Health Education Research (HEALTH EDUC RES)

Publications in this journal

• Article: Why some walk and others don’t: exploring interactions of perceived safety and social neighborhood factors with psychosocial cognitions.

  Marielle A. Beenackers, Carlijn B. M. Kamphuis, Johan P. Mackenbach, Alex Burdorf, Frank J. van Lenthe
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  ABSTRACT: Although physical activity is often believed to be influenced by both environmental and individual factors, little is known about their interaction. This study explores interactions of perceived safety and social neighborhood factors with psychosocial cognitions for leisure-time walking. Cross-sectional data were obtained from residents (age 25–75 years) of 212 neighborhoods in the South-East of the Netherlands, who participated in the Dutch GLOBE study in 2004 (N = 4395, survey response 64.4%). Direct associations of, and interactions between perceived neighborhood safety, social neighborhood factors (social cohesion, social network and feeling at home) and psychosocial cognitions (attitude, self-efficacy, social influence and intention) on two outcomes of leisure-time walking [yes versus no (binary), and among walkers: minutes per week (continuous)] were analyzed in multilevel regression models. The association between attitude and participating in leisure-time walking was stronger in those who felt less at home in their neighborhood. Social influence and attitude were stronger associated with participation in leisure-time walking in those who sometimes felt unsafe in their neighborhood. A positive intention was associated with more minutes walked in those who perceived their neighborhood as unsafe among those who walked. Only limited support was found for interactions between neighborhood perceptions and psychosocial cognitions for leisure-time walking.
  Health Education Research 02/2013;
• Article: Factors influencing hand washing behaviour in primary schools: process evaluation within a randomised controlled trial

  Chittleborough C, Nicholson AL, Basker E, Bell S, Campbell R
  Health Education Research 01/2012;
• Article: Identifying cluster subtypes for intentions to have colorectal cancer screening among non-compliant intermediate-risk siblings of individuals with colorectal cancer.

  Sharon L Manne, Elliot J Coups, Gary Winkel, Arnold Markowitz, Neal J Meropol, Samuel M Lesko, Paul B Jacobsen, Daniel Haller, Lina Jandorf, Susan K Peterson
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  ABSTRACT: Although first-degree relatives of colorectal cancer (CRC) patients diagnosed at an early age are at increased risk for CRC, their compliance with colorectal cancer screening (CRCS) is not high. Relatively little is known about why these intermediate-risk family members do not comply with CRCS. Study aims were to identify subgroups of siblings of individuals diagnosed with CRC prior to age 61 who were not compliant with CRCS using cluster analysis and to identify demographical, medical and attitudinal correlates of cluster membership. A total of 421 siblings completed measures of pros, cons, processes of change, CRCS knowledge, physician and family CRCS support, CRC risk, severity, preventability, curability, closeness with the affected sibling, distress about the sibling's cancer and screening intentions. Three clusters characterized as 'Positive about Screening', 'Uncertain about Screening' and 'Negative about Screening' were identified. External validation revealed that those in the Positive about Screening cluster reported significantly stronger CRCS intentions than those who are Uncertain about Screening and Negative about Screening clusters. Results provide an empirical typology for understanding motivations for CRCS among at-risk family members and may lead to the development of more effective interventions to improve screening uptake.
  Health Education Research 09/2009; 24(5):897-908.
• Article: Compensatory beliefs about glucose testing are associated with low adherence to treatment and poor metabolic control in adolescents with type 1 diabetes.

  Marjorie A Rabiau, Bärbel Knäuper, Thien-Kim Nguyen, Maria Sufrategui, Constantin Polychronakos
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  ABSTRACT: The goal of this research was to investigate whether compensatory beliefs (CBs) regarding glucose testing predict blood glucose levels and adherence to treatment in adolescents with type 1 diabetes. CBs are convictions that the negative effects of one behavior (e.g. not testing one's glucose level) can be compensated for by engaging in another behavior (e.g. not eating any sweets). Adolescent patients from the Diabetes Clinic at the Montreal Children's Hospital and their parents filled out scales while coming for a regular visit. Results from their HbA(1c) blood test from that visit and prior visits were obtained from their medical records. Results showed that holding glucose testing CBs was associated with poorer HbA(1c) and poorer adherence to self-care behaviors. Hierarchical regression analyses showed that glucose testing CBs predicted blood glucose control and adherence to treatment above and beyond a number of other constructs including diabetes knowledge. Addressing CBs in diabetes education, in particular targeting those concerning glucose testing, could improve the adherence to treatment and thereby the long-term health of people with diabetes.
  Health Education Research 08/2009; 24(5):890-6.
• Article: There's alcohol in my soap: portrayal and effects of alcohol use in a popular television series.

