The target population had a strong sense of trust and identification with the center, and already attended regularly for a variety of services and programs. Additionally, some elderly community members lived onsite at aged care housing operated by the center Finally, there were three studies which utilized community networks and local media in the promotion and recruitment aspects of programs. This included the use of local, language appropriate radio and television, and print media 21 , 23 , 24 , 32 , announcements at local religious facilities 24 , 32 , and community meetings and events 21 , The campaign was delivered through local print and radio media channels and theater advertisements.
Additionally, campaign material was included in local press releases, print inserts, and direct mailers and was featured on road signs at one community Various culturally oriented adaptations and strategies were implemented across the evaluated interventions, with the majority of studies including several different cultural aspects. Finally, three Australian studies reported the development of interactive and visual intervention resources 16 , 20 , 35 as a strategy for increasing the cultural appropriateness of health promotion for aboriginal people.
Before and after every clinic, ceremonies were held under the guidance of an invited spiritual leader from the community. Open circles were held for participants to discuss physical, mental, spiritual, and emotional health issues and goals.
- Forever and Ever.
- The French Touraine, a great history of tradition, flavor and taste.
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A tepee was set up outside the clinic for attendees to gather to socialize and participate in more cultural activities There were three primary forms in which interventions were made linguistically appropriate for target groups: There were seven studies in which participants could choose to have the entire intervention delivered in a language other than English: In four studies, partial language adaptations appropriate for the population were implemented. A further two studies included minimal language adaptations, through the use of native words in spoken and written aspects of the programs 25 , In some studies, the creation or translation of written materials, such as forms and documents, or educational materials for program participants, was only one aspect of a broader program 19 , 21 , 27 , These interventions were as follows: The video was pilot tested and evaluated with aged care workers and service users, and community members to assess the effectiveness of the resource and evaluate the difference that culturally safe inter-communication can make toward dementia education There were two main types of outcomes using various indicator measures across the studies: While the included studies reported many positive outcomes, there were measurement and study quality issues which limit the interpretability and generalizability of results.
There was a lack of validated measurement tools used to assess outcomes and inconsistent reporting of outcomes. Multiple outcomes were also reported in many studies. Even studies which evaluated the same indicator type measured and reported this in different ways. Furthermore, it is not possible to link outcomes directly with types of strategies because of the multistrategic nature of most interventions, and absence of attribution of outcomes to particular strategies. Positive appraisal of interventions was reported in all studies, which addressed this indicator.
Five studies reported directly on patient satisfaction 17 , 22 , 24 , 27 , 28 , while the remaining seven reported a range of other outcomes related to program acceptability 16 , 18 , 21 , 25 , 26 , 32 , Only one study used a validated satisfaction measurement tool 28 , and only two reported an increase in satisfaction following interventions 17 , A further six studies evaluated the acceptability and usefulness of health interventions from the perspectives of health professionals 16 , 18 — 20 , 26 , 35 , Four studies reported outcomes related to health knowledge and awareness with three of these noting improvements from pre-intervention levels 16 , 18 , While eight studies discussed some behavior change outcomes resulting from interventions because of a lack of information on measurement tools and outcomes, only one study reported significant improvements on this measure Finally, there is a significant focus of the cultural competency literature on improving specific health-related outcomes.
The review found some evidence of improved health outcomes across five studies. The presence of improved health outcomes has been demonstrated in past cultural competency literature. Unlike other reviews that found strong evidence of improved health outcomes for cultural appropriate diabetes interventions across the literature 6 , 11 , with limited evidence reported for other health conditions 6 , this review found evidence for improvements in depression severity resulting from culturally adapted mental health interventions 28 , 32 , and positive outcomes for cardiovascular disease 24 , 37 with only one study reporting on improved diabetes risk indicators This study also showed preliminary results of a statistically significant improvement in overall quality of life QOL.
Ward and Brown reported a decrease from moderate to mild depression and improvements in QOL measures of physical health and mental health in their first pilot, and a decrease from moderate depression to no depression in their second pilot, utilizing measures which have been validated with African-American people Similar to other cultural competency reviews 6 , we found that the overall methodological quality of studies was moderate to poor. This lack of strong quality studies limits conclusive statements about the effectiveness of cultural competence interventions. There was a lack of properly controlled studies where the study outcomes can be attributed to the intervention only.
