Extending the Purview of the Risk Perception Attitude Framework: Findings from HIV/AIDS Prevention Research in Malawi

The risk perception attitude (RPA) framework posits that efficacy beliefs moderate the relationship between risk perception and health outcomes. To extend the purview of the theory, this central hypothesis was tested in the context of HIV/AIDS-prevention behaviors. Data (N = 890) were collected from 8 districts in Malawi in southern Africa as part of a baseline research effort to obtain benchmark measures on key behavior-change indicators. Results pertaining to 2 behaviors, use of condoms and remaining monogamous, are reported in this study. Relationships between risk perception and behavioral intentions were not significant, but those between efficacy beliefs and behavioral intentions were. Furthermore, efficacy beliefs were found to moderate the relationship between risk perception and intentions to remain monogamous, but not between risk perceptions and intentions to use condoms. The model was able to explain approximately 40% of the variance in intentions to use condoms, and 19% of the variance in intentions to remain monogamous. Implications for health campaigns, particularly the need to strengthen efficacy beliefs and the need to be careful in enhancing risk perceptions without simultaneously strengthening efficacy beliefs, are also discussed.     

Understanding Health Information Seeking: A Test of the Risk Perception Attitude Framework

The authors used the Risk Perception Attitude framework, which is grounded in the Extended Parallel Process Model, to predict people's intentions to seek health information. In an online survey, 689 participants recruited from a crowdsource website were queried about their anticipated health information seeking, perceived risk, and efficacy in response to four scenarios pertaining to hypertension, hypercholesterolemia, alcohol dependence, and diabetes. Each participant was categorized for each scenario as responsive (higher risk, higher efficacy), avoidant (higher risk, lower efficacy), proactive (lower risk, higher efficacy), or indifferent (lower risk, lower efficacy). As predicted, responsive individuals were more likely to seek information than avoidant individuals, but only in three of the four scenarios. Also as expected, there was no difference between proactive and indifferent individuals’ likelihood of seeking health information for any scenario. Risk and efficacy, while significant predictors of anticipated health information seeking, left much of the variance unexplained. An analysis of the reasons for information seeking and nonseeking among nonconforming cases suggests that a wider range of influences on health information seeking should be investigated, including curiosity, prior knowledge, social expectations, and situational norms.     

Integrating Risk Perception Attitude Framework and the Theory of Planned Behavior to Predict Mental Health Promotion Behaviors among Young Adults

ABSTRACT

Mental disorder is a pressing public health issue in Singapore, especially among young adults. By integrating the risk perception attitude (RPA) framework and the theory of planned behavior (TPB), this study examines psychosocial factors underlying two mental health promotion behaviors – seeking counseling and employing self-help methods – among young Singaporeans. The results of an online survey (n = 232) showed that, as predicted by RPA framework, perceived risk interacted with self-efficacy to affect behavioral intention to seek counseling. However, this interaction existed only among individuals with favorable attitudes toward counseling-seeking behavior and not among those with unfavorable attitudes. In addition, the interaction between perceived risk and self-efficacy was not significant for the intention to perform self-help methods. The current findings demonstrated that the nature of focal behavior and attitudes are boundary conditions of the interaction effect between perceived risk and efficacy, which is the core premise of the RPA framework. These findings offer practical implications for developing campaign strategies to promote mental well-being among young adults in Singapore.     

A Test of The Risk Perception Attitude Framework as a Message Tailoring Strategy to Promote Diabetes Screening

The risk perception attitude (RPA) framework was tested as a message tailoring strategy to encourage diabetes screening. Participants (N = 602) were first categorized into one of four RPA groups based on their diabetes risk and efficacy perceptions and then randomly assigned to receive a message that matched their RPA, mismatched their RPA, or a control message. Participants receiving a matched message reported greater intentions to engage in self-protective behavior than participants who received a mismatched message or the control message. The results also showed differences in attitudes and behavioral intentions across the four RPA groups. Participants in the responsive group had more positive attitudes toward diabetes screening than the other three groups, whereas participants in the indifferent group reported the weakest intentions to engage in self-protective behavior.     

