Applying conjoint analysis of consumer preferences to the development of utility-responsive health promotion programs

This paper describes a method for systematically incorporatingthe study of consumer preferences or utility judgements in healthpromotion program development research. It illustrates an attemptto integrate the science of consumer behavior with the scienceof health behavior modification, toward the end of utility-responsivehealth promotion. A method that appears to be particularly usefulin the investigation of health promotion program consumer utilityjudgements is conjoint analysis. Conjoint analysis facilitatesevaluation of consumer response to program features or attributeswhen they are considered jointly, rather than one at a time.It can be used to conduct program concept testing, or assessmentof preference for diverse combinations of program attributesin various consumer groups. It thus aids in tailor fitting anintervention to specific segments of targeted populations, andin developing promotional materials. None the less, a literaturesearch failed to reveal any applications of conjoint analysisto health promotion program development research. This paperbriefly describes conjoint analysis and the potential benefitsof its application in this area. A heuristic framework for applyingconjoint analysis to health promotion program development isdelineated, based on procedures followed during formative workon a smoking cessation program. Four stages of program developmentare outlined.     

AIDS education and risk reduction for homeless women and children: implications for health education

The most preferable approach to implementing an AIDS education program among homeless women would be to establish a systematic comprehensive procedure addressing political, social, economic, and health concerns facing the ethnic minority community. A pragmatic approach would be to implement health education programs within the closed environment of homeless shelters. Such programs should incorporate distribution of materials which include specific information about how AIDS can be transmitted and prevented using simple and culturally relevant language. Health education interventions should use former homeless women in addition to health educators in development of exercises to improve self-esteem, communication, and decision making skills as related to negotiation of safe sex with their partners. Implementation of this process may help health educators make a meaningful contribution to the promotion of AIDS education and risk reduction for HIV infection within the growing population of homeless women and children in the United States.     

Marketing strategies for recruiting gay men into AIDS research and education projects

Recruiting gay and bisexual men into AIDS-related research and education programs will become increasingly common as federal, state and local funds become available. The Pitt Men's Study, a study of the natural history of Human Immunodeficiency Virus (HIV) infection, developed a recruitment strategy based on marketing principles. These techniques allowed the study to target particular gay and bisexual groups for inclusion. 1718 gay and bisexual men were recruited. Non-whites and unemployed men were targeted and recruited in numbers comparable to their representation in the larger community.Anthony Silvestre, M.A., is Director of Community Programs for the Pitt Men's Study, Department of Infections Diseases and Microbiology, University of Pittsburgh. David W. Lyter, M.D., is Clinical Director of the Pitt Men's Study, Department of Medicine, University of Pittsburgh. Charles R. Rinaldo, Jr., Ph.D., is the Principal Investigator of the Pitt Men's Study, Departments of Pathology and Infectious Diseases and Microbiology, University of Pittsburgh. Lawrence A. Kingsley, Dr. P.H., is the Epidemiologist of the Pitt Men's Study, Department of Medicine, University of Pittsburgh. Randall Forrester, B.A., is a consultant with the Pitt Men's Study and the Executive Director of the Persad Center. James Huggins, M.S.W., A.C.S.W., is a consultant of the Pitt Men's Study and the Director of Clinical Programs of the Persad Center.This study was supported by NIH Contract NO 1-AI32513.We are indebted to Pittsburgh's gay community for its support of our project. We thank Brett Cassens, Nick Ifft, Art Duprat, Albert Pasquarelli, Nnena Odim, the late Daniel Sbrochi, Deborah C. Laurie, Alan Simmons, Richard Witt and Douglas Johnson.A portion of this paper was presented at the International Conference on AIDS in Atlanta in April, 1985.     

Financing health promotion and education programs in HMOs

Health education and promotion programs provide numerous benefits to HMOs, plan members, and society. There are many approaches to financing such programs, and their application varies across organizations, depending on organizational values, managerial styles, decision-making structures, resources, administrative preferences, and program objectives.     

The APHA criteria for development of health promotion programs applied to four Healthy Community projects in British Columbia

The British Columbia Healthy Communities projects are intersectoralhealth promotion programs emphasizing local policy developmentto put the vision of the World Health Organization's and Canadianfederal initiatives of Achieving Health for All into practicalcommunity action and organization. They attempt to convert theOttawa Charter for Health Promotion into practical communityaction projects, including operationalizing the concepts ofparticipation, empowerment and ownership. The American PublicHealth Association's (APHA) criteria for the development ofhealth promotion and education programs (American Journal ofPublic Health, 77, 89–92, 1987) offer five standards bywhich to guide program design and implementation. As a testof the compatibility of these two models, we present case analysesof four Healthy Community projects in relation to the APHA criteria.At this early stage of the projects we can only speculate asto the results likely to be attained by these municipalities.We conclude that the APHA criteria would disqualify most ofthe Healthy Community projects as worthy health promotion programs,mainly on the APHA criteria requiring projects to have a modifiablerisk-factor target of known epidemiological importance to healthoutcomes, having interventions that will clearly and effectivelyreduce a targeted risk factor and having built-in evaluation.We weigh the relative merits of the Canadian community projectsaround the APHA criteria, concluding that different criteriamight apply to different types of health promotion policiesand programming.     

