"I used to worry about what other people thought but now I just think ... well I don't care": shifting accounts of learning difficulties in public places

This paper will explore the ways in which mothers of children with learning difficulties account for their children's behaviour when they are in public places. Children with learning difficulties may demonstrate unconventional behaviour without having any apparent sign of impairment. This may lead others, unfamiliar with the children, to make inappropriate judgements about both the children and their mothers. An exploration of the ways in which mothers account for their children's behaviour illustrates both the ways in which the mothers make sense of their children's learning difficulties and how they attempt to facilitate their children's participation in social life in public places. This paper draws upon the findings of a qualitative research project involving 18 mothers of children with moderate to severe learning difficulties. I begin by presenting a brief overview of the contextual and theoretical framework for the analysis focusing upon public places and disability. This section includes a discussion about the sociological concept of accounts and account making. The next section discusses the methods used in the study and this is followed by a section presenting the research findings. Finally, a discussion of these findings highlights how mothers shift in their approach to accounting for their children's behaviour over time and I conclude by suggesting that the exploration of the use of accounts in public places is a useful tool for highlighting changes in perceptions of disability.     

Testicular self-examination: a test of the health belief model and the theory of planned behaviour

The aim of this study was to test the utility and efficiencyof the theory of planned behaviour (TPB) and the health beliefmodel (HBM) in predicting testicular self-examination (TSE)behaviour. A questionnaire was administered to an opportunisticsample of 195 undergraduates aged 18–39 years. Structuralequation modelling indicated that, on the basis of all the fitindices, the TPB model was the better model, however, the qualityof the models was very similar. The TPB explained 50% of thevariance in intention and 22% in behaviour while the HBM (withself-efficacy) accounted for 56 and 21%, respectively. Self-efficacywas the most important predictor of TSE behavioural intentionacross both models. These findings contribute to the growingliterature on the testing of multiple models in the health psychologydomain. Received on May 23, 2006; accepted on June 6, 2006     

Enhancing performance in health care: a theoretical perspective on agency and the role of information

This paper examines the role of information in securing control of health care systems. The discussion focuses on the impact of the proposed 'Performance Framework', which entails a significant increase in the importance attached to formal performance indicators in the management of the UK National Health Service. The paper starts with a discussion of the role of performance data in securing organizational control within health care systems and summarizes recent research into the behavioural consequences of seeking to control health care agents using such information. A theoretical principal/agent model is then used to illustrate the incentives that exist for dysfunctional behaviour within health care when only imperfect information systems are available. The theoretical results are then examined in the context of a qualitative empirical study, which elicited the perceptions of managers and health care professionals connected with eight NHS hospitals. The study confirmed the existence and importance of serious dysfunctional consequences arising from the use of information as a means of control, and concludes that the Performance Framework will be successful only if it is used in careful conjunction with other means of control.     

Use of health services in Hill villages in central Nepal

This paper reports the use and non-use of health care facilities in the Hill villages in central Nepal. The health behaviour model (HBM) is applied to test the significance of socioeconomic variables on the use of the modern health care system. The study finds that all three characteristics of the HBM model, predisposing, enabling and need, are significantly related to use and non-use of the modern health care system. The analysis shows that number of living children, respondent's education, nearness to the road and service centre, value of land, knowledge about health workers and experience of child loss are some of the variables that are positively and significantly related to the use of modern health care. Age of the respondents and household size were found to be negatively associated with health-care use. Contrary to expectation, caste is unimportant. Making use of the qualitative data, this paper argues that the health care system is unnecessarily bureaucratic and patriarchal, which favours the socio-economically well-off.     

The health belief model and participation in programmes for the early detection of breast cancer: a comparative analysis

Extravagant claims have been made about the power of the Health Belief Model (HBM) to explain both decisions to adopt patterns of health behaviour and to use preventive health services. However, studies where information on beliefs are collected before information on behaviour are not common. The analyses presented here are based on prospective studies examining how far the variables which make up the HBM predict attendance at (i) a class teaching breast self-examination and (ii) a clinic providing mammography. The results show that different dimensions of the HBM are amongst the best predictors of attendance at each of the different services although the overall variance explained by the HBM in both sets of analysis was small.     