  Joris J van Hoof, Menno D T de Jong, Bob M Fennis, Jordy F Gosselt
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  ABSTRACT: Two studies are reported addressing the media influences on adolescents' alcohol-related attitudes and behaviours. A content analysis was conducted to investigate the prevalence of alcohol portrayal in a Dutch soap series. The coding scheme covered the alcohol consumption per soap character, drinking situations and drinking times. Inter-coder reliability was satisfactory. The results showed that alcohol portrayal was prominent and that many instances of alcohol use reflected undesirable behaviours. To assess the influence of such alcohol cues on adolescents, a 2x2 experiment was conducted focusing on the separate and combined effects of alcohol portrayal in the soap series and surrounding alcohol commercials. Whereas the alcohol commercials had the expected effects on adolescents' attitudes, the alcohol-related soap content only appeared to have unexpected effects. Adolescents who were exposed to the alcohol portrayal in the soap series had a less positive attitude towards alcohol and lower drinking intentions. Implications of these findings for health policy and future research are discussed.
  Health Education Research 06/2009; 24(3):421-9.
• Article: Assessment of a national network: the case of the French teacher training colleges' health education network.

  Marie-Renée Guével, Didier Jourdan
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  ABSTRACT: The French teacher training colleges' health education (HE) network was set up in 2005 to encourage the inclusion of HE in courses for primary and secondary school teachers. A systematic process of monitoring the activity and the impact of this initiative was implemented. This analysis was systematically compared with the perceptions of teaching staff involved in the network. This paper assesses the network after 2 years using documents produced and interviews with 24 coordinators. Twenty-nine teacher training colleges out of a total of 31 are involved in the network. The network has helped to create links between teacher training colleges, extend HE training and encourage partnerships with other public health organizations. By 2007, HE was included in courses offered by 19 teacher training colleges as opposed to only 3 in 2005. This study not only showed the positive impact of the network but also revealed issues in its management and presented new challenges to ensure the effectiveness of the network. The network has succeeded in attracting and training trainers who were already providing or were interested in HE. Reaching other trainers who are not familiar with HE remains a challenge for the future.
  Health Education Research 06/2009; 24(3):430-41.
• Article: Effects of episodic variations in web-based avian influenza education: influence of fear and humor on perception, comprehension, retention and behavior.

  Paul Kim, Piya Sorcar, Sujung Um, Heedoo Chung, Young Sung Lee
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  ABSTRACT: In order to provide empirical evidence on the role of a web-based avian influenza (AI) education program for mass communication and also ultimately help young children learn and develop healthy behaviors against AI and all types of influenza, an education program with two episodic variations (i.e. fear and humor) has been developed and examined with 183 fifth-grade elementary students. A quasi-experimental design was employed to find potential differential effects on the context-specific risk perception, AI knowledge acquisition, retention and behavior. The study results reveal that the fear appealed AI web-based education program was much more effective than the humor-based program in improving risk perception and educating the students about healthy behaviors (i.e. against influenza infection). However, a significant behavior change or improvement of health practices was not apparent on the post-tests (i.e. 1 month after the treatment) in either episode of the program.
  Health Education Research 06/2009; 24(3):369-80.
• Article: Mass media campaign improves cervical screening across all socio-economic groups.

  Jenny O Anderson, Robyn M Mullins, Mohammad Siahpush, Matthew J Spittal, Melanie Wakefield
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  ABSTRACT: Low socio-economic status (SES) has been associated with lower cervical screening rates. Mass media is one known strategy that can increase cervical screening participation. This study sought to determine whether a mass media campaign conducted in Victoria, Australia, in 2005 was effective in encouraging women across all SES groups to screen. Data were obtained from the Victorian Cervical Cytology Registry for each Pap test registered during 2005 and categorized into SES quintiles using the Index of Socio-Economic Advantage/Disadvantage. Negative binomial regression was used to determine the impact of the campaign on the weekly number of Pap tests and whether the media campaign had a differential effect by SES, after adjusting for the number of workdays per week, age group and time since previous test. Cervical screening increased 27% during the campaign period and was equally effective in encouraging screening across all SES groups, including low-SES women. Mass media campaigns can prompt increased rates of cervical screening among all women, not just those from more advantaged areas. Combining media with additional strategies targeted at low-SES women may help lessen the underlying differences in screening rates across SES.
  Health Education Research 05/2009; 24(5):867-75.
• Article: Mobilizing men as partners: the results of an intervention to increase dual protection among Nigerian men.