Sex and the Internet: gay men, risk reduction and serostatus

Access to the Internet has increased dramatically over the past decade as has its use for meeting sexual partners (e-dating), particularly among gay men. Between June 2002 and January 2004, 128 gay/bisexual men living in London were interviewed one-to-one about their experience of e-dating, sexual risk and HIV prevention. The men were recruited both online (through the Internet) and offline (in clinics and the community); 32 men were HIV-positive, 59 HIV-negative, while 13 had never had an HIV test. A key finding was that both identity as well as anonymity are vital to e-dating. Through a process of online filtering and sero-sorting, HIV-positive men are able to meet other positive men for anal sex without condoms. While this does not present a risk of HIV transmission to an uninfected person it does have implications for the potential transmission of other STIs such as syphilis and LGV. Through e-dating, HIV-positive gay men can also avoid abuse, discrimination and sexual rejection. Our findings do not support the suggestion that the attraction of e-dating is that it affords absolute anonymity. We found that the gradual expression of identity is vital for e-dating among gay men. Internet-based HIV prevention campaigns need to take account of the different ways in which gay reflexively manage aspects of their identity online.     

HIV/AIDS case profile of African Americans: guidelines for ethnic-specific health promotion, education, and risk reduction activities for African Americans

There are discrepancies in health care services for the poor and ethnic minorities in the United States. Within the past decade widespread concerns regarding the need to reform the nation's health care services, including the problem of human immunodeficiency virus/acquired immune syndrome (HIV/AIDS) among African Americans has continued. These inequalities have been the cornerstone of the U.S. Healthy People 2010 national priority objectives. The objectives focus on health and social outcomes such as low quality of life and mortality rates, poverty, lack of accessibility to and appropriateness of care, and the prevalence of certain degenerative conditions and infectious diseases. The dearth of preventive health services for the high-risk groups, particularly children, adolescents, young adults, and older African American adults undermines early intervention efforts, including prompt HIV/AIDS identification and diagnosis, prevention education, health promotion, effective substance abuse treatment, and counseling services. This work reviews the magnitude of HIV/AIDS among African Americans between 1996 and 1999 by race/ethnicity, gender, and age groups. It also addresses the major factors responsible for the continued upward trend in the distribution and rate of infectiousness of HIV/AIDS among African Americans. The study recommends and discusses culturally sensitive and ethnic-specific intervention strategies for the prevention and control of HIV/AIDS among African Americans.     

Applying the health promotion model to development of a worksite intervention.

INTRODUCTION: Consistent use of hearing protection devices (HPDs) decreases noise-induced hearing loss, however, many workers do not use them consistently. Past research has supported the need to use a conceptual framework to understand behaviors and guide intervention programs; however, few reports have specified a process to translate a conceptual model into an intervention. PURPOSE: The strongest predictors from the Health Promotion Model were used to design a training program to increase HPD use among construction workers. SUBJECTS/SETTING: Carpenters (n = 118), operating engineers (n = 109), and plumber/pipefitters (n = 129) in the Midwest were recruited to participate in the study. DESIGN: Written questionnaires including scales measuring the components of the Health Promotion Model were completed in classroom settings at worker trade group meetings. MEASURES: All items from scales predicting HPD use were reviewed to determine the basis for the content of a program to promote the use of HPDs. Three selection criteria were developed: (1) correlation with use of hearing protection (at least .20), (2) amenability to change, and (3) room for improvement (mean score not at ceiling). RESULTS: Linear regression and Pearson's correlation were used to assess the components of the model as predictors of HPD use. Five predictors had statistically significant regression coefficients: perceived noise exposure, self-efficacy, value of use, barriers to use, and modeling of use of hearing protection. Using items meeting the selection criteria, a 20-minute videotape with written handouts was developed as the core of an intervention. A clearly defined practice session was also incorporated in the training intervention. CONCLUSION: Determining salient factors for worker populations and specific protective equipment prior to designing an intervention is essential. These predictors provided the basis for a training program that addressed the specific needs of construction workers. Results of tests of the effectiveness of the program will be available in the near future.     