The impact of patients' perceptions of high blood pressure on attendance at screening: An extension of the health belief model

This study is concerned with a neglected area: the synthesis of two approaches relevant to health-related behaviour—the Health Belief Model and Attribution Theory. A prospective design was used to test the combination of health beliefs and causal attributions that predispose patients to attend a screening for raised blood pressure. It was proposed that causal attributions concerning high blood pressure (HBP) would (i) affect other health beliefs, (ii) would act in conjunction with health beliefs in relation to actual behaviour and (iii) might show, in some cases, a more direct influence on behaviour and behavioural intention. One hundred and three adults responded to the questionnaire.Multivariate analyses were used to discriminate between the characteristics of attenders and non-attenders. The general prediction was confirmed: overall, eight factors comparing both HBM and attributional items produced a highly significant discrimination. A correlational analysis revealed a variety of linear relationships between HBM-items and causal attributions. Much of the variance in attendance was accounted for by the intention variable, and multiple regression analysis was performed to examine the determinants or intention, as a significant intervening factor between beliefs and behaviour.Participation bias limits the generalisability of these findings. The potential significance of causal attributions as predictors of both health beliefs and behaviour is nevertheless apparent. The implications of such a synthesis of approaches are discussed in terms of psychological theory and health education.     

Pricing, demanders, and the supply of health care.

This paper is divided into three substantive sections. In the first section the conventional neoclassical paradigm is augmented by consideration of the agency relationship in which the physician is considered not only as the agent who controls the supply of health care, but also as the decision maker who articulates demand because patients forego this role and rely on "expert" advice. The next section is concerned with the effects of pricing on consumer demand and draws on the available empirical evidence to present estimates of price elasticity, cross elasticity, and other characteristics of the choice process. This analysis is completed by integrating the agency relationship into the discussion and arguing that if the policy objectives are expenditure containment and greater efficiency in resource utilization, the price mechanism should be used to affect the behavior of the primary demander and the supplier: the physician. In the final section the implications of this analysis are discussed in the contexts of two competing perspectives: the liberal market perspective and the collective "needology" perspective, and an attempt is made to distinguish some of the characteristics of the two views of the world.     

Effects of health claims on eating habits of the Dutch population

This artide reviews whether and how health daims on food productscan influence eating behaviour in The Netherlands. At present,the research data on the possible influence of health daimson eating behaviour are Insuffident to be able to condude thatthis information does or does not have a significant impacton eating behaviour. Therefore, a model of behaviour changethrough education is used to analyse the possible effects ofhealth daims on eating habits. Among the questions which ariseare the following: who reads health daims, are health daimsunderstood and under what conditions do health claims affectfood choice? Based on the theoretical model it is conduded that,if daims have an effect on eating behaviour, this will probablybe true for only a limited group of people. Several recommendationsare made how to increase the potential effect of daims. It isconduded that experimental research should examine whether theserecommendations indeed lead to a greater impact on eating behaviour.     

The Child and Adolescent Health Survey: collection of health behavior data from parents and children

The first German Health Survey for Children and Adolescents will start in 2003. During three years, a representative sample of children and adolescents between 0 and 18 years of age shall be examined and will, together with their parents, be interviewed on health-relevant issues. With this survey, health information on about 18,000 children will be gathered. The health behaviour of the parents as far as their children's health is concerned, as well as the personal health behaviour during adolescence will be assessed, since this will be highly relevant for future health. Questions on nutrition behaviour, eating disorders, alcohol consumption, smoking as well as leisure-time behaviour, with special emphasis on physical activity, will be asked. These questions were tested for feasibility in a one-year pilot study. With this survey, the occurrence of certain unhealthy behaviour characteristics may be documented and risk groups may be identified. This may help to conceptualize prevention measures.     

Reliability of health belief indexes: confirmatory factor analysis in sex, race, and age subgroups.

