Intervention Mapping

AIMS: Action to prevent the spread of HIV among young people in Sub-Saharan Africa is needed urgently. In order to be effective, such action should be theory and evidence based and carefully adapted to local cultures and contexts. The present article describes the organization, theoretical basis, and methodological approach of a project that aims at developing and evaluating school-based interventions targeting adolescents aged 12-14 years. METHODS: Researchers from European and African universities have developed interventions that were conducted in three sites: Cape Town and Polokwane (South Africa) and Dar es Salaam (Tanzania). In each site the interventions were evaluated through large-scale field experiments with intervention schools and delayed intervention schools and with baseline and two follow-up data collections. Minimum sample sizes were estimated for each site based on local data and taking into account that the unit of allocation was schools and not individual students (the design effect). During the formative phase as well as within the field experiments, qualitative studies were also conducted. DISCUSSION: The interventions were developed consistent with the Intervention Mapping approach, and the theoretical framework was based on a modified version of the Theory of Planned Behaviour. The limitations of Western social cognition models were recognized, and the theoretical framework has therefore been expanded in two directions: towards integrating cultural processes and towards taking societal factors and constraints into account. CONCLUSION: The project will throw light on the application of social cognition models as well as the usefulness of the Intervention Mapping approach to intervention development in sub-Saharan Africa.(click here to hide abstract)

This paper provides a process evaluation of a 6-day teacher training programme which forms part of a sexuality education project. The training aimed at providing teachers with the necessary knowledge and skills to effectively teach a 16-lesson Grade 8 (14 year olds) life skills curriculum consisting of participatory exercises on sexual reproductive health, human immunodeficiency virus (HIV), sexual decision-making, abstinence, consequences of sexual activity, safe sex practices, substance abuse and sexual violence. Questionnaires administered prior to the training, on completion of the training and at two follow-up time periods were analysed as well as participant observation notes. Findings indicate that teachers reported increased confidence and comfort in teaching the sexuality curriculum. However, many struggled with the transfer of sexual reproductive knowledge and facilitative teaching methods into the classroom context. This highlights the need for HIV education to form part of teacher trainee programmes. Ongoing support and engagement with teachers is needed to encourage alternative teaching practices. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)(click here to hide abstract)

The objective of this study was to describe and understand gender roles and the relational context of sexual decision-making and safe sex negotiation among Afro-Surinamese and Dutch Antillean women in the Netherlands. Twenty-eight individual in-depth interviews and eight focus group discussions were conducted. In negotiating safe sex with a partner, women reported encountering ambiguity between being respectable and being responsible. Their independence, autonomy, authority and pride inherent to the matrifocal household give them ample opportunity to negotiate safe sex and power to stand firm in executing their decisions. The need to be respectable burdens negotiation practices, because as respectable, virtuous women there would not be the need to use condoms. Respectable women will only participate in serious monogamous relationships, which are inherently safe. Women's desire to feel like a woman, 'to tame the macho-man' and constrain him into a steady relationship, limits negotiation space because of emotional dependency. Respectability seems to enforce not questioning men's sexual infidelity. In developing STI/HIV prevention programmes this ambiguity due to cultural values related to gender roles should be considered. Raising awareness of power differences and conflicting roles and values may support women in safe-sex decision-making.(click here to hide abstract)

The present study investigated disclosure patterns among mental health consumers (N = 500) and examined the relationships among disclosure, perceived stigmatization, perceived social support, and self-esteem. Results suggest that selective disclosure optimizes social support and limits stigmatization. Perceived stigmatization has a detrimental impact on self-esteem, especially for those who are relatively open about their mental disorder. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (from the journal abstract)(click here to hide abstract)

Self-esteem is an important construct that is related to academic achievement, social functioning and psychopathology in children and adolescents. Therefore, it is not surprising that many interventions have tried to change levels of self-esteem in this population. In this article a theoretical overview of self-esteem in children and adolescents is presented, in which recent research on different aspects of self-esteem will be discussed. Subsequently, research on treatment and primary prevention programs to change self-esteem in children and adolescents is reviewed. It is argued that self-esteem interventions will be more effective when they are theory- and evidence-based and tailored to the specific needs of different target groups. Finally, a roadmap for the development of theory- and evidence-based interventions is presented and some recommendations for future self-esteem interventions are provided. (PsycINFO Database Record (c) 2008 APA, all rights reserved) (from the journal abstract)(click here to hide abstract)

Since the Lalonde report, contemporary public-health theory has given steadily more attention to the role of environments in influencing health status. Environments, both social and physical, influence health directly or through complex interactions with behavior, genetics and health-care systems. They are also important for public-health because environments are the complex systems through which people are both empowered and exercise their empowerment. If public-health professionals are to play a significant role in influencing environments for health, they need analytical instruments that enable them to link specific environmental conditions with the actions necessary to improve them. These instruments must also enable public-health professionals to identify points of leverage for stimulating key actors to take the actions necessary to make environments more promoting of health. This article first presents one such analytical instrument. Then, building on examples relating to socio-economic health inequities, the analytical instrument is applied to reveal how it can add value to health professionals' effectiveness in planning interventions for more health-promoting environments.(click here to hide abstract)

