Alcohol, other drugs, and sexual risk-taking among young adults.

Recent studies based on small convenience samples of men and women have found the use of alcohol and other drugs to be associated with unprotected sexual intercourse that places women at elevated risk for sexually transmitted diseases and unintended pregnancy. An analysis of data from a representative sample of 12,069 younger adults indicates that the use of alcohol and other drugs is related to sexual risk-taking among both men and women after controlling for age, education, family income, and other variables.

Adoption and maintenance of lifestyle modifications.

The search for determinants of compliance and noncompliance with prescribed medical treatments has yielded mixed results. Sociodemographic variables do not account for much variance in behavior, while various situational and attitudinal variables, particularly the health belief model and self efficacy, are better predictors of compliance. Successful attempts to explain health promotive behavior will require expanded models of helping and coping that encompass but go beyond the traditional medical model. The application of one such expanded model seems useful in assisting motivated clients to avoid various addictive and indulgent behaviors and in helping them prevent relapses to former high-risk behavior patterns. Health professionals are urged to join in partnership with their clients, particularly in regard to high-risk behaviors, on the dual grounds that a therapeutic alliance is more likely to result in mutually desired change and that clients should be free to choose their own lifestyles.

Social learning theory and the Health Belief Model.

The Health Belief Model, social learning theory (recently relabelled social cognitive theory), self-efficacy, and locus of control have all been applied with varying success to problems of explaining, predicting, and influencing behavior. Yet, there is conceptual confusion among researchers and practitioners about the interrelationships of these theories and variables. This article attempts to show how these explanatory factors may be related, and in so doing, posits a revised explanatory model which incorporates self-efficacy into the Health Belief Model. Specifically, self-efficacy is proposed as a separate independent variable along with the traditional health belief variables of perceived susceptibility, severity, benefits, and barriers. Incentive to behave (health motivation) is also a component of the model. Locus of control is not included explicitly because it is believed to be incorporated within other elements of the model. It is predicted that the new formulation will more fully account for health-related behavior than did earlier formulations, and will suggest more effective behavioral interventions than have hitherto been available to health educators.

Evaluation of smoking prohibition policy in a health maintenance organization.

Four months after Group Health Cooperative of Puget Sound adopted a policy prohibiting smoking in its 35 facilities, we assessed attitudes and behavior of a sample of 447 employees. Results indicated that 85 per cent of employees approved of the decision to go smoke-free, the rate of reported smoking decreased, and a large proportion of non-smokers believed that their own and co-workers' work performance had improved. Suggestions for successful implementation of future programs are provided.

The role of self-efficacy in achieving health behavior change.

The concept of self-efficacy is receiving increasing recognition as a predictor of health behavior change and maintenance. The purpose of this article is to facilitate a clearer understanding of both the concept and its relevance for health education research and practice. Self-efficacy is first defined and distinguished from other related concepts. Next, studies of the self-efficacy concept as it relates to health practices are examined. This review focuses on cigarette smoking, weight control, contraception, alcohol abuse and exercise behaviors. The studies reviewed suggest strong relationships between self-efficacy and health behavior change and maintenance. Experimental manipulations of self-efficacy suggest that efficacy can be enhanced and that this enhancement is related to subsequent health behavior change. The findings from these studies also suggest methods for modifying health practices. These methods diverge from many of the current, traditional methods for changing health practices. Recommendations for incorporating the enhancement of self-efficacy into health behavior change programs are made in light of the reviewed findings.

Understanding and enhancing patient compliance with diabetic regimens.

Behavioral research on patient compliance with regimens to manage diabetes has suffered from lack of conceptual rigor, although a handful of recent studies and reviews are more theoretically oriented. The present review proposes a comprehensive conceptual framework in the context of learning theory to explain patient compliance and to derive approaches for enhancing compliance. The conceptual framework is the health belief model (HBM) expanded to include the concept of perceived self-efficacy. This expanded model may both serve as an agenda for future research as well as a set of guidelines for the education of patients with diabetes. A variety of educational interventions is recommended for use in patient education provided they succeed in reinforcing relevant health beliefs, behavioral skills, and the sense of self-efficacy. The problem of long-term maintenance, of particular significance in chronic disease management, is addressed by the relapse prevention model derived from social learning theory and emphasizing self-efficacy and the learning of coping skills.

The health belief model and nutrition education.

Five axioms of learning explain the stability of dietary practices and suggest approaches to teaching more healthful habits. These axioms include the influence of prior beliefs and attitudes upon people's interpretations, the fact that effective learning is incremental, the value of reinforcement, the habitual nature of much behavior, and the fact that learning includes both cognitions and skills. The Health Belief Model (HBM), a specification of the first axiom, holds that people are likely to follow health recommendations if they are motivated about their health and if they believe that they are susceptible to an ill health condition; that the occurrence of that condition would have serious impact on their lives; that following a particular set of health recommendations would be beneficial in reducing either their susceptibility to or the severity of the condition; and that the psychological benefits of following the health recommendation outweighs its costs. Educational diagnosis may be made by identifying peoples' status on each variable in the HBM and then formulating an educational plan directed toward modifying beliefs, as needed, taking into account the other learning axioms. An ethical stance is adopted that holds that informed individuals should be entitled to maintain the practices they prefer.

Parental and child health beliefs and behavior.