中小学校预防烟草使用健康促进干预效果评价

[目的 ]通过开展以预防烟草使用为切入点的健康促进学校活动 ,提高中小学生预防烟草使用的知、信、行水平。 [方法 ]采用整群抽样调查方法 ,1998年 10月至 2 0 0 0年 3月 ,在嘉兴市对试点学校和对照学校学生分别进行健康知识调查后 ,在试点学校开展以预防烟草使用为重点的健康促进综合干预活动 ,对照学校按常规进行控烟健康教育。干预后再对试点学校和对照学校学生进行调查 ,并对干预效果进行评估。 [结果 ]试点学校不同学龄段中小学生相关健康知识均有所提高 ,与烟草有关的正确信念和健康行为形成率明显提高。且试点学校学生能够较之以前更为容易地获取控烟知识。 [结论 ]学校预防烟草使用健康促进项目对于提高中小学生健康知识水平 ,改善与烟草有关的健康信念 ,建立拒烟技巧等健康行为效果显著     

Balancing Risk Prevention and Health Promotion: Towards a Harmonizing Approach in Care for Older People in the Community

Many older people in western countries express a desire to live independently and stay in control of their lives for as long as possible in spite of the afflictions that may accompany old age. Consequently, older people require care at home and additional support. In some care situations, tension and ambiguity may arise between professionals and clients whose views on risk prevention or health promotion may differ. Following Antonovsky’s salutogenic framework, different perspectives between professionals and clients on the pathways that lead to health promotion might lead to mechanisms that explain the origin of these tensions and how they may ultimately lead to reduced responsiveness of older clients to engage in care. This is illustrated with a case study of an older woman living in the community, Mrs Jansen, and her health and social care professionals. The study shows that despite good intentions, engagement, clear division of tasks and tailored care, the responsiveness to receive care can indeed not always be taken for granted. We conclude that to harmonize differences in perspectives between professionals and older people, attention should be given to the way older people endow meaning to the demanding circumstances they encounter (comprehensibility), their perceived feelings of control (manageability), as well as their motivation to comprehend and manage events (meaningfulness). Therefore, it is important that both clients and professionals have an open mind and attempt to understand each others’ perspective, and have a dialogue with each other, taking the life narrative of clients into account.     

Children in the context of "Achieving Health for All: a Framework for Health Promotion"

We analyze Achieving Health for All: A Framework for Health Promotion with respect to children. Although the document acknowledges the health needs of children, it depicts them as passive beneficiaries of health care efforts taken by others on their behalf. We believe that, like adults, children should become active participants in all of the health-promoting activities proposed in the framework and that they can do so if taught life skills for health which emphasize decision making, coping and community participation skills.     

嘉兴市学校预防烟草使用项目效果评价

目的 通过开展以预防烟草使用为切入点的健康促进学校活动,提高中小学生预防烟草使用的知、信、行水平。方法 采用流行病学调查研究方法,对试点学校开展以预防烟草使用为重点的健康促进综合干预活动,并对干预有效性进行评价。结果 不同学龄段中小学生相关健康知识考核均分明显上升;与烟草有关的正确信念和健康行为形成率明显提高,干预有效率分别为72．4％和83．3％。结论 学校预防烟草使用健康促进项目对于提高学生健康知识水平和改善与烟草有关的健康信念及建立拒烟技巧等健康行为效果显。     

Urban Crack Users: Gender Differences in Drug Use,HIV Risk and Health Status

SUMMARY

This study assessed gender differences in drug use, HIV risk, and health status in a sample of urban crack users. Using targeted sampling, 1434 crack users (66% male and primarily African-American and Puerto Rican), were recruited from the streets of East Harlem, New York City. A standardized, structured interview was administered, drug use was validated by urinalysis, and HIV testing was offered. Gender differences were observed on sociodemo-graphic variables and patterns of drug use. Other than welfare, men and women cited different major sources of income. Women reported greater use of crack, and men were more likely to use injection drugs as well as crack. Data on sexual risk indicated that women had more sexual partners than men, but the percentage of unprotected vaginal sex for both men and women was greater for those who did not exchange sex for drugs and/or money. The number of persons already infected with HIV was substantial. Many reported histories of other sexually transmitted diseases which were generally higher among men. Future research should investigate the relationship between gender and other factors (e.g., ethnicity, geographic location) associated with HIV risk.     

