Empowerment of women for health promotion: a meta-analysis.

The objective of this paper is to identify conditions, factors and methods, which empower women and mothers (WAM) for social action and health promotion movements. WAM are the primary caregivers in almost all cultures; they have demonstrated bold leadership under extreme adversity. Consequently, when empowered and involved, WAM can be effective partners in health promotion programs. The methodology includes a meta-analysis of 40 exemplary case studies from across the world, which meet predetermined criteria, to draw implications for social action and health promotion. Cases were selected from industrialized and less-industrialized nations and from four problem domains affecting quality of life and health: (1) human rights, (2) women's equal rights, (3) economic enhancement and (4) health promotion. Content analysis extracted data from all cases on six dimensions: (1) problem, (2) impetus/leadership, (3) macro-environment, (4) methods used, (5) partners/opponents and (6) impact. Analysis identified seven methods frequently used to EMPOWER (acronym): empowerment education and training, media use and advocacy, public education and participation, organizing associations and unions, work training and micro-enterprise, enabling services and support, and rights protection and promotion. Cochran's Q test confirmed significant differences in the frequencies of methods used. The seven EMPOWER methods were used in this order: enabling services, rights protection/promotion, public education, media use/advocacy, and organizing associations/unions, empowerment education, and work training and micro-enterprise. Media and public education were more frequently used by industrialized than non-industrialized societies (X2 tests). While frequencies of methods used varied in all other comparisons, these differences were not statistically significant, suggesting the importance of these methods across problem domains and levels of industrialization. The paper integrates key findings into an empowerment model consisting of five stages: motivation for action, empowerment support, initial individual action, empowerment program, and institutionalization and replication. Implications for policy and health promotion programs are discussed.

Workplace health education: results from a national survey.

A national survey of individuals responsible for workplace health education was conducted by self-administered mailed questionnaire. The present analysis examines the responses to the questions on the types of health education activities undertaken and the prior training in health education of those responsible for this work. Results suggest that interest and activity in workplace health education is increasing but that there is a serious lack of training in health education on the parts of those responsible for this work.

A psychosocial model of health behavior: implications for nutrition education, research and policy.

The paper presents a multidimensional psychological model of determinants of health behavior, tested empirically in three countries to ascertain its validity. The model postulates that given that ethnic, socioeconomic, and biological statuses (exogenous variables) are homogeneous, a health risk-taking behavior in a population is a function of direct, additive, and interaction effects of five categories of independent variables both internal to the persons and external in the action environment. Although the model is tested on contraceptive behavior, it is argued that the determinants and basic processes of this risk-taking behavior are similar to those involved in other health risk behaviors and that the five basic factors identified affect nutritional behaviors as well. The paper presents several broad implications on the model for nutrition education and research; but holds that specific implications could be best derived by the specialists in nutrition field.

PIP: This paper presents a multidimensional psychosocial model of determinants of health behavior, tested empirically in 3 countries to ascertain its validity. The model postulates that given that ethnic, socioeconomic, and biological statuses (exogenous variables) are homogeneous, a health risktaking behavior in a population is a function of direct, additive and interaction effects of 5 categories of independent variables both internal to the persons and external in the action environment. Although the model is tested on contraceptive behavior, it is argued that the determinants and basic processes of this risktaking behavior are similar to those involved in other health risk behaviors and that the 5 basic factors identified affect nutritional behaviors as well. The paper presents several broad implications of the model for nutrition education and research but holds that specific implications could be best derived by specialists in the field of nutrition.

Psychosocial environment: a health promotion model.

This article presents a multidimensional model of psychosocial determinants of health behavior for health promotion research and policy analysis. Frequently, health promotion focuses almost exclusively on intrapsychic determinants and on individual level behavior. Based upon Field Theory and attitude theories, this proposed model holds that in populations with comparable sociodemographic and biological status (exogenous variables) a health behavior is a function of direct and interaction effects of five key intrapsychic and external variables. These are: behavioral intentions, social support, accessibility of means for action, personal autonomy, and action situation. Empirical tests with cross-cultural studies in Venezuela, Kenya, and the Philippines provide substantial support for the model. The findings suggest that while health promotion strategies should deal with intrapsychic determinants of behavior, key extrapsychic factors (such as social support, quality and accessibility of health care measures, and situational factors) all have direct and independent effects on health behavior as well. Health promotion research and interventions which aim exclusively at intrapsychic determinants would thus have rather limited overall value. The article discusses key research and policy implications of the model presented.