Applying logics of change to the evaluation of community development in health promotion

Evaluation of community-oriented health promotion programs requirethat professional evaluators clearly distinguish between exogenouslyand endogenously defined goals and definitions of ‘success’.Acknowledging the different dynamics which underpin community-ledchange and externally initiated health programs and interventionsis essential to this task. It will be argued that the intersectionof, and boundaries around, exogenous and endogenous change canbest be understood and clarified through the application of‘logics of rationality’, adapted from social theory.Community activity is characterised by what we have called ‘lifeworldrationality’ community-based health promotion interventionsare characterised by ‘formal ratonality’. In addition,we suggest that the value dimensions (‘substantive rationality’)underpinning programs and interventions may be overlooked bypolicy makers, program planners and professional evaluatorsunder pressure to demonstrate cost-effectiveness and efficiency.Key requirements for successful and appropriate evaluation ofcommunity-based programs which are sensitive to the needs andsuccess criteria of communities include a shared understandingby the researchers, program sponsors and community actors ofthe nature of the changes sought. The co-production of healthpromotion standards and of indicators to judge the performanceof the program or intervention by all stakeholders should bepreferred over the trend for establishing community-controlledprocess evaluations to coexist alongside expert-controlled impactevaluations. It is argued that current approaches to standardsetting and indicator development to judge the processes andimpacts of interventions are inadequate and several principlesfor improving their content are given. A locally controlledethnographic approach to evaluate endogenous community-led changeis described in the hope that program planners and evaluatorsmay become more sensitive and receptive to local knowledge.We suggest that engagement with what we have termed the ‘communitystory’ should be a fundamental requirement for the planningand evaluation of community health programs.     

Individual and aggregate level change in sexual behavior among gay men at risk for AIDS

Until an effective vaccine or treatment for AIDS is developed, the rate of spread of the epidemic will be determined primarily by the willingness of infected and at-risk individuals to refrain from behaviors implicated in the spread of the disease. Consequently, public health efforts have focused on educating these populations about the dangers inherent in certain practices. To date, the impact of these educational activities has been most extensively studied with regard to gay and bisexual men. Researchers, however, seem not always to appreciate the necessity to examine change at two levels of analysis—the individual and the aggregate because it is possible to draw different but valid conclusions about the nature of change, depending upon the level of analysis used. A series of models for examining individual and aggregate level change are described. These models are then used to examine whether there is evidence of change over a 6-month period in the sexual behavior of a sample of gay men from New York City. The data reveal evidence of a significant trend in the direction of safer sexual behavior at both the individual and aggregate level.This work was supported in part by grants from the National Institute of Mental Health (MH39551) and the New York State AIDS Institute (C00577).     

Applying health education theory to patient safety programs: three case studies

Program planning for patient safety is challenging because intervention-oriented surveillance data are not yet widely available to those working in this nascent field. Even so, health educators are uniquely positioned to contribute to patient safety intervention efforts because their theoretical training provides them with a guide for designing and implementing prevention programs. This article demonstrates the utility of applying health education concepts from three prominent patient safety campaigns, including the concepts of risk perception, community participation, and social marketing. The application of these theoretical concepts to patient safety programs suggests that health educators possess a knowledge base and skill set highly relevant to patient safety and that their perspective should be increasingly brought to bear on the design and evaluation of interventions that aim to protect patients from preventable medical error.     

Understanding why gay men seek HIV-seroconcordant partners: intimacy and risk reduction motivations

Our goal was to situate the interest of some gay men in having HIV-seroconcordant partners within the psychosocial context of concurrent motivations for intimacy and sexual risk reduction. Data were obtained from semi-structured qualitative interviews with a racially/ethnically diverse sample of 32 gay men (16 HIV-positive and 16 HIV-negative) living in New York City who sought HIV-seroconcordant partners. Thematic analysis indicated that seroconcordant partner selection was strongly motivated by a desire to reduce sexual risk as well as the pursuit of multiple forms of intimacy. Affirmative experiences in seroconcordant relationships and goals for future long-term relationships also informed men's current partner selection practices. When seeking seroconcordant partners, men reported key junctures and disjunctures between motivations for intimacy and interests in risk reduction. Our findings suggest that HIV prevention efforts will have greater relevance if they address broader motivational concerns for partner selection and serosorting, including the pursuit of intimacy.     

Cost-benefit and cost-effectiveness analysis for health promotion programs

Health promotion programs have been hailed as having great potential to help solve the problem of rapidly increasing health care costs. In order to assess whether health promotion programs are "worth it," some kind of cost-benefit or cost-effectiveness analysis must be included as part of program evaluation. This article provides a basic introduction to the concepts of cost-benefit and cost-effectiveness analysis, compares them, and presents a simple procedure for performing a basic cost-effectiveness analysis. The potential for health promotion programs to impact on the rising costs of medical care is discussed.     