Additionally, there was an over-reliance on self-report measures and a lack of objective evidence of intervention effectiveness, as well as a lack of properly validated measurement tools for assessing outcomes. Overall, the strongest evidence came from United States-based and Canadian studies with Australian and New Zealand lagging behind in terms of study quality.
Similar to what has been previously identified in the literature 6 , 11 , we found the interventions used across studies to be very heterogeneous in terms of target population, health issues and settings, intervention strategies, and outcomes. This variation reflects the complexity of cultural competency services and programs and their implementation in practice and research 6. Yet despite this heterogeneity, there are clear patterns across the included literature, in both intervention strategies and outcomes.
These broad strategy and outcome types can help to inform future cultural competency services and programs. Preliminary framework for health services and programs to improve cultural competency. Consistent with health promotion evidence that multi-level approaches are required when designing appropriate interventions to address health-care disparities 38 , studies used multiple intervention strategies including community-, culture-, and language-focused approaches.
There were several community-focused strategies commonly implemented across the studies, the most common being the participation of community members in intervention implementation. While community participation is important for cultural competency interventions, it needs to be distinguished from the kind of community-based partnerships recognized as key to addressing health disparities at the local level 2. The results from this review indicate some progression toward stronger community partnerships throughout the whole research process.
However, there were only two studies which explicitly utilized a CBPR approach in project development, design, implementation, evaluation, and dissemination Considering that working in collaborative partnership with community leaders and key stakeholders to build community capacity is identified as a health promotion core competency 40 , this feature of program planning and implementation deserves greater attention in cultural competency initiatives within health promotion services and programs.
Another community-focused strategy of the included studies was the use of community resources, through both the use of community space and community networks. Health interventions conducted in non-clinical or community settings have received global research attention 41 — In the reviewed evaluations, this approach was shown to be an effective strategy for reaching different population groups that typically do not access health services, especially mental health services.
This intervention strategy demonstrates innovation on the part of health services, showing flexibility in approaches to increase the accessibility and appropriateness of services. Finally, the use of community networks in health service recruitment and promotion was a strategy not previously discussed in the cultural competency literature. This strategy was shown to be effective in engaging the target population and building community support for interventions.
The tailoring or adaptation of health interventions to be more congruent with the cultural beliefs, values, and practices of target groups is one of the most recognized and utilized strategies in cultural competency services and programs. However, the inclusion of cultural focused strategies has the potential to go beyond merely attempting to make health care more appropriate for communities into understanding the health benefits of cultural engagement.
This is particularly pertinent for groups such as indigenous peoples who hold worldviews of health and well-being that link engagement in cultural activities with health benefits 47 , There is research evidence to link engagement in practices of caring for country to better health outcomes for aboriginal peoples in Australia 49 and engagement in traditional cultural and spiritual activities with increased alcohol cessation with Native American peoples The interconnection of spirituality and culture is also a potentially powerful resource for culturally appropriate health promotion, which was utilized throughout the included interventions.
Spiritually based resources, which include values, beliefs, and practices based on a connection to a higher or sacred power have been correlated with the long-term survival of those with breast and other treatable cancers, and have been utilized as a resource for positive engagement of different populations with health services The studies reviewed provide some innovative examples of cultural adaptation and engagement strategies utilized by cultural competency services and programs.
Clear and effective communication between health service providers and users is critical to quality and safe health-care provision. Interestingly, even when programs were made language accessible, it was not necessary that this was utilized by participants. For example, while Jones et al.
Similarly, Taylor et al. These studies both highlighted a point that was stated throughout many studies.
When working with people with worldviews divergent from the biomedical model, language accessibility needs to go beyond the use of interpreters and translators As noted by Vass et al. For example, miscommunication has been extensively documented in interactions between health-care providers and aboriginal Australian people accessing health care, related to a lack of shared understanding around basic health concepts 53 — When working in cross-cultural spaces, an extensive exploration of the meaning of words in health and specific health topics is needed, as is the development of health interventions and information which incorporates and builds on both traditional and contemporary indigenous health frameworks Some of the included studies addressed such issues of intercultural communication in the context of worldview differences.
Some studies also detailed the testing of translated program resources for appropriateness with the target population, while others did not. When reported, different levels of detail around the process and quality of the translation were provided in the included studies. This issue of differences in fundamental concepts of health and comprehension of health information is one area that deserves further attention in cultural competency program design and implementation. The included studies utilized varying levels of integration of community-, cultural-, and linguistically focused cultural competency strategies.