  Theresa M Exner, J E Mantell, L A Adeokun, I A Udoh, O A Ladipo, G E Delano, J Faleye, K Akinpelu
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  ABSTRACT: This quasi-experimental, proof-of-concept study evaluated the effects of an intervention designed to help Nigerian men decrease risk for HIV/sexually transmitted infections and unintended pregnancy. The intervention was delivered in groups during two 5-hour workshops, with a monthly 2-hour check-in session. A comparison condition consisted of a group-based half-day didactic workshop. Based on recruitment area, 149 men were assigned to the intervention and 132 to the comparison. Men were evaluated at baseline and 3-month post-intervention. At follow-up, men assigned to the intervention were almost four times more likely than comparison men to report condom use at last intercourse (P < 0.001) and to report fewer unprotected vaginal sex occasions, greater self-efficacy for negotiation, a more egalitarian power dynamic in their primary relationship, more positive expectations for condom use and greater intention for future consistent condom use (all P values < 0.05). Findings suggest that this intervention is both feasible and effective.
  Health Education Research 05/2009; 24(5):846-54.
• Article: Baseline survey of sun protection policies and practices in primary school settings in New Zealand.

  A I Reeder, J A Jopson, A Gray
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  ABSTRACT: The SunSmart Schools Accreditation Programme (SSAP) was launched as a national programme in October 2005 to help reduce the risk of excessive child exposure to ultraviolet radiation. As part of the need for evaluation, this paper reports the findings of a national survey of a randomly selected sample of approximately 12% of New Zealand primary schools prior to the national launch of the SSAP. Principals at 242 schools completed a mail survey (81% response rate) relating to school sun protection policies, practices, curriculum and environment. Survey responses were evaluated according to the 12 criteria of the SSAP, with schools assigned a score from 0 to 12. No school fully met all 12 accreditation criteria, although 2% of schools attained 11 criteria and another 2% attained 10. Nine per cent of schools attained three or fewer criteria. Overall, 7 was the most common score, achieved by 23%. School socio-economic decile rating and roll size were positively associated with higher scores (both P < 0.02). Continued support and resources are needed to encourage schools to address sun protection across the spectrum of curriculum, practices and environment and through commitment to written policy.
  Health Education Research 05/2009; 24(5):778-87.
• Article: Secretos de la Buena Vida: processes of dietary change via a tailored nutrition communication intervention for Latinas.

  Barbara Baquero, Guadalupe X Ayala, Elva M Arredondo, Nadia R Campbell, Donald J Slymen, Linda Gallo, John P Elder
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  ABSTRACT: Secretos de la Buena Vida was a successful tailored nutrition communication intervention delivered to Latinas living along the US-Mexico border in California. The intervention was delivered over a 14-week period and consisted of three intervention conditions: weekly home visits with promotoras + weekly tailored mailed newsletters in the first condition, weekly tailored mailed newsletters in the second condition and targeted materials in the attention control condition. The current study examined what elements of the promotora + tailored newsletter and tailored newsletter-only conditions were most effective for behavioral adoption and maintenance in a sample of 238 Latina women. Process evaluation measures assessed the implementation, fidelity and dose of these two intervention conditions. Results indicate that there was high fidelity to program implementation and delivery. Perceived effort, perceived support and intervention length predicted adoption of a lower fat diet at the 15-month follow-up. In the promotora + tailored newsletter condition, married women were four times more likely to be adopters of dietary fat changes than single women. These findings highlight the importance of process evaluation measures and help us understand the mechanism by which tailored print materials and interpersonal health communication via promotoras can facilitate health behavior change.
  Health Education Research 05/2009; 24(5):855-66.
• Article: Smoking among Dutch elementary schoolchildren: gender-specific predictors.

  M Ausems, I Mesters, G van Breukelen, H De Vries
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  ABSTRACT: Higher rates of smoking initiation and continuation by female compared with male adolescents, as found in many developed countries, may call for gender-specific prevention programs. Risk factors of smoking initiation and continuation were examined prospectively (1997-2002) among 3205 Dutch elementary schoolchildren (mean age 11.64) in an intervention trial using written questionnaires and multilevel logistic regression. At baseline, smoking prevalence was lower among girls than among boys; at follow-up, smoking initiation was lower among girls than among boys. Concerning smoking initiation, girls and boys shared the following risk factors: age, modeling from parents and siblings ('modeling nuclear'), modeling from other members in the social circle ('modeling diffuse') and perceived pro-tobacco pressure to smoke. The only gender-specific predictor of smoking initiation was parent origin; girls with non-Dutch parents could be targeted for prevention programs. Concerning continuation, girls and boys shared the following risk factors: older age, more modeling nuclear and diffuse, fewer smoking disadvantages and lower self-efficacy to refrain from smoking. This study confirms that social modeling, smoking attitude and self-efficacy information to refrain from smoking deserve a prominent place in smoking prevention programs for schoolchildren. Besides booster sessions, family-directed programs are suggested. No gender-specific predictors of later smoking initiation were found, apart from parent origin, which is not amenable to intervention.
  Health Education Research 05/2009; 24(5):818-28.
• Article: Use of focus group data to develop recommendations for demographically segmented colorectal cancer educational strategies.