Evidence-based health promotion programs for schools and communities

Healthy People 2020 includes an objective to increase the proportion of elementary, middle, and senior high schools that provide comprehensive school health education to prevent health problems in the following areas: unintentional injury; violence; suicide; tobacco use and addiction; alcohol or other drug use; unintended pregnancy, HIV/AIDS, and sexually transmitted infections (STI); unhealthy dietary patterns; and inadequate physical activity. These specific goals are part of the efforts of Healthy People 2020 to increase the proportion of elementary, middle, and senior high schools that have health education goals or objectives that address the knowledge and skills articulated in the National Health Education Standards. A focus on Pre-K through 12 health education is a prerequisite for the implementation of a coordinated, seamless approach to health education as advocated by the Healthy People Curriculum Task Force and incorporated into the Education for Health framework. To help accomplish these goals, this article views the role of education as part of the broader socioecologic model of health. A comprehensive literature review was undertaken to identify evidence-based, peer-reviewed programs, strategies, and resources. The results of this review are presented organized as sexual health, mental and emotional health, injury prevention, tobacco and substance abuse, and exercise and healthy eating. Evidence-based implementation strategies, often considered the missing link, are recommended to help achieve the Healthy People 2020 objective of increasing the prevalence of comprehensive school health education programs designed to reduce health risks for children.     

Estimating risk reduction required to break even in a health promotion program

PURPOSE: To illustrate a formula to estimate the amount of risk reduction required to break even on a corporate health promotion program. DESIGN: A case study design was implemented. Base year (2001) health risk and medical expenditure data from the company, along with published information on the relationships between employee demographics, health risks, and medical expenditures, were used to forecast demographics, risks, and expenditures for 2002 through 2011 and estimate the required amount of risk reduction. SETTING: Motorola. SUBJECTS: 52,124 domestic employees. MEASURES: Demographics included age, gender, race, and job type. Health risks for 2001 were measured via health risk appraisal. Risks were noted as either high or low and related to exercise/eating habits, body weight, blood pressure, blood sugar levels, cholesterol levels, depression, stress, smoking/drinking habits, and seat belt use. Medical claims for 2001 were used to calculate medical expenditures per employee. RESULTS: Assuming a dollar 282 per employee program cost, Motorola employees would need to reduce their lifestyle-related health risks by 1.08% to 1.42% per year to break even on health promotion programming, depending upon the discount rate. Higher or lower program investments would change the risk reduction percentages. CONCLUSION: Employers can use information from published studies, along with their own data, to estimate the amount of risk reduction required to break even on their health promotion programs.     

Employees attitudes to workplace health promotion programs for cancer prevention

OBJETIVE: We describe a method for feasibility assessment of workplace health promotion (WHP) programs as a necessary prerequisite of any WHP program. METHODS: A total of 167 employees from five workplace communities participated in the study. A questionnaire on the basic components of feasibility (risk factors, attitudes to workplace health promotion interventions, and social-occupational context) was administered. RESULTS: Risk behaviours were common among the employees interviewed. Health promotion in the workplace was favorably viewed by 79% of subjects but reported participation would be lower. Interventions on diet and physical activity received the highest acceptance. Participation would be greatest among local administration employees. CONCLUSIONS: The method demonstrated its utility in obtaining useful data for designing workplace health promotion interventions.     

Gingrich vows to hold hearing to block use of gay themes in AIDS programs

House Speaker Newt Gingrich announced that a Congressional hearing will be held to determine whether Federally funded AIDS prevention programs promote homosexuality. Gingrich told members of a town meeting that he had evidence that Federally funded AIDS programs and public education programs were encouraging homosexual practices, including "effective methods of sadomasochistic interaction." Gingrich, who says he is very "pro-family", does not favor repression against gay men or lesbians. His younger sister is a lesbian. However, he rejects the idea of the Federally funded schools teaching first-graders about homosexuality.     

2006—2010年苏州市艾滋病健康教育与健康促进工作分析

目的了解苏州市艾滋病健康教育与健康促进现况,并作出相应分析。方法计算覆盖率,采用动态数列方法列出增长率的动态数列表。结果 2006—2010年该市艾滋病健康教育与健康促进工作各项指标,如健康宣传(11.3%～28.1%),宣传资料入户(4.0%～34.7%)、宣传材料放置(1.3%～42.0%)、墙体广告(0.6%～83.3%)、学校宣传和讲座(27.4%～37.3%)、广告牌及宣传栏表(13.3%～100.0%)等覆盖率均有大幅度增加。结论该市艾滋病健康教育与健康促进工作已逐步走向常规运作,主要采取多种途径、多种方式,针对不同地区、不同人群的特点开展工作,覆盖面有所扩大,增长率逐年提高,上升幅度明显。