This concept of a continuum of cultural adaptations in health programs has predominantly been discussed in relation to the adaptation of evidence-based treatments EBT 57 , Nonetheless, it has relevance beyond EBT to the design and implementation of other cultural competency interventions. The literature points out that surface and deep-structure adaptations can be very effective for many interventions with different groups. However, for some groups, particularly indigenous peoples, there is a greater need for culturally grounded approaches which are embedded in and created from the specific cultural viewpoint and needs of communities from the outset To improve the evaluation quality of cultural competency services and programs, greater attention on the use of appropriate, and where available, validated measurement tools is needed.
The included studies provide useful evidence on intermediate outcomes such as satisfaction levels and service utilization rates. Nevertheless, the presence of key methodological flaws, such as a lack of pre-intervention comparisons, diminishes the strength of outcome data on intermediate health outcomes. In contrary, the studies demonstrating improved health outcomes generally used fairly rigorous study designs with appropriate measurement tools. This kind of attention to study quality is needed to measure intermediate and health outcomes, both of which are important indicators of intervention success.
Viewed together, these studies illustrate a wealth of potential approaches to inform future health promotion services and programs to improve culturally competency. The similarities in intervention strategies seen across these studies can be useful when planning cultural competence interventions in health services and programs.
However, we would caution against the assumption that what works in one context is appropriate for others, even with the same cultural or ethnic group. The types of adaptations and strategies that are appropriate will differ according to the unique needs and circumstances of each community and target group. This reaffirms the importance of community partnerships to ensure that health interventions are responsive to the local context in which they are placed. The publications in this review were identified with a non-exhaustive search strategy designed to produce peer- and non-peer-reviewed health studies that evaluated cultural competence interventions in health services.
Therefore, it is possible that some relevant publications were not found. Additionally, because of the breadth of this field, only studies that explicitly addressed improving cultural competency were included. This strategy possibly excluded studies that might have implicitly aimed to increase cultural competency. For the development of the literature base on the effectiveness of various interventions to improve cultural competency, it is important that studies explicitly address this in their aims and measures.
Another limitation occurred within the frameworks used to study quality. To determine whether and to what extent culturally competent service provision enhances outcomes of services and treatment, it is essential that cultural competency is accurately assessed 8. However, a lack of systematic tools and approaches for measuring the presence, level, and contribution of cultural competency interventions to quality health care continues to weaken the growing evidence base 8 , Additionally, there was a preponderance of intermediate and short-term health outcome reported. Further research is needed into longitudinal, population-based studies to determine the overall impact of cultural competence interventions on population health and health disparities among groups.
The included studies demonstrate a growing evidence base for the impact of health promotion services and programs to improve cultural competency on intermediate and health outcomes. Nonetheless, because of methodological issues related to appropriate indicators and study design, it cannot be definitively concluded what types of interventions produce what types of outcomes with particular populations. The primary lesson from reviewing the strategies and approaches to culturally tailoring or developing culturally grounded health interventions for minority population groups is that each needs to be consistent with the unique cultural needs and characteristics of target populations and need to be embedded in context and community.
CJ is the primary author and was responsible for the data extraction of the search update and the writing of the final review manuscript. RB completed the data extraction for the first search and authored a paper on the larger review in which informed this review. The authors are assured of the accuracy and integrity of the review and agree to be accountable for all aspects of the publication manuscript. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The authors acknowledge the contributions of Mary Kumjav for conducting the literature search, Komla Tsey for participating in the screening process, and Anton Clifford for participating in the screening process and contributing authorship to the larger systematic review which this review is part of. The Supplementary Material for this article can be found online at http: National Center for Biotechnology Information , U. Journal List Front Public Health v. Published online Feb Crystal Sky Jongen, ua. Received Nov 18; Accepted Feb 8. The use, distribution or reproduction in other forums is permitted, provided the original author s or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice.
No use, distribution or reproduction is permitted which does not comply with these terms. This article has been cited by other articles in PMC. Abstract Background Cultural competency is a multifaceted intervention approach, which needs to be implemented at various levels of health-care systems to improve quality of care for culturally and ethnically diverse populations. Methods This scoping review was completed as part of a larger systematic literature search conducted on evaluations of cultural competence interventions in health care in Canada, the United States, Australia, and New Zealand.