Renegotiating cultural practices as a result of HIV in the eastern region of Malawi

A number of studies have shown that HIV awareness is very high among Malawians and yet infection rates are rising. Local cultural practices have been identified as contributing to this contradictory situation. Using data from 12 focus-group discussions collected in Balaka, Zomba, Machinga and Mangochi, the paper explores the reformulation of nine cultural practices as a preventive measure against HIV. The study reveals that cultural practices that involve sexual acts for completion are mediated through condoms and HIV tests. The study also shows that traditional herbs known for healing ailments are repurposed to symbolise sexual acts. We conclude that the idea of repurposing offers an avenue in which initiation and cleansing rites that involve sexual acts are replaced by other semiotics such as a traditional medicine called mtela. We also conclude that the modifications to cultural practices do not indicate complete abandonment of associated traditions, rather, they constitute the renegotiation of cultural practices and meanings associated with particular rites of passage. Lastly, we propose that a comprehensive prevention programme needs to be part of a wider national HIV-prevention effort combining a women and child rights and empowerment agenda and, critically, lifestyle lessons in a process of cultural renegotiation.     

The Role of Screenings Methods and Risk Profile Assessments in Prevention and Health Promotion Programmes: An Ethnographic Analysis

In prevention and health promotion interventions, screening methods and risk profile assessments are often used as tools for establishing the interventions’ effectiveness, for the selection and determination of the health status of participants. The role these instruments fulfil in the creation of effectiveness and the effects these instruments have themselves remain unexplored. In this paper, we have analysed the role screening methods and risk profile assessments fulfil as part of prevention and health promotion programmes in the selection, enrolment and participation of participants. Our analysis showed, that screening methods and health risk assessments create effects as they objectify health risks and/or the health status of individuals, i.e., they select the individuals ‘at risk’ and indicate the lifestyle modifications these people are required to make in order to improve their health. Yet, these instruments also reduce the group of participants thereby decreasing the possible effect of interventions, as they provide the legitimisation for people to make choices to whether they enrol or not and what lifestyle changes they incorporate into their lives. In other words, they present a space of interaction, in which agency is distributed across the practice nurses, the participants and the instruments. Decisions were not just made upon the projection of the outcomes of these instruments; decisions that were made by both the patients and practice nurses were the resultant of their opinions on these outcomes that were formed in interaction with the instruments.     

健康促进策略在肺结核病防治中的实践

结核病是一种危害很大的传染病 ,在我国具有传染性的结核病人约 15 0万例 ,约占全球病人的 30 % ;每年约有2 5万人因患结核病而死亡。目前主要的原因是对结核病诊治不规范 ,治疗不彻底 ,出现大量耐药病人 ,造成结核病疫情回升。为有效地控制结核病疫情 ,我市在实施《卫生部加强和促进结核病控制项目》工作中 ,全面贯彻世界卫生组织健康促进策略 ,较好地发挥健康促进的核心功能。在结核病防治的整个过程中 ,健康教育和健康促进起到了重要的作用。建立有利于结核病防治的健康政策 ,形成政府支持、工作规范、网络完善的结防体系。结核病作为一…     

Marriage as a risk factor for HIV: Learning from the experiences of HIV-infected women in Malawi

Abstract

The gender inequalities that characterise intimate partner relationships in Malawi, a country with one of the highest HIV prevalence rates in the world, arguably place marriage as an important risk factor for HIV infection among women, yet few studies detail the complex interactions of marriage and risk. In order to develop HIV-prevention interventions that have lasting impacts in such communities, we need a deeper understanding of the intricacies of women's lives, how and why they are involved in marital relationships, and the implications of these relationships for HIV transmission or prevention. This article describes how women understand marriage's effects on their lives and their HIV risks. Drawing from focus group discussions with 72 women attending antiretroviral clinics in Malawi, we explore why women enter marriage, what women's experiences are within marriage and how they leave spouses for other relationships. Based on their narratives, we describe women's lives after separation, abandonment or widowhood, and report their reflections on marriage after being married two or three times. We then review women's narratives in light of published work on HIV, and provide recommendations that would minimise the risks of HIV attendant on marriage.     

