Mass media health communication campaigns combined with health-related product distribution: a community guide systematic review.

CONTEXT: Health communication campaigns including mass media and health-related product distribution have been used to reduce mortality and morbidity through behavior change. The intervention is defined as having two core components reflecting two social marketing principles: (1) promoting behavior change through multiple communication channels, one being mass media, and (2) distributing a free or reduced-price product that facilitates adoption and maintenance of healthy behavior change, sustains cessation of harmful behaviors, or protects against behavior-related disease or injury. EVIDENCE ACQUISITION: Using methods previously developed for the Community Guide, a systematic review (search period, January 1980-December 2009) was conducted to evaluate the effectiveness of health communication campaigns that use multiple channels, including mass media, and distribute health-related products. The primary outcome of interest was use of distributed health-related products. EVIDENCE SYNTHESIS: Twenty-two studies that met Community Guide quality criteria were analyzed in 2010. Most studies showed favorable behavior change effects on health-related product use (a median increase of 8.4 percentage points). By product category, median increases in desired behaviors ranged from 4.0 percentage points for condom promotion and distribution campaigns to 10.0 percentage points for smoking-cessation campaigns. CONCLUSIONS: Health communication campaigns that combine mass media and other communication channels with distribution of free or reduced-price health-related products are effective in improving healthy behaviors. This intervention is expected to be applicable across U.S. demographic groups, with appropriate population targeting. The ability to draw more specific conclusions about other important social marketing practices is constrained by limited reporting of intervention components and characteristics.

A meta-analysis of health status, health behaviors, and health care utilization outcomes of the Chronic Disease Self-Management Program.

INTRODUCTION: The Chronic Disease Self-Management Program (CDSMP) is a community-based self-management education program designed to help participants gain confidence (self-efficacy) and skills to better manage their chronic conditions; it has been implemented worldwide. The objective of this meta-analysis was to quantitatively synthesize the results of CDSMP studies conducted in English-speaking countries to determine the program's effects on health behaviors, physical and psychological health status, and health care utilization at 4 to 6 months and 9 to 12 months after baseline. METHODS: We searched 8 electronic databases to identify CDSMP-relevant literature published from January 1, 1999, through September 30, 2009; experts identified additional unpublished studies. We combined the results of all eligible studies to calculate pooled effect sizes. We included 23 studies. Eighteen studies presented data on small English-speaking groups; we conducted 1 meta-analysis on these studies and a separate analysis on results by other delivery modes. RESULTS: Among health behaviors for small English-speaking groups, aerobic exercise, cognitive symptom management, and communication with physician improved significantly at 4- to 6-month follow-up; aerobic exercise and cognitive symptom management remained significantly improved at 9 to 12 months. Stretching/strengthening exercise improved significantly at 9 to 12 months. All measures of psychological health improved significantly at 4 to 6 months and 9 to 12 months. Energy, fatigue, and self-rated health showed small but significant improvements at 4 to 6 months but not at 9 to 12 months. The only significant change in health care utilization was a small improvement in the number of hospitalization days or nights at 4 to 6 months CONCLUSION: Small to moderate improvements in psychological health and selected health behaviors that remain after 12 months suggest that CDSMP delivered in small English-speaking groups produces health benefits for participants and would be a valuable part of comprehensive chronic disease management strategy.

Multiple health risk perception and information processing among African Americans and whites living in poverty.

We investigated the risk-information-processing behaviors of people living at or near the poverty line. Because significant gaps in health and communication exist among high- and low-income groups, increasing the information seeking and knowledge of poor individuals may help them better understand risks to their health and increase their engagement in health-protective behaviors. Most earlier studies assessed only a single health risk selected by the researcher, whereas we listed 10 health risks and allowed the respondents to identify the one that they worried about most but took little action to prevent. Using this risk, we tested one pathway inspired by the risk information seeking and processing model to examine predictors of information insufficiency and of systematic processing and extended this pathway to include health-protective action. A phone survey was conducted of African Americans and whites living in the southern United States with an annual income of ≤$35,000 (N= 431). The results supported the model pathway: worry partially mediated the relationship between perceived risk and information insufficiency, which, in turn, increased systematic processing. In addition, systematic processing increased health-protective action. Compared with whites and better educated respondents, African Americans and respondents with little education had significantly higher levels of information insufficiency but higher levels of systematic processing and health-protective action. That systematic processing and knowledge influenced health behavior suggests a potential strategy for reducing health disparities.