Results The review identified three overarching strategies utilized in health promotion services and programs to improve cultural competency: Discussion Examined together, these intervention strategies and outcomes provide a framework that can be used by service providers and researchers in the implementation and evaluation of health promotion services and programs to improve cultural competency.
Introduction The Ottawa Charter for Health Promotion set out a broad vision and inclusive framework to guide the global movement for advancing health equity 1. Open in a separate window. Systems analysis of cultural competency in healthcare. Publications were included if the following criteria were met: The study was focused on cultural competence as it pertains to indigenous or other racial or ethnic groups; and. Search Strategy The search strategy employed for the review comprised six steps covering an initial search in , for the period —July , and a search update in for the period — The updated search identified 1, references from the electronic database search and an additional 16 from the gray literature.
The 1, references identified were imported into Endnote and their abstracts examined manually. There were 26 intervention studies that met the inclusion criteria. The reference lists of an additional 4 literature reviews revealed 16 more studies to be included. A total of thirty studies were excluded at this stage, leaving 63 total studies for inclusion.
Identification, Screening, and Inclusion of Publications The search results of both searches were imported into the bibliographic citation management software, Endnote X7 with duplicates removed. Data Extraction and Analysis Data were extracted from the full texts of studies for publication authorship, year and type, country, population and sample size, intervention setting, intervention type and strategies, study design, outcome measures, and outcomes reported the full data extraction table for the included studies can be found in the supplementary material.
Results Twenty-two studies of cultural competency services and programs were included. Table 1 Studies by country, target population, and health issue. Table 2 Intervention strategies and outcomes. Cultural Competency Intervention Strategies The interventions in the included studies utilized various approaches to increase cultural competence in promoting health for the population groups being targeted. Community-Oriented Strategies The greatest diversity of approaches implemented across studies was within community-oriented strategies.
Example 1 Community participation. Example 2 Community partnerships. Example 3 Community spaces. Example 4 Community networks and media. Culture-Oriented Strategies Various culturally oriented adaptations and strategies were implemented across the evaluated interventions, with the majority of studies including several different cultural aspects.
Example 5 Cultural strategies. Language-Oriented Strategies There were three primary forms in which interventions were made linguistically appropriate for target groups: Example 6 Audiovisual resources. Cultural Competency Intervention Outcomes There were two main types of outcomes using various indicator measures across the studies: Example 7 Patient-perceived acceptability. Example 9 Health knowledge and behavior outcomes.
Example 10 Improved health outcomes. Study Quality Similar to other cultural competency reviews 6 , we found that the overall methodological quality of studies was moderate to poor. Discussion Similar to what has been previously identified in the literature 6 , 11 , we found the interventions used across studies to be very heterogeneous in terms of target population, health issues and settings, intervention strategies, and outcomes.
Limitations The publications in this review were identified with a non-exhaustive search strategy designed to produce peer- and non-peer-reviewed health studies that evaluated cultural competence interventions in health services. Conclusion The included studies demonstrate a growing evidence base for the impact of health promotion services and programs to improve cultural competency on intermediate and health outcomes.
Author Contributions CJ is the primary author and was responsible for the data extraction of the search update and the writing of the final review manuscript. Conflict of Interest Statement The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Acknowledgments The authors acknowledge the contributions of Mary Kumjav for conducting the literature search, Komla Tsey for participating in the screening process, and Anton Clifford for participating in the screening process and contributing authorship to the larger systematic review which this review is part of. Supplementary Material The Supplementary Material for this article can be found online at http: Click here for additional data file.
The Ottawa Charter for Health Promotion. Planning, implementing, and evaluating culturally appropriate programs. Patient centeredness, cultural competence and healthcare quality.
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J Natl Med Assoc Towards a Culturally Competent System of Care: Georgetown University, Child Development Center; Interventions to improve cultural competency in healthcare: Cultural Competence in Health: A Review of the Evidence. Springer Healthcare; in press. Does it make a difference? Generations 26 3: Brach C, Fraserirector I. Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Med Care Res Rev 57 Suppl 1 4: How are these practical applications integrated into an effective intervention?
Essential in the collaboration with creative consultants is mutual respect: Creative consultants are seldom aware of the parameters for effectiveness that apply to methods, and it is the responsibility of the behavioral scientist to make sure that those parameters will stay intact. IM suggests that in step 3 intervention planners first describe their ideas about the concrete parts of the program: A program theme is a general overarching construct for a program, sometimes organized into sub-themes.