Patient and Staff Perspectives on the Use of a Computer Counseling Tool for HIV and Sexually Transmitted Infection Risk Reduction

PurposeTo explore use of an interactive health communication tool- “Computer Assessment and Risk Reduction Education (CARE) for STIs/HIV.”MethodsThis was a mixed method study utilizing participant observation and in-depth interviews with patients (n = 43), and focus groups with staff (5 focus groups, n = 41) from 5 clinics in 3 states (1 Planned Parenthood, 1 Teen, 2 STD, and 1 mobile van clinic). Data were managed using Atlas.ti. Inter-rater reliability of qualitative coding was .90.ResultsUsers were 58% nonwhite with mean age 24.7 years (74% < 25). Patients could use CARE with minimal to no assistance. Time for session completion averaged 29.6 minutes. CARE usefulness was rated an average of 8.2 on an ascending utility scale of 0 to 10. Patient themes raised as strengths were novelty, simplicity, confidentiality, personalization, and plan development, increased willingness to be honest, lack of judgment, and a unique opportunity for self-evaluation. Staff themes raised as strengths were enhanced data collection, handout customization, education standardization, behavioral priming, and expansion of services. Patient limitation themes included limited responses and lack of personal touch. Staff limitation themes were selecting users, cost, patient-provider role, privacy, and time for use.ConclusionsCARE was well-received and easily usable by most (especially 18–25-year-olds). Patient and staff perceptions support the use of CARE as an adjunct to usual practice and as a method to expand services. Honesty, reduced time constraints, and lack of judgment associated with CARE appeared to enhance self-evaluation, which may prove an important component in moving patients forward in the behavior change process.     

A Pilot Trial of a Health Promotion and Illness Prevention Paradigm in the Perinatal Period

Maternal and Child Health Journal - This is a pilot study of the Vermont Family Based Approach, an innovative health promotion program designed to address behavioral health prevention in primary...     

Mapping as a Visual Health Communication Tool: Promises and Dilemmas

In the era of evidence-based public health promotion and planning, the use of maps as a form of evidence to communicate about the multiple determinants of cancer is on the rise. Geographic information systems and mapping technologies make future proliferation of this strategy likely. Yet disease maps as a communication form remain largely unexamined. This content analysis considers the presence of multivariate information, credibility cues, and the communication function of publicly accessible maps for cancer control activities. Thirty-six state comprehensive cancer control plans were publicly available in July 2005 and were reviewed for the presence of maps. Fourteen of the 36 state cancer plans (39%) contained map images (N?=?59 static maps). A continuum of map interactivity was observed, with 10 states having interactive mapping tools available to query and map cancer information. Four states had both cancer plans with map images and interactive mapping tools available to the public on their Web sites. Of the 14 state cancer plans that depicted map images, two displayed multivariate data in a single map. Nine of the 10 states with interactive mapping capability offered the option to display multivariate health risk messages. The most frequent content category mapped was cancer incidence and mortality, with stage at diagnosis infrequently available. The most frequent communication function served by the maps reviewed was redundancy, as maps repeated information contained in textual forms. The social and ethical implications for communicating about cancer through the use of visual geographic representations are discussed.     

在人口健康促进项目中引入世界卫生组织健康服务拓展框架理论研究

《健康服务项目拓展框架》是世界卫生组织在健康服务领域提出的最新项目拓展策略,本文介绍了该拓展策略的定义和要素,以及在国家人口计生委人口健康促进项目拓展中的具体应用。