Health Education & Behavior

Shifts in the expectations of the public. in the practice of medicine, and in the state of the art of health education call for an examination of the nature of the relationship between the health education and medical professions. Their relationship can be characterized in terms of competition or cooperation. This paper examines a number of issues related to these shifts and discusses the potential and pitfalls of this relationship. It is concluded that power is a fundamental issue to be recognized and addressed by health education specialists.

By definition, the objective of health education is to change health behavior. One assumption underlying this objective is that changed health behaviors will result in improved health status. Both the objective and its assumption are based largely on experience with acute health problems. However, health education is now changing its focus towards chronic diseases.

This paper cxamines a number of chronic disease health education studies. Investigation reveals that although there is often an improvement in health status, the associations between changed health behaviors and improved health status are not clear and at times do not appear to exist. In light of this evidence, the authors suggest that there is, in some cases, a need to reevaluate the assumptions that underlie health education and a need in health education programs to study factors other than, or in addition to, behavior change as mediators of health status.

Despite dissemination of modem contraceptive techniques among college women, unplanned pregnancy and pregnancy termination rates remain a major health issue.¹ An investigation of 495 college women who use the diaphragm method of contraception was conducted in order to estimate pregnancy occurrence, to better understand factors related to successful use, and to profile service utilization patterns. Data were collected by medical record audit and client survey. Fifteen percent of the diaphragm clients reported a diaphragm-related pregnancy: clinical ef fectiveness was estimated to be 88% with a rate of 9.75 pregnancies per 100 woman years of diaphragm use. A variety of demographic, personal history, and behavioral variables were found to be related to three dependent variables: pregnancy, consistent diaphragm use, and accurate diaphragm use. Review of clinic service utilization for this group of patients demonstrated considerable resource use, including frequent switching of prescription contraception methods. Considering all pregnancies, diaphragm related or not, 27% of the study subjects reported at least one unplanned pregnancy. Abortion was elected in 98% of these cases.

There is general agreement about the need to focus on education, information, and service measures to reduce the incidence of unintended fertility. Many universities have family planning services available, yet unsuccessful outcome continues to be a concern. Specific and practical protocols for service implementation need clearer definition. Thus, the implications of this research for the content and organization of clinic services are discussed with reference to counseling and education and other systems strategies.

This paper presents results from an experimental study designed to evaluate the relative effectiveness of three methods of teaching women how to do breast self-examination (BSE). Frequency of BSE, confidence in examination performance, proficiency of BSE technique, and lump detection performance were the main outcome variables assessed. The three training methods compared in this study were provision of a pamphlet describing how to do BSE, having women view a videotape depicting proper performance of BSE, and having women practice doing BSE on a life-like breast model. Results showed that passive methods of BSE instruction such as the use of pamphlets or films were of little value in helping women develop the tactile skills necessary for proficient BSE. Three months after training, it was found that lump detection performance, as measured on silicone breast models, was significantly higher among those women who had been given an opportunity to practice doing the breast examination on a breast model with corrective feedback given by a BSE instructor. The opportunity to practice doing the examination with corrective feedback on performance appears to be a critical variable in the acquisition of BSE skill.

When I began worrying about this presentation several months ago, I coined a title that I was embarrassed seeing in print later, "The Paradox of Increasing Responsibility and Declining Influence: What is SOPHE Besides Small?" I was concerned then with the de cline in our membership, a 20% drop in 1978 and a 10% net loss each year after that. What happened in 1978 to cause that abrupt, precipitous change in our strength?

The need for one voice for health education and health educators has been discussed for some time. Recently, it has become a more prevalent topic at professional meetings. This article discusses the role of professional associations and the process of professionalization, professional associations for health educators, the Coalition of Health Education Organizations, and current issues with possible alternative solutions. The solutions proposed include merging existing associations, fostering greater understanding of the purposes of various professional organiza tions, adopting a new approach for selecting memberships, and strengthening the role and function of the Coalition of National Health Education Organizations. A final point discussed is the importance of health educators belonging to at least one professional association to indicate their support of the profession.

For the low-income elderly residents of America's single room occupancy (SRO) hotels, poor health, social isolation, and powerlessness often are intimately connected. This article presents a case study of an attempt to address these interrelated problems by fostering social support and social action organizing among elderly residents of San Francisco's Tenderloin hotels. Following a brief look at the parameters of the problem, an overview of the Tenderloin Senior Outreach Project (TSOP) is presented. The Project's theoretical base is described, followed by a brief account of TSOPs genesis and growth from an informal University-sponsored project to a privately incorporated community-based organization. Examples of individual and community empowerment through TSOP are presented, as is a look at some of the dilemmas and compro mises that are encountered as a community group trades its grassroots status for a more formal and bureaucratized structure. Problems in the areas of indigenous leadership development and community versus funding agency agendas are examined, as is the utility of combining social action and social planning approaches to community organizing. Finally, the potentials and limitations of Freire's "education for critical consciousness" as an organizing tool in this en vironmental context are discussed, with implications drawn for other projects attempting to build self-reliance and community cohesion among inner-city populations.

Monitoring the implementation of a program being evaluated can improve the interpretability of data collected and help evaluators to avoid committing a Type III error: evaluating a program that has not been adquately implemented. This article describes an evaluation that analyzed the implementation of a school health education curriculum, assessed cognitive learning outcomes attributable to the curriculum, and examined the relationship between classroom implementation and changes in students' knowledge. Five fifth-grade classes (n = 101) participated in the curriculum, and five classes (n = 84) served as a comparison group. Data collection procedures involved a pretest and posttest of all students' health-related knowledge, daily monitoring of classroom implementation by the five teachers participating, and questionnaires completed by principals and teachers. Analysis methods included descriptive statistics, parametric and non- parametric tests of significance, and qualitative assessment procedures. Results indicated that the curriculum had a positive effect on learning in students; curriculum implementation varied considerably among the five classes participating; teaching/learning activities that were most and least likely to be implemented could be identified and described; both teachers and principals perceived the program favorably: some health instruction was occurring in the comparison classes, so it was not appropriate to consider them as pure controls; and no statistically significant relationship between curriculum implementation and cognitive outcomes was observed. This study provides evidence of the need for and value of measuring implementation of programs being evaluated. Implications for developing implementation measures and the role of formative evaluation in health education practice are considered.

The Self-Care Rehabilitation in Pediatric Asthma (SCRPA) project was designed to ascertain (1) the level to which children with asthma are able to acquire the asthma knowledge and skills presented in a self-management training program conducted by the American Lung Association of Utah and (2) the effect of such training on the asthma experience.

The preschool SCRPA Curriculum (ages 2-5) consisted of six 1-hour classes scheduled twice a week for 3 weeks. The first and last classes were for one or both parents only, and the middle four sessions were for the child and parent(s). The school-age SCRPA curriculum (ages 6-14) consisted of eight 90-minute classes for both child and parent(s) scheduled twice a week for 4 weeks.

Private physicians referred 21 preschool children and 38 school-age children into the program. The school-age children were randomly assigned to a study or control group, and the preschool children served as their own controls.

A comparison of asthma episodes during the 3 months before and after training showed a statistically significant decrease in the number of episodes but no change in severity in the preschool, school study, and school control groups. The decrease in episodes for the control groups suggest that the family record keeping required of all subjects may have a beneficial effect, a phenomenon worth further investigation. Also, the school-age group, in pre- and posttesting, demonstrated that the SCRPA curriculum increased knowledge and skills in the study group, changes not found in the control group.