Examples of themes include: The scope refers to the breadth and size of the program, describing what is and what is not in the program. The sequence refers to the order in which the elements of a program are delivered across time. Sometimes existing materials may be useful. All materials and products need to be pilot tested. If possible, apply experimental designs in pretests Whittingham et al. Table 2 gives examples of methods, parameters, and applications. Table 3 gives an example of program scope and sequence of the Dutch sex education program with the theme: Once the intervention has been created, a solid diffusion and implementation process is vital to ensure program success Knittle, Remember that thinking about implementation is an ongoing process straight from the beginning of the planning.
For example, a school program with 20 lessons might seem necessary but will be very difficult to implement in schools with already overcrowded curricula. Without implementation, the intervention will not have any chance of impact on determinants, behaviors, or health. In IM Step 5 a plan is developed for the systematic implementation of the program. First one needs to develop a linkage system, making sure that program developers are linked with program users in the planning team; if not, add implementers to the planning group.
Next, an intervention is developed to promote adoption and implementation of the program by the intended program users. Intervention planners develop interventions to facilitate the implementation of the health promotion intervention with high fidelity - making sure the intervention is implemented as intended - and high completeness - making sure the full intervention is implemented.
They develop theory-based interventions to facilitate program adoption by key stakeholders, to support appropriate implementation by program users, and to encourage program institutionalization by considering opportunities for incorporating the program into organizational routines. Thus, interventions are not only required to change individual behavior, but also to facilitate program implementation.
Indeed, the same steps involved in intervention development are repeated to anticipate program diffusion and to target program implementers: In , we started a database of references and publications about Intervention Mapping, which now contains over titles accessible via the Intervention Mapping website http: Most of these, over , are related to intervention projects in which the use of IM is claimed or planned. These publications relate to over intervention projects and include papers about needs assessment, program development, evaluation protocols, effect evaluation, process evaluation, dissemination, and cost-effectiveness.
So far, we have identified about projects for which there are papers about use of IM in program development as well as papers about program effects. For the future we intend to conduct a meta-analysis in which the use of IM steps and tasks in these projects will be categorized in detail and will be linked to effect size.
In the current paper we will describe some applications of IM in practice. As said above, IM is mainly applied in the health promotion field, the field in which it was developed. Applications in this field cover about all typical and well-known health-related behaviors diet, physical activity, sexual behavior, smoking, drinking, drug use, and behaviors related to unintentional injury , but are certainly not limited to these. In addition, topics inside and outside the field of health promotion include: Although most IM projects are from Europe and North America, use of IM is spreading and, up to now, has been reported for 46 countries scattered across most continents.
An example from a developing country is the Teenage Mothers Project, a community-based program to improve empowerment and psychological and social well-being of unmarried teenage mothers in rural Uganda Leerlooijer et al. Unplanned teenage motherhood is associated with low self-esteem, depression, stigma, isolation, rejection from families and community members, limited social and financial support, high rates of school dropout and limited career opportunities.
A planning group consisting of community leaders, teenage mothers, staff of a community-based organization and a health promotion professional was involved in the six steps of IM. The group decided to intervene among teenage mothers, parents, community decision makers including religious leaders and tribal chiefs, school principals, and members of the community at large. The behavioral outcomes for unmarried teenage mothers covered improved coping with stigma and motherhood, continuation of education, increased income generation, abstinence or protected sex and advocacy for the rights of unmarried teenage mothers.
Environmental outcomes were also drawn up, for example, for parents the outcome was that they support their daughter to continue education. Related performance objectives for parents were to: For all target groups determinants of performance objectives were identified, such as knowledge and awareness, attitude, perceived social influence, and skills and self-efficacy, based on interviews and focus groups in the needs assessment. A comprehensive program was developed which included five intervention components: In each of the components several theoretical methods were used.
For instance, the community awareness raising component included the methods entertainment education, persuasive communication, instrumental support and social action. Practical applications of entertainment education were theater plays and songs performed by the teenage mothers to create awareness and knowledge of stigma and its consequences and attitude change among community members. In public goat-giving ceremonies, giving goats application of instrumental support to generate income was combined with speeches by community leaders who supported the project application of persuasive communication to influence community members' attitude.