Despite frequent reference to the Health Belief Model (HBM), few studies address the internal consistency (within questionnaires) or the stability across populations of scales used to measure HBM variables. As part of a 1983 Michigan statewide blood pressure survey, trained interviewers administered 32 health belief questionnaire items to 2,802 randomly selected adult Michigan residents. Exploratory common factor analysis was used to examine the structure of these questionnaire items. Six correlated factors, which corresponded closely with theoretical constructs, appeared. Guided by these results, we developed a confirmatory common factor model. The model's fit was examined in random population halves and in univariate sex, race, and age subgroups. Except perhaps in the oldest age group, the model's fit appeared constant. Reliabilities estimated for HBM factor scales formed with these questionnaire items appeared independent of age, race, or sex.     

Research on ethics in two large Human Biomonitoring projects ECNIS and NewGeneris: a bottom up approach

Assessment of ethical aspects and authorization by ethics committees have become a major constraint for health research including human subjects. Ethical reference values often are extrapolated from clinical settings, where emphasis lies on decisional autonomy and protection of individual's privacy. The question rises if this set of values used in clinical research can be considered as relevant references for HBM research, which is at the basis of public health surveillance. Current and future research activities using human biomarkers are facing new challenges and expectancies on sensitive socio-ethical issues. Reflection is needed on the necessity to balance individual rights against public interest. In addition, many HBM research programs require international collaboration. Domestic legislation is not always easily applicable in international projects. Also, there seem to be considerable inconsistencies in ethical assessments of similar research activities between different countries and even within one country. All this is causing delay and putting the researcher in situations in which it is unclear how to act in accordance with necessary legal requirements. Therefore, analysis of ethical practices and their consequences for HBM research is needed.This analysis will be performed by a bottom-up approach, based on a methodology for comparative analysis of determinants in ethical reasoning, allowing taking into account different social, cultural, political and historical traditions, in view of safeguarding common EU values. Based on information collected in real life complexity, paradigm cases and virtual case scenarios will be developed and discussed with relevant stakeholders to openly discuss possible obstacles and to identify options for improvement in regulation. The material collected will allow developing an ethical framework which may constitute the basis for a more harmonized and consistent socio-ethical and legal approach. This will not only increase the possibilities for comparison between data generated but may also allow for more equality in the protection of the rights of European citizens and establish trustful relationships between science and society, based on firmly rooted ethical values within the EU legislative framework.These considerations outline part of the research on legal, socio-ethical and communication aspects of HBM within the scope of ECNIS (NoE) and NewGeneris (IP).     

Predicting intentions to get the COVID-19 vaccine in India: An integration of theory of planned behaviour and health belief model

The aim of the study was to determine intention to receive Coronavirus disease-19 (COVID-19) vaccination in India. An integrated model of Theory of Planned behaviour (TPB) and Health Belief Model (HBM) was used. Online survey was conducted in Delhi NCR region to find out the intention to receive vaccination. Data was collected from 845 respondents during 15 February 2021–15 March 2021, just after COVID-19 vaccination became available in the India. Partial Least Square-Structural Equation Modelling was used to establish the relationships. The results of the analysis show that proposed framework is significant and explained 71% variance in intentions. Attitude, subjective norm, perceived behaviour control and self-efficacy from the TPB had direct (or significant independent) effects on intention and perceived benefits, perceived susceptibility from the HBM have indirect effect on the intentions through attitude. The present study can be used to maximise the uptake of vaccination in any future pandemic. This theoretically-driven model can be used to guide health policy makers and health care providers to increase the uptake of vaccination.     

