Health Education & Behavior

Aptitude x treatment interaction (ATI) has been used only rarely in patient educa tion research. This research paradigm incorporates individual differences (aptitudes) into experimental studies exploring differences in information strategies (treatments). ATI has great potential for applications to patient education research. It identifies patient characteristics and optimal instructional treatments, it is compatible with psychological theories and clinical approaches alike, and it offers a specific method ology for approaching existing problems in a new way. This article presents studies in which ATI has illuminated specific patient needs and treatments, and suggested further applications. Three studies (in addition to those reviewed) are examined in depth. One study determined general guidelines for designing instructional literature to accom pany medication (drug package inserts), that would satisfy the requirements of a group of patients with varied reading ability. Another study examined the effect of patients' "prior knowledge" on their participation in a health education program. A third study explored the interaction between patients' view of self-control over their health and the use of different media for health-care instruction. Guidelines and considerations for conducting further ATI-based research are presented and discussed.

Few companies or organizations involved in health promotion have addressed the major question of whether they are reaching the employees with the greatest health needs or those who could benefit most from these efforts. The popular view that only individuals who are already physically fit and healthy participate in worksite wellness programs was critically examined. Data from 523 survey respondents at the University of Oregon were analyzed to determine whether employees differed on health-related characteristics and their interest in attending a worksite health promotion program. Comparisons between program participant "intenders" and "nonintenders" revealed that both groups had similar lifestyle habits, preventive health practices, and health status profiles. Significant differences were more related to age and perceptions about their physical and emotional health status. Implications for health risk reduction pro gram planning in the work setting are discussed.

Interest in workplace health promotion programs has raised important questions regarding these programs' ability to attract participants. Typically, participation has been examined as a function of personal characteristics of employees. But participa tion in a workplace health promotion program may be influenced as much by organi zational characteristics as by health-related characteristics of employees. This prelimin ary study, conducted at AT&T Communications, used path analysis, a statistical technique for controlling for the effects of causally prior variables, to develop a model of participation. The influence of three sets of factors was detected: (1) Sex of em ployee was significant, with women more likely than men to participate in the pro gram, (2) Increased perceived risk of illness led to decreased health satisfaction which in turn led to increased intention to change health habits culminating in increased participation, and (3) The organizational climate factor of perceived supportiveness of the supervisor contributed to participation. While several potential limitations require that these findings be replicated and extended, the study suggests that developers of workplace health promotion programs should attend to organizational work climate as well as personal health characteristics of employees in an effort to increase program impact.

The Federal Occupational Safety and Health Act of 1970 (OSHAct), while empha sizing the importance of engineering controls, explicitly recognizes the salience of worker behavior to the prevention of injury and illness by mandating training in job safety and health. Selected research findings from the published literature illustrate that: (1) reliable behavioral procedures that took advantage of existing engineering controls improved the health protection of workers, (2) changes in environmental con ditions were effected through changes in worker behavior, and (3) changes in the social environment favorable to the adoption of safe behavior resulted from training and motivation programs. At present individuals who are responsible for workplace health education rarely have appropriate training in this area. Until individuals with special training in health education enter this field it is unlikely that education will achieve its potential as a method for combatting occupational illness and injury.

The rapid proliferation of community-based health education programs has out- paced the knowledge base of behavior change strategies that are appropriate and effec tive for public health interventions. However, experiences from a variety of large-scale studies suggest that principles and techniques of social marketing may help bridge this gap. This article discusses eight essential aspects of the social marketing process: the use of a consumer orientation to develop and market intervention techniques, ex change theory as a model from which to conceptualize service delivery and program participation, audience analysis and segmentation strategies, the use of formative research in program design and pretesting of intervention materials, channel analysis for devising distribution systems and promotional campaigns, employment of the "marketing mix" concept in intervention planning and implementation, development of a process tracking system, and a management process of problem analysis, planning, implementation, feedback and control functions. Attention to such variables could result in more cost-effective programs that reach larger numbers of the target audience.

Tobacco and alcohol use among adolescents continue at historically high rates, and school-based interventions designed to deter students from smoking and drinking are increasingly being implemented. This study reports a meta-analysis of 47 smoking and 29 alcohol school-based intervention programs published after 1970. Results indicate that, in general, smoking and alcohol interventions have equally modest effects on immediate behavioral outcomes. Smoking interventions, however, have been more successful than alcohol interventions at altering students' long term behavior. All of the alcohol programs and all but one of the smoking programs reviewed successfully increased knowledge regarding the risks of these behaviors. Attitude change appears to be more difficult to achieve. Twenty-nine of 33 smoking studies and only 19 of 31 alcohol studies successfully changed students' attitudes. Finally, the data indicate that for immediate smoking outcomes and long-term alcohol outcomes innovative interven tions relying upon social reinforcement, social norms, and developmental behavioral models are more effective than traditional "awareness" programs designed to inform adolescents about the health risks associated with tobacco and alcohol use. The impli cations of these findings for the future of school-based health promotion programs are discussed.

As part of a larger investigation of health behaviors and beliefs during pregnancy, a sample of 529 women were asked to identify their major sources of information about what they should and should not do during their pregnancies. Health care providers and books were cited as first or second most important by the largest number of respondents. When associations between respondent characteristics and preferred in formation sources were explored, it was found that women of higher socioeconomic status (SES) relied more on books and less on family than did women of lower SES. In addition, having had a previous pregnancy was associated with greater use of one's self as an information source. Although provider characteristics were not associated with choice of information source, women who perceived more support from their pro viders viewed them as more important sources of information. A similar effect for family was found. Health locus of control beliefs also were related to the relative importance of selected sources of information, while general social support was not.