The objective of this study is to investigate whether the Theory of Planned Behaviour (i.e. attitude, subjective norm, perceived behavioural control and intention), fluctuations in motivation over time, and variables from the Prototype-Willingness Model (i.e. behavioural expectation and behavioural willingness to have unprotected sex) predict preparatory behaviours for condom use. Sixty-two female undergraduates completed baseline and one-year follow-up questionnaires. Having condoms at home and carrying condoms were predicted by behavioural willingness to have unsafe sex at baseline. Having bought condoms was predicted by the behavioural expectation to use condoms with new partners at baseline. Intention and fluctuations in motivation did not emerge as significant predictors of preparatory actions. Female undergraduates, who are more willing to have unprotected sex under risk-conducive circumstances, are also less likely to prepare adequately for condom use, and thereby increase their chances of encountering such situations. Overall, the findings are in support of the Prototype-Willingness Model. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract)(click here to hide abstract)

A pre-post test follow-up design was used to test the effects of a systematically developed photo-novella (Laduma) on knowledge, attitudes, communication and behavioural intentions with respect to sexually transmitted infections, after a single reading by 1168 secondary school learners in South Africa. The reading resulted in an increase in knowledge on the spread of sexually transmitted infections (STIs), change in attitude to condom use and towards people with STIs and/or HIV/AIDS, as well as increased intention to practice safe sex. Laduma did not influence communication about sexually transmitted infections and reported sexual behaviour and condom use. While print media proved to be an effective strategy to reach large numbers of youth and prepare them for adequate preventive behaviours, the study also identified the need to combine print media with other planned theory-based interventions that build confidence and skills to initiate the preventive behaviour. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract)(click here to hide abstract)

A study into the relevance of cultural factors in predicting condom-use intentions among Antillean migrants in the Netherlands is described in this article. The association between the intention to use condoms with a new sexual partner and a perceived taboo on discussing sex, beliefs about sex education and machismo beliefs on gender and power relationships is addressed. The study was conducted among 346 Dutch Antilleans from a random sample of an Antillean population aged 15-50 years. The response rate was 37.8%. The results showed that condom-use intentions were primarily determined by perceived subjective norms, the perceived taboo on discussing sex, machismo attitudes, gender, age and educational background. Moreover, the respondent's opinion regarding machismo was an effect modificator for the association between condom-use intentions and subjective social norm. It is concluded that, in predicting condom-use intentions, factors specific to the culture of a population contribute significantly to the determinants drawn from the general social-cognition models. It is recommended that future research should use measurement instruments that are adapted to culture-specific beliefs, and should explore the influence of cultural factors on actual condom use. Moreover, interventions promoting condom use among migrant populations should target the cultural correlates of condom use. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)(click here to hide abstract)

Purpose: Present a 10-year update of the ecologic model of health promotion published by Richard et al. in the American Journal of Health Promotion in 1996. Approach: We adapted and simplified the model by leaving out settings, focusing on levels, and incorporating interpersonal and individual levels and agents that are in control of environmental conditions. Setting: Health care facilities, schools, workplaces, living environments, and public environments were represented in program descriptions. Participants: Forty-three program coordinators responsible for 47 programs were interviewed in the United States and The Netherlands. Methods: A systematic interview protocol elicited general program descriptions and relevant aspects of the ecologic approach. Program aspects from written reports were coded by the authors into levels, interventions, targets, and strategies. Results: The programs had 234 strategies and 276 targets, with a mean of 2.15 levels. Twenty-seven distinct intervention strategies were identified, with the most common being modification of an organization to which the at-risk individuals belong, followed by policy and community changes. Conclusion: Our data fit the ecologic model and our adaptations and indicate that over the past decade health promotion practice may have changed to include more multilevel programs. Systematic analysis of program strategies within and across environmental levels allows better understanding of the social ecology of health-related behavior and potential leverage points for change. (PsycINFO Database Record (c) 2008 APA, all rights reserved) (from the journal abstract)(click here to hide abstract)

This article presents the development of a theory- and evidence-based Internet HIV-prevention program for Dutch men who have sex with men (MSM) they have met on the Internet. The program is based on a protocol called Intervention Mapping (IM), which includes six steps. In Step 1 of IM, we conducted a needs assessment. In Step 2 we established program objectives to get e-dating MSM to use condoms consistently. In Step 3 we translated theoretical methods into practical strategies. In Step 4 we integrated the strategies into an intervention called Gay Cruise in which virtual pursers introduced participants to the strategies. In Step 5 we discussed large-scale implementation. And in Step 6 we discussed process and effect evaluation. We conclude that IM can be a helpful tool for developing and improving Internet HIV-prevention interventions.(click here to hide abstract)