The Health Belief Model

The objective of this discussion is to show how the Health Belief Model (HBM) can be applied to family planning in general, and in particular to the use or nonuse of contraception among sexually active young females. Katatsky has argued that the HBM should be used to guide family planning research, but the shortcoming of her article is that she fails to go into detail regarding how the specific concepts of the HBM would be useful. The attempt in this is made in this discussion to go beyond Katastky's general statement. Her main argument for use of the HBM is that it focuses on the role of motivating factors in the prevention of health problems. This is particularly relevant in understanding the birth control practices of teenagers, for whom motivational factors are more important than lack of knowledge in inhibiting the use of contraception. The HBM assumes that motivation is a necessary condition for action. The 2 major components of motivation in the HBM are perceived susceptibility and perceived severity. In the family planning area, perceived susceptibility refers to the perceived risk of becoming pregnant and is an important factor explaining the use or nonuse of contraception particularly among adolescents. Lack of perceived susceptibility to pregnancy can result in risk taking, but risk taking itself can lead to lowered feelings of susceptibility. The HBM assumes that the more serious a health problem is viewed, the more likely one is to take preventive action against it. Research has consistently shown that contraceptive effectiveness rates for couples who have definitely decided not to have any more children is considerably higher than for those couples who only want to delay the next pregnancy. Research with unmarried women has shown that those who have high educational and career goals are more likely to practice effective contraception than those who give priority to motherhood over a career. According to the HMB, before taking preventive health actions, persons weigh the perceived benefits of the health action against the cost of taking the proposed actions. There are major costs of using contraceptives that are not method specific. These include the reluctance to plan ahead for sexual intercourse and the cost of admitting to others that one is sexually active. Other costs are method specific. The final major concept of the HBM is a cue to action that stimulates preventive behavior. Cues could be internal (coming from within the individual) or external (coming from others). An internal cue could be a delayed menstrual period.     

Medical education about human sexuality: the impact of film in the workshop setting

The current study uses a pre-test-post-test control group design in which students who were volunteer participants were randomly assigned, controlled for sex, to one of two 1-day human sexuality workshops (n=19 , n=21 ) or a control group (n=17 ). The two workshops were identical in format and content. Each included four topic areas: homosexuality, psychosexual development of the male and female, masturbation, and the meaning of touch. After introduction to topic areas in large group sessions, small group discussions were held, led by trained teams of male and female co-leaders. The independent variable was the inclusion of films of explicit sexual behaviour in one workshop (film and discussion) during each of the large group sessions, while no films were used in the other workshop (discussion only). Post-test data from the attitude and knowledge sections of the SKAT test showed that participants in both the film and discussion and discussion-only workshops changed significantly more than the control group on the heterosexual relations (P < 0.05 ) and masturbation attitude scales (P<0.01 ). No significant changes occurred on the knowledge section. Comparisons of pre to post scores of experimental subjects with previous research indicates that the present SKAT results are comparable to those that have been interpreted as significant. However, an analysis of variance comparing pre to post SKAT scores of both experimental groups revealed only one SKAT scale differential between the groups, with discussion-only participants showing more change (masturbation, P < 0.05 ). Thus, the addition of explicit films to a workshop was not shown to have a significant effect on attitude change and knowledge scores as measured by the SKAT. Implications of the findings for future course planning are discussed.     

A review of theory and health promotion strategies for new immigrant women

BACKGROUND: There has been little empirical research on the best ways to influence women's health behaviour, particularly among women who are recent immigrants to Canada. METHODS: This paper presents information from a literature review conducted for the Ontario Women's Health Council on effective theoretical models and health promotion strategies for women. FINDINGS: Health promotion activities for all women should address theoretical variables as well as the broader determinants of women's health. New immigrant women represent a diverse group who often face multiple cultural, linguistic and systemic barriers to adopting and maintaining healthy behaviour. INTERPRETATION: Many theoretical constructs of potential importance to recent immigrant women have not been adequately researched. More research is also needed on the relevancy and the applicability of commonly used health promotion approaches for this group.     

Theories of behavioural change and their use in health promotion: some neglected areas

The paper begins with a brief review of some of the main modelsof health behaviour which have and are being used in healtheducation and promotion work. Some significant theoretical gapsare identified characterized by underdeveloped conceptions ofsocial structure and cultural process. Some recent work is citedwhich represents different theoretical approaches. Finally,suggestions are made for the development of theory and practice.     