The parameters for using each method were acknowledged. For instance, parameters for persuasive communication were that messages need to be relevant, not too be discrepant from the receiver's beliefs, and to include new arguments. The messages in the project focused on giving unmarried teenage mothers a second chance and on helping them to continue their education, thus still acknowledging the community's deeply rooted disapproval of out-of-wedlock teenage pregnancy.
Throughout the entire project, the general method of cultural similarity was applied. The project deliverers originated from the same tribe and communities as the beneficiaries, contributing to a positive reception of the intervention. Also, interventions were designed to address program adoption and implementation. Adoption started with sensitization of tribal, religious and government decision makers. They were repeatedly exposed to the project's messages and to interactions with the teenage mothers, resulting in attitude change and supportive behavior towards the mothers, their parents, other leaders and the community at large.
Subsequently they were involved as implementers by giving them a leading role in community meetings and activities of support groups. Journalists were regularly invited to meetings and community occasions, encouraging them to report about the project. Trained coordinators community-based volunteers were appointed in each community to implement activities. Moreover, applications were first implemented on a small scale and monitored. If applications were adopted and initiated change, the activities were upscaled and incorporated in the intervention. The program was evaluated with a qualitative evaluation Leerlooijer et al.
This evaluation indicated that the project contributed to the well-being of unmarried teenage mothers increased agency, improved coping, continued education, increased income generation and to a supportive environment supportive community norms towards the mothers' position and future opportunities. Vonk Noordegraaf et al. There is a large discrepancy between expected duration of physical recovery and actual return to work after gynecological surgery. After discharge, detailed convalescence recommendations are mostly not provided and postoperative care is fragmented, poorly coordinated and given only on demand.
For patients, this contributes to irrational beliefs and avoidance of resumption of activities, resulting in a prolonged sick leave and unnecessary costs for society. In the needs assessment, literature research into behavioral and environmental conditions of prolonged sick leave was supplemented with focus group discussions with patients to establish performance objectives for patients, gynecologists, family physicians FP , occupational physicians OP and employers. Performance objectives for the non-patient target groups were mainly to acquaint themselves with recommendations for their patients gynecologist, FP, OP or to show involvement and discuss a work-reintegration plan with their employee employer.
Detailed recommendations for resumption of work were developed in a Delphi study by a multidisciplinary expert panel. Performance objectives for patients were to acquaint themselves with information recommendations, surgery- and care-related issues, telephone numbers , to not extend their sick leave beyond the recommended period on their own initiative, to develop a work-reintegration plan and discuss it with their employer, to identify barriers for a safe return to work, to exchange experiences with other patients and to receive answers to questions and uncertainties.
Determinants were identified as the patient's attitude, social influence, self-efficacy and skills, as well as external barriers and facilitators. The program that was developed was a tailored Internet application; www. It had two main sections for patients -a central home page and an action list- and a different section for gynecologists, FPs and OPs which included guidelines, casuistry and background information based on the Delphi study. The action list section for patients consisted of various tools for actions: The priority of the different actions was based on the date of surgery and information from the gynecologist.
The home page section for patients included a video about common pitfalls during the perioperative and reintegration period, recommendations, a forum to contact other patients, FAQ, a glossary, and links to other websites. Various methods were used in the tools, including persuasive communication, self-re-evaluation, modeling, goal-setting, and mobilizing social support; parameters for these methods were acknowledged.
In the test phase, the eHealth program was evaluated favorably by patients, physicians and eHealth specialists, and in result, only minor adjustments were made. Adoption and implementation were anticipated by involving patients and a linkage system representatives of national medical boards of gynecologists, FPs and Ops and of a patient organization in all stages of intervention development and evaluation. Health care providers, OPs and eHealth specialists participated in the test phase of program production.
Health Behavior and Health Education | Part Four, Chapter Fourteen: References
Furthermore, use of the intervention by the various target groups was intended to be easy and without any need for support. It was compared to a control eHealth website; both websites were offered as a supplement to standard perioperative care. The intervention had favorable effects on time to full sustainable return to work hazard ratio 1. Safety interventions in small metal fabrication businesses.
They compared two interventions; one intervention for business owners only, and one for both business owners and employees. Their planning group consisted of owners, economic development consultants, occupational health and safety professionals, technical school faculty and a union representative. They also had group meetings with employees. Examples of performance objectives for owners were: Examples of performance objectives for employees were: Intervention components were linked to determinants and targeted the chosen change objectives.