Personal interviews concerning health beliefs and behaviors were conducted with a parent and child in each of 250 households. Index scores were constructed for parental and child health beliefs, and these scores were entered, along with demographic variables, in a series of multiple regression analyses predicting child health beliefs and behaviors. The age of the child was the variable most highly associated with three of four child health behaviors and four of six child health beliefs. The children's snacking between meals and cigarette smoking were related to several parental behaviors and, to a lesser extent, parental health beliefs. The children's health beliefs were less predictable than were their health behaviors, and the observed significant relationships were with parental health beliefs and demographics. The implications for the design of health education programs are discussed.

Linking research and practice in patient education for hypertension: patient responses to four educational interventions.

Data from a longitudinal study of 432 hypertensive patients under the care of private practitioners are used to answer two questions: How do patients react to educational interventions, and how are their responses related to changes in their adherence behaviors? The four educational interventions, introduced sequentially and tested in a factorial design, were written messages, nurse's phone call, self-monitoring and social support. Patients' reactions to the interventions were assessed, using data from questions asked at post-intervention interviews and information recorded during the interventions. Cognitive, attitudinal and behavioral data are examined. Findings indicate that respondents were cognizant of the interventions and viewed them positively; also, some predictions about intervention features were supported. However, actions which respondents attributed to the interventions were not found to be related to increased adherence, according to the test used in this study.

A test of interventions to increase adherence to hypertensive medical regimens.

Low rates of adherence to hypertensive therapy limit patients' securing the full benefits of treatment. While some factors related to adherence have been identified research on the effectiveness of interventions to increase adherence levels is sparse. The present study was designed to assess the impact of a series of different interventions on a group of some 400 patients, all under the care of private physicians in a small community. A factorial design was employed to deliver four, sequential educational interventions, about four months apart, to randomly selected sub-groups. Interviews before and after each intervention provided information concerning self-reported adherence, health status, health beliefs, and personal characteristics. Pertinent medical records and pharmacy data were also obtained. The first intervention - printed material - did not significantly affect adherence. The second and fourth interventions - nurse telephone calls and social support - each increased medication taking and the third intervention - self-monitoring - led to better weight control. There was no cumulative impact of the interventions and different aspects of regimens were not significantly related to one another.

Initial knowledge and attitudes as predictors of intervention effects: the individual management plan.

This paper addresses questions concerning the effects of patient education strategies to increase adherence to antihypertensive medical regimens. It endeavors to fill gaps in our knowledge about intervention effects that may link research findings with health care applications. Data from a community intervention study of 432 hypertensives are used to address two broad questions relating research on patient education to health care practice: Do interventions have different effects on individuals who differ with respect to initial attitudes or knowledge, and to what extent do interventions produce changes in the factors thought to mediate their effects on behavior? This investigation tests a client-oriented approach to the delivery of interventions, the Individual Management Plan (IMP). The IMP approach is based on the hypothesis that interventions will be differentially effective for individuals with varying levels of initial attitudes and knowledge thought to mediate the effects of the interventions on behavior. Analysis of variance, correlational analyses, and analysis of covariance models are used to test various aspects of this hypothesis. Analyses are performed for adherence to medication regimens, dietary sodium restrictions, and weight-loss recommendations. The results of analyses offer only minimal support for the IMP hypothesis. The state of the art and constraining factors in the study are examined to guide future applications of the IMP approach.

Health beliefs of the school-aged child and their relationship to risk-taking behaviours.

Health educators are frequently exhorted to encourage the development of functional lifestyles among school-aged children. Current efforts, however, often neglect consideration of the full spectrum of relevant age groups and the context imposed by the students' existing health beliefs. Interview data from a probability sample of children 6-17 years of age enable such assessment. Findings indicate that "health" is a meaningful concept and of concern to a majority of students, regardless of age or sex. However, a majority also report engaging in health-related risk-taking behaviours, and yet deny personal responsibility for poor health outcomes. Children of all ages were found to discriminate among illnesses, in terms of both their perceived personal vulnerability to the conditions and the extent to which they worry about them. Finally, by incorporating these attitudinal components as well as other social and demographic characteristics, regression analyses provide exploratory profiles of the current cigarette smoker and user of alcohol. Differences between each risk-taking behaviour are reviewed, as are areas for improving research into children's health beliefs and behaviours.

Dimensions of children's health beliefs.

Health beliefs interviews were conducted with 250 children aged 6-17 years. A factor analysis of the items resulted in six correlated factors which were interpreted as 1) specific health concerns, 2) general health concerns, 3) perceived parental concern, 4) perceived general susceptibility, 5) perceived susceptibility to specific conditions, and 6) perceived seriousness of and susceptibility to disease. Factor scores were computed and two-way analyses of variance (by age and sex of child) were conducted on six sets of factor scores. No significant sex differences or sex by age interaction effects were noted. Younger children scored significantly higher on "specific health concerns" and "perceived general susceptibility," while older children scored significantly higher on "perceived parental concern." Tests of differences among variances showed a tendency for the variability to be greater among younger children. The results are interpreted as providing partial support for a model of children's health beliefs and as a basis for further operationalization of concepts which are central to an understanding of motivated health behavior. Implications for practice are discussed.

Factors influencing mothers' compliance with a medication regimen for asthmatic children.

This study lends support to the utility of a compliance-adapted health belief framework for exploring mothers' differential adherence to medication regiments prescribed for their asthmatic children. Most of the Model components behaved as hypothesized in predicting mothers' drug administration. The findings offer empirical evidence which can be applied to the purposes of identifying potential noncompliers and designating those specific, health-related orientations of the mother which are related to poor cooperation with therapy. Based on an educational diagnosis, the clinician may thus intervene to alter inappropriate health beliefs in order to enhance the likelihood of compliance for the asthmatic patient.