Gender differences in health related behaviour: some unanswered questions

To date, no single explanation has accounted for discrepancies between male and female morbidity rates and health care utilization patterns. The sociomedical approach to sex/gender differences in health related behaviour has generated a variety of hypotheses. However, despite extensive study, many unanswered questions remain. The findings of this study fall short of offering conclusive evidence as to the causes of variations in morbidity and health services use between women and men. However, an effort is made to identify the salience of social role and related social status characteristics (e.g. labour force participation) in accounting for variation in health, illness and sick role behaviour. This paper utilizes data from the 1983 Winnipeg Area Study. Findings of this study raise questions about the adequacy of current concepts and measures for studying sex/gender differences in health related behaviour. The study concludes with a critical discussion of conceptual, methodological and theoretical issues which must be considered in our efforts to advance our understanding of why women experience greater longevity, but experience greater morbidity and make more extensive use of health services.     

Zweigeschlechtlichkeit und hierarchische Geschlechterordnung

The aims of this article are to illustrate how the discussion on inclusion of the social category gender has changed, which theoretical concepts determine this discussion and to which extent an institutionalisation has taken place with the objective of reducing gender-specific discrimination in the areas of health care as well as health sciences. To show this, in the first section three theoretical concepts will be explained which allow the meaning of gender as a central social category to be understood. These three concepts are (1) approaches to analyse gender as a social structural category, (2) social-constructivist approaches and (3) approaches that deal with symbolic-discursive orders. The second section presents an historic outline of female and gender-specific health sciences over the last 30 years with its different phases of discussion, especially regarding the process of the inclusion of gender in research work on health. The final third section relates the methodological thoughts deducted from the theoretical concepts as well as the historic discussion, resulting in the concepts of "gender bias" to the action-orientated approach of "gender mainstreaming".     

Cultural components of behavioural epidemiology: implications for primary health care

In this article we discuss the association of culturally linked behaviour and epidemiology: that patterns of disease are significantly related to cultural sets of normative beliefs and behaviour. The literature on this is vast and includes much of what is written under the headings of Medical Anthropology as well as, for example, Cross-cultural Psychiatry and Medical Geography. A comprehensive review is obviously impossible, but as this is presented primarily as a background paper, basic issues are raised, and related to examples from the literature, to stimulate discussion. The article is divided into four subsections which give an indication of our focus: culture, disease and illness causation; utilization and provision of health resources; health, illness and normative socio-political and economic behaviour and primary health care, community participation and culture--implications for the future.     

Environmental surveys, specimen bank and health related environmental monitoring in Germany

Production of chemicals, use of products and consumer goods, contamination of food as well as today's living conditions are related to a substantial exposure of humans to chemicals. Safety of human beings and the environment has to be safeguarded by producers and government. Human biomonitoring (HBM) has proven to be a useful and powerful tool to control human exposure and facilitate risk assessment. Therefore, the German Federal Environment Agency (Umweltbundesamt, UBA) employs two major HBM tools, the German Environmental Survey (GerES) and the German Environmental Specimen Bank (ESB). GerES is a nationwide population representative study on HBM and external human exposure, which has, inter alia, been used to identify lead in tap water, lead dustfall, time spent in traffic, and age of dwelling as exposure sources for lead and, thus, to derive risk reduction measures. The ESB is a permanent monitoring instrument and an archive for human specimens. Retrospective monitoring of phthalates and bisphenol A provides a continuous historical record of human exposure in Germany, over the last decades. Additionally it revealed that estimations of human exposure based on production and consumption data may supply misleading information on human exposure. HBM data demonstrated that (a) the use if the restricted isomer di-n-butylphthalat decreased while di-i-butylphthalate levels remained constant and (b) human bisphenol A exposure might be overestimated without monitoring data. The decrease of polycyclic aromatic hydrocarbon-exposure proves the success of German environmental policy after German re-unification. In addition to GerES and ESB UBA is involved in different co-operation networks, the two most prominent of which are (1) the harmonization of HBM in Europe (ESBIO; Expert Team to Support Biomonitoring in Europe, COPHES/DEMOCOPHES; Consortium to Perform Human Biomonitoring on a European Scale/Demonstration of a study to Coordinate and Perform Human Biomonitoring on a European Scale) and (2) the co-operation between BMU and the German Chemical Industry Association (VCI). In the latter project emphasis will be placed on substances with a potential relevance for health and on substances to which the general population might potentially be exposed to a considerable extent and for which HBM methods are not available up to now.