The object of this study was to develop a class stress-management programme which would help children to develop a broader coping repertoire. First a problem analysis was conducted to determine the need for the programme. Next, the programme was developed, using the five steps of intervention mapping (IM) as a guide: 1) formulating proximal programme objectives, 2) selecting methods and strategies, 3) producing programme components, 4) planning for adoption and implementation and 5) planning for evaluation. A multidisciplinary group of researchers, health care workers, teachers and fifth-and sixth-formers from a primary school were closely, involved during all stages of the development process. The final programme is based on therapeutic principles derived from behavioural and cognitive therapy, combined with methods of information-processing principles. The programme was conducted by teachers who had been trained in the programme and who integrated it into their curriculum. The programme was evaluated positively by both teachers and pupils. We conclude that the framework of IM contributed to the development and implementation of a qualitative, sound programme. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)(click here to hide abstract)

This article describes the process evaluation of a stress management program called 'Learn Young, Learn Fair' for 5th and 6th graders. Studies, reviews and meta-analyses of prevention programs report that a common limitation in studies is the restricted documentation of process factors that contribute to the success of interventions. Program implementation is such a factor and findings indicate that the quality of implementation significantly affects outcomes. It is associated with Type III error: no effect is established because the program itself is inadequately designed or delivered. The potential role for school psychologists in process evaluation is discussed, and the great deal Intervention Mapping has to offer in this respect. A questionnaire for both teachers and pupils was developed, with items formulated to assess implementation and to investigate whether teachers and pupils valued the program. The latter would give an indication of future adoption and implementation in the field. Implementation was divided into completeness and fidelity. Completeness for the main parts of the program, the lessons and homework assignments, was good (98.5 and 95.8 percent respectively). Completeness for the auxiliary components, the booster sessions and the daily practice exercises, was moderate (62.2 and 69.3 percent respectively). Fidelity was good; mostly the teacher implemented the lessons, almost all items were discussed, and the manual was quite strictly followed (94, 98 and 95 percent respectively). Implementation of the program was of good quality. The program was delivered as intended. Effect evaluation will not be threatened by a Type III error. The results of this study favoured the feasibility of program implementation. It is stated that school psychologists can use the findings as a criterion for program selection. In that case it will be an example of the process of enlarging the potential role of school psychology in process evaluation of mental health interventions for schools. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (from the journal abstract)(click here to hide abstract)

Background: This study examined the effects of a universal stress management program (Learn Young, Learn Fair) on stress, coping, anxiety and depression in fifth and sixth grade children. Methods: Fifty-two schools (1467 children) participated in a clustered randomized controlled trial. Data was collected in the fall of 2002, the spring of 2003, and the winter of 2004. Given the nested structure of the design mixed (multilevel) regression analyses were applied. Results: Positive effects were found for emotion-focused coping at posttest (p < .01) and increased stress awareness at both time points. At posttest a decrease in problem solving was found (p < .01). After correcting for mediation by stress awareness the results showed that the program significantly reduced stress symptoms (p = .05) and anxiety (p = .01) at posttest. Effect sizes varied from small to large. Conclusions: Universal prevention programs that address stress and coping in children are warranted given the high prevalence of stress in children and the relationship between stress, on the one hand, and health complaints and pathology, on the other. Such programs are expected to be particularly salient for children with an increased sensitivity to stress and inadequate coping styles (e.g., diathesis-stress model). The results indicate that the school-based program 'Learn Young, Learn Fair' may be a valuable program for reducing stress in children. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract)(click here to hide abstract)

Understanding blood donation motivation among non-donors is prerequisite to effective recruitment. Two studies explored the psychological antecedents of blood donation motivation and the generalisability of a model of donation motivation across groups differing in age and educational level. An older well-educated population and a younger less well-educated population were sampled. The studies assessed the role of altruism, fear of blood/needles and donation-specific cognitions including attitudes and normative beliefs derived from an extended theory of planned behaviour (TPB). Across both samples, results showed that affective attitude, subjective norm, descriptive norm, and moral norm were the most important correlates of blood donation intentions. Self-efficacy was more important among the younger less well-educated group. Altruism was related to donation motivation but only indirectly through moral norm. Similarly, fear of blood/needles only had an indirect effect on motivation through affective attitude and self-efficacy. Additional analyses with the combined data set found no age or education moderation effects, suggesting that this core model of donation-specific cognitions can be used to inform future practical interventions recruiting new blood donors in the general population. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (from the journal abstract)(click here to hide abstract)

To enable improvements in school health promotion, this paper examines associations between the number of health-promotion issues addressed by primary school teachers in the Netherlands and factors thought to influence this behavior. The main factors studied are context characteristics and constructs of attitude, social influence, self-efficacy (SE) and perceived barriers. A total of 180 