. (4) The experimental group patients demonstrated higher appointment-keeping ratios (an average number of appointments kept divided by an average number of appointments made) during a four-month prospective monitoring period.

Emergence of consumer health self-care is a reflection of the increased commitment of health professionals to patient education, growing consumer awareness that they are capable of sophisticated self-help, and a variety of social, economic and technological currents. These currents are reviewed and a survey of existing medical self-care programs is summarized. The attempts and potentials to evaluate these programs are critically examined. A number of important research and demonstration issues are raised including the determination of behavioral outcomes, technical limits, and manpower implications. A federal program of replicative studies on such issues would provide substantive knowledge in the self-care field, generalizable to the larger field of health education, but the hazards of undermining the voluntaristic and non-establishment character of the programs must be considered in designing evaluative studies.

Learning outcomes of a simulation game designed to have one-to-one correspondence between behavioral objectives and game plays is reported. The behavioral objectives were core concepts in psychiatric mental health nursing taught to associate degree nursing students. Decisions to use the simulation game method method grew out of difficulties inherent in the community college nursing program, as well as the need for self-paced, efficient, learner-centered learning and evaluative tools. After the trial and revision of the game, a number of research hypotheses were tested. Simulation gaming was found to be an effective mode of learning, and students who acted as teachers for other students learned significantly more than those who were taught. Some of the recommendations for further research were to study varied nursing populations, to add a control group, to test the long-range learning effects of playing the game, to decrease experimenter bias, to study transfer of learning to actual nurse-patient situations and changes in attitudes toward psychiatric patients, and to develop more simulation games for nursing education.

A five-year effort has been planned to test the efficacy of health education integrated in primary care services for a rural area. Impacts on health care provider and study population behavior have been hypothesized. The evaluation design includes one study and one control health care district with pre- and post-program surveys conducted in each area. The study will be completed in 1978. Baseline and longitudinal results are reported. Specific change objectives have been achieved in early cancer detection and in maternal and child health.

Traditionally, informed consent has been handled by the physician in a one-to-one interchange with the patient. As standards for adequate disclosure become more rigid and demands on physician time increase, however, the physician-patient model may cease to be practical. This study evaluated four alterative disclosure models: a formal discussion, a videotape, a pamphlet, and an informal discussion, each designed and executed by a team of health educators. Study results suggest that the informed consent process is little affected by disclosure medium and that it may be possible to strive for cost-efficiency in disclosure without compromising the quality of the consent obtained. Based on these results, a two-part disclosure process is proposed which allocates certain aspects of the disclosure to the treating physician, others to health education.

Health care is shifting from a professional-independent to a business-bureaucratic orientation. Both professional and business ideology have been unfavourable to the development of self-care and a strong health care role for families. But business ideology contains more loopholes for the emergence of a higher level of family self-care activity. The shift forces consumers to take a cautious posture in the marketplace, encouraging active management of their own health care. However, families will obtain government support for their self-care activities and a policy-influential role in health system governance only through organized political action.

The problem of compliance in family planning is discussed in relation to the lack of theoretical and conceptual clarity in research, which has produced contradictory, and often inconsistent findings. Current research has contributed little to explaining the phenomenon of compliance and to directing further research. The Health Belief Model, which has been demonstrated to have application in the areas of preventive health behavior and compliance with medical regimens, is offered as a potentially useful conceptual framework for family planning research. The generalization of the Health Belief Model to family planning behavior is seen as an out-growth of the theoretical strength of the Model and the similarities between family planning and other health behavior.

Problems in collection of uniform data on health education manpower on a continuing basis are discussed. Sources of data on current health education manpower projections for future needs are reviewed. Possible directions for improving manpower planning in this field are cited.