An important component was building the skills of a health and safety committee, with at least two employees and one manager with safety responsibility. Machine safety audit and survey results were used to tailor information and skills training for each committee. Other components were role models and peer trainers. Businesses that added health and safety committees, or those that started with the lowest baseline, showed the greatest improvements.
The goal was to promote the compliance to these guidelines, i. The target population consisted of health care providers who manage hypertension. Determinants, benefits and barriers that were identified included awareness, outcome expectations, skills and self-efficacy, perceived norms and standards of care, as well as pharmaceutical marketing influence. The proposed settings were medical practice staff meetings, hospital staff meetings, residency programs, local medical societies and other venues as identified by the educator or project manager.
The educator also left cues to action such as newsletters with role model stories, pocket cards with guidelines and tips, and posters to encourage patients to talk with their doctors. A second strategy for reaching health care providers was through their professional associations. The intervention reached more than These participants demonstrated statistically significant positive differences in pretest versus posttest scores.
A later effect evaluation showed that the counties with the most project activities showed the highest increase in following the JNC7 guidelines. In an example of theory use in program development from the pre-IM era, the first author of this paper was involved in a project targeting the modification of the driving behavior for energy saving Siero et al. This intervention promoted a fuel saving driving style among van-drivers of a mail company. Important energy-wasting behaviors among van-drivers were identified: Consequently, the performance objectives for a fuel saving driving style included: Next, determinants of the performance objectives were examined with a questionnaire based on the reasoned action theory.
At a higher level, the management of the mail company should order cars with much more saving potential. Modeling, which involves presenting an appropriate model that performs the desired action, was one of the chosen methods. The practical application for van-drivers would be a fellow driver demonstrating the fuel saving driving style, showing less fuel use while driving the same car, over the same distance, and within the same time. The program consisted of an intervention package composed of several practical applications of theoretical methods which were combined to complement and reinforce the effect of the other applications.
The theoretical methods underlying these applications were information, physical facilitation, model demonstrations, task assignment and control, and feedback. The information included persuasive communication about relevant beliefs and misconceptions about car engines, fuel use, and driving speed. The physical facilitation involved stickers on the dashboard as cues for action, and tachometers and gas flow meters for making the fuel saving behavior easier. The model demonstrations triggered interest and active learning of skills.
The task assignment and control were methods at the organizational level, based on power differences: Finally, weekly feedback on fuel consumption was provided with the aim to reinforce, monitor, and sustain performance. The program was evaluated in a field experiment. First, differences in fuel use between the experimental and control group were examined. Second, reported behaviors were also compared. Van drivers in the experimental group shifted gears timely, and anticipated braking significantly more often than those in the control group.
Measurement In Health Behavior
Increasing science achievements among middle-school students. Non-Asian minority students perform poorly and one of the reasons might be a lack of minority Hispanic teachers, serving as role models. The overall program goals were increased performance SAT10 and interest in science. Performance objectives were formulated for students and teachers as well as determinants, such as attitudes, perceived norms, self-efficacy, and skills.
Behavior change methods targeted these determinants, and were translated into videos and classroom activities.
The video stories provided vicarious learning through stories, for example modeling support from families and peers for expressing an interest in science. Other videos showed career stories of scientists, many of whom were minorities and several of whom were women. Classroom activities included worksheets, hands-on exercises, individual and group participation activities, case studies and problem-based learning.
Teachers followed three training workshops. An intervention school was matched to a control school in a quasi-experimental design. Fifth-grade students were followed up for three years. At eight-grade students from the intervention school scored significantly higher on the SAT10 and reported higher interest in science. Intervention Mapping IM is a helpful protocol for planning behavior change interventions.
Most of IM applications target health behavior, but the protocol can be applied to any situation in which behavior change is desirable. IM was developed in as a reaction to a lack of comprehensive frameworks for health promotion program planning. IM describes the process of program planning in six steps, with each step comprising several tasks. Three highlights are of particular relevance for using IM: IM is a complex and time-consuming process, reflecting the difficulty of changing health behaviors.
IM has been described by some authors as complex, elaborate, tiresome, expensive, and time consuming. However, the same authors have also concluded that IM assisted in bringing the development of interventions to a higher level as is evidenced by the successful applications of IM in different domains as we described above.
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