  Cheryl L Holt, Michele Shipp, Mohamad Eloubeidi, Kimberly S Clay, Mary Ann Smith-Janas, Michael John Janas, Kristi Britt, Maria Norena, Mona N Fouad
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  ABSTRACT: Screening is available and effective in colorectal cancer (CRC) control, but underutilized. The purpose of this study was to use focus group data to develop recommendations for the development of educational interventions to increase CRC screening, using an audience segmentation strategy. Demographic segments were based on urban-rural residence, race (African-American, White) and sex. One hundred and sixty-five participants age 50+, with no history of CRC participated in 17 focus groups in Alabama urban and rural communities. Transcripts were examined by independent coders. Knowledge among participants was limited regarding age to begin screening, insurance coverage and risk factors for CRC. Perceived barriers to screening included lack of physician recommendation, cost/lack of insurance coverage, pain/discomfort and embarrassment. African-American men reported postponement in seeing their physicians. White women were proactive at initiating discussion of CRC screening with their providers while African-American women felt that providers should drive the process. No urban-rural differences were identified. This study identified cultural and gender characteristics and perceptions that can be used in the development of demographically segmented health communication interventions to increase CRC awareness and screening.
  Health Education Research 05/2009; 24(5):876-89.
• Article: Daughter-initiated health advice to mothers: perceptions of African-American and Latina daughters.

  M Mosavel, T Thomas
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  ABSTRACT: The prevailing paradigm of health exchange within the family is for health advice to flow from parent to child. Consistent with this pattern of exchange, most research has focused on the one-directional influence of the parent on the child and there is thus an absence of literature that explores the ability of adolescents to influence their parents' health behaviors. This qualitative study addressed this gap by exploring the feasibility of daughters providing health advice to their mothers. Twelve focus groups were conducted with 78 African-American and Latina daughters between the ages of 12 and 17 from low-income neighborhoods in a Mid-Western city in the United States. This study utilized a grounded theory approach to examine the focus group data. The findings indicate that many daughters report that they are already giving their mothers a wide spectrum of advice, including health advice. Differences were found in the reported willingness of African-American daughters when compared to Latina daughters to provide their mothers with specific cancer advice. These data suggest that some of these daughters have the potential to be valuable health education conveyers in the family.
  Health Education Research 05/2009; 24(5):799-810.
• Article: Everybody's talking: using entertainment-education video to reduce barriers to discussion of cervical cancer screening among Thai women.

  G D Love, Michele Mouttapa, S P Tanjasiri
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  ABSTRACT: Although Southeast Asian women are at exceedingly high risk for cervical cancer, low rates of the Pap testing necessary for early detection and successful treatment continue among this group. Previous research suggests that discussions about Pap testing with important people in a woman's life, particularly her doctor, may increase the likelihood of screening; therefore increasing women's discussions about cancer screenings is an important step toward behavior change. The purpose of this study was to determine the effectiveness of a culturally sensitive, seven-minute video intervention in reducing barriers to discussions about Pap tests among Thai women. This unique video presented Thai actors, speaking in Thai, in a soap opera format. Participants completed a self-report questionnaire at baseline, immediately after the intervention and at 3-month follow-up. The comparison group received an educational pamphlet. Although the results indicated that both groups experienced reductions in barriers to communicating with others about Pap tests, the intervention group had significantly stronger outcomes than the comparison group for communicating about Pap tests in general as well as to doctors. These findings suggest that intermediate communication effects such as self-efficacy, collective efficacy and perhaps interpersonal communication may reduce barriers to discussion and positive decision making regarding Pap tests.
  Health Education Research 04/2009; 24(5):829-38.
• Article: Smoking cessation and diabetes control in Kerala, India: an urgent need for health education.

  C U Thresia, K R Thankappan, M Nichter
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  ABSTRACT: This study documented the tobacco use among male diabetes patients in a clinic-based population of urban India, patient reports of physician cessation messages and patients' perception of tobacco use as a risk factor for diabetes complications. All the 444 male diabetes patients who attended three public sector hospitals in Thiruvananthapuram district, Kerala, were surveyed to ascertain their tobacco use as well as the frequency and content of quit messages received from health staff. A significant proportion (59%) of diabetes patients were tobacco users prior to diagnosis and more than half of them continued to use tobacco, many daily, even after diagnosis. Of the 100 current smokers, 75% were asked about their tobacco use at the time of diagnosis; of those, 52% were advised to quit. However, a lack of patient awareness existed regarding the linkages of smoking and diabetes complications. Notably, 52% of patients did not associate smoking with diabetes complications. Given the magnitude of tobacco use among diabetics, there is clearly a need for more proactive cessation efforts. The times of illness diagnosis, illness flare-ups and emerging illness complications are teachable moments when patients are primed to change their behavior and more motivated to quit tobacco.
  Health Education Research 04/2009; 24(5):839-45.