Assessing perceptions of and responses to multiple health risks among the southern poor.

INTRODUCTION: We explored perceptions of and responses to multiple health risks among people living in poverty in the southern United States. METHODS: We conducted 12 focus groups and interviewed 66 focus group participants in 3 southern US cities (Birmingham, Alabama; Jackson, Mississippi; and Columbia, South Carolina). Thematic analysis was used to identify major themes. RESULTS: Study participants worried most about chronic health conditions and the costs to treat those conditions. Feelings of threat were influenced by family health history and race. Barriers to health-protective behaviors included time, work, family, apathy, and low response efficacy. Physical activity and checking blood pressure were the health-protective behaviors in which participants most often engaged. CONCLUSION: Our results will be useful for the development of interventions that target the southern poor. Intervention messages should address the barriers that poor people face when attempting to engage in health-protective behaviors and should help strengthen people's confidence in their ability to change their behaviors.

Community capacity building in CDC's Community Coalition Partnership Programs for the Prevention of Teen Pregnancy.

PURPOSE: To describe lessons learned from the Centers for Disease Control and Prevention's Community Coalition Partnership Program (CCPP) about building a community's capacity to prevent teen pregnancy through strengthening of partnerships, mobilization of community resources, and changes in the number and quality of community programs. METHODS: A multi-component post-test-only evaluation. In-person interviews (n = 364) were conducted with a sample of CCPP project staff, evaluators, and community and agency members from each of the 13 CCPP communities. RESULTS: All partnerships reported that new groups worked together to address teen pregnancy prevention; however, more time, effort, and resources than anticipated were spent engaging these groups and strengthening their partnerships. Respondents reported increases in community awareness of the problem of teen pregnancy and the willingness to discuss the issue. As a result of partnerships' activities, knowledge and skills related to addressing teen pregnancy improved among partnership members, but respondents were concerned that the broader community did not share these gains. To a lesser extent, respondents reported that partners worked together to reduce duplication and fill gaps in services either through increased collaboration and/or differentiation of activities. Respondents from most of the partnerships also reported new programs were developed as a result of the project; however, in several partnerships, only a few programs were developed in their community. Many respondents doubted whether the limited mobilization of resources during the program would translate into increased agency and community capacity. CONCLUSIONS: Overall, increased partner skills, program improvements, and new programs did not appear to be sufficient to affect community capacity. Research is needed to identify the pathways between changes in community capacity and in individual-level behavior that might result in the avoidance or reduction of teen pregnancy.

Coalition models: lessons learned from the CDC's Community Coalition Partnership Programs for the Prevention of Teen Pregnancy.

PURPOSE: To describe the models created by the 13 communities in the Centers for Disease Control and Prevention's Community Coalition Partnership Program (CCPP), and the relationship between key organizational features of the coalitions and the perception by coalition members of interim and community-wide outcomes. METHODS: This study relied on three sources of data: interviews conducted on site with a sample of coalition staff, evaluators, and members (n = 364); a written survey administered after the site visit to those interviewed (n = 216) asking about perceived outcomes and changes between the beginning and end of the project; and a coalition member survey mailed to all coalition members at all sites (n = 341) focusing on perceptions of coalition functioning, outcomes, and satisfaction. RESULTS: A variety of coalition models were developed. Respondents were positive in their assessments of how their coalitions operated even though few were sustained. The coalitions for which members perceived more positive outcomes were better established at the outset of the grant, led by paid staff, and had an area-wide focus, a steering committee, and a hub that was not a community-based organization. Coalitions composed primarily of neighborhood members were difficult to maintain. CONCLUSIONS: Despite members' high ratings, by the end of the funding period most coalitions were no longer functioning. It may be that coalitions are useful but not as permanent structures in communities. Grassroots and individual members not affiliated with an agency may require meaningful incentives to sustain participation. Because maturity of the coalition at the start of the project was a good predictor of sustainability, time should be spent verifying the stage of coalition development before funding.