Factors in consistency between attitudes and behavior: implications for policies and programs.

The paper deals with the factors which affect contraceptive attitudes, behaviors, and the relationship between the two. The analysis is based upon original survey data from 2,446 women in Venezuela and related literature. The results suggest that both positive attitudes and contraceptive accessibility are major determinants of contraception but at the aggregate level neither has a decisive advantage over the other. The three best predictors of contraceptive use are: specific contraceptive attitudes, social support, and accessibility of contraceptives. Their impacts on behavior are direct and additive; however, their impacts vary significantly by education and number of living children. In general attitude change strategy is more effective with younger women while improving accessibility affects older women more often. Implications for policy and programs are presented.

Attitudinal and nonattitudinal determinants of contraception: a cross-cultural study.

Survey data from women in pregnancy risk in Venezuela and Kenya are used to examine the determinants of contraceptive intention, use, and the intention/use consistency. The five ranking determinants of contraceptive use are: intention to contracept, social support, accessibility, conjugal communication, and desire for additional children. All five determinants have direct and additive effects on contraception, but their relative impacts vary significantly between the two cultures. Contraceptive intention and use are highly consistent, while level of consistency varies significantly between the two samples and within each by various combinations of ranking variables and by parity. Major research and policy implications of the results are reviewed.

PIP: Survey data from women in pregnancy risk in Venezuela and Kenya are used to examine the determinants of contraceptive intention, use, and the intention/use consistency. The 5 ranking determinants of contraceptive use are: intention to contracept, social support, accessibility, conjugal communication, and desire for additional children. All 5 determinants have direct and additive effects on contraception, but their relative impacts vary significantly between the 2 cultures. Contraceptive intention and use are highly consistent, while level of consistency varies significantly between the 2 samples and within each by various combinations of ranking variables and by parity. Major research and policy implications of the results are reviewed.

Consistency between fertility attitudes and behaviour: A conceptual model.

Abstract The consistency (or lack of it) between attitude and behaviour has been a controversial issue in social psychology for the past several decades,(1) and more recently has become a focus of considerable controversy in the field of population studies.(2) In accordance with Freedman, Hermalin and Chang,(3)it is argued here that this controversy will not be resolved by theoretical discussions, and evidence is needed from many countries at several time points to resolve this issue. This paper presents evidence on consistency between fertility attitudes and behaviour from survey data from Venezuela and, based upon analysis of the present data, suggests a conceptual model for the study of consistency between fertility attitudes and behaviour.

Perceived probability of success and motivational basis for family planning programme. part II.

PIP: In the context of the role of family planning programs as part of total national developmental efforts, 2 exploratory studies of motivational correlates in family planning are discussed. The 2 samples were drawn from the lower socioeconomic strata of the U.S. and India. A significant difference is noted in the pattern of aspirations between the early and late acceptors in the U.S. sample, as well as in the acceptors and nonacceptors in the Indian sample. The need for evolving educational messages that are consonant with the existing patterns of hopes, aspirations, fears, and worries of the people is manifest so that individuals would realize that contraception is a means of fulfilling their primary aspirations and of preventing some of their major worries. The present study also suggests a significant and direct relationship between the levels of aspirations and acceptance of family planning. Subjects with lower levels of aspiration will require greater personalized persuasion and follow-up services to initiate a change in their fertility behavior in favor of practicing systematic contraception.^ieng

Perceived probability of success and motivational basis for family planning programme. Part I.

PIP: The role of family planning programs in the context of total national developmental efforts is reviewed. It is suggested that the effective implementation of family planning programs should be supplemented by maintaining the progress made in other developmental areas. Depth studies will constitute effective incentives (other than monetary) for the adoption of family planning by the masses where no tangible improvement in the standard of living is immediately possible. The perceived probability of success of program goals can significantly influence the workers' dedication to the work and their actual performances. The present empirical pilot study indicates that the majority of the respondents to the questionnaire felt that the reduction in the birthrate from 41 to 25/1000 is not likely to be achieved in 10 years, but that one may expect a significant decline in the birthrate in the next 20 years. It should be determined whether it is desirable to relax the program goals or orientate the workers to develop in them the conviction that the attainability of the present program goals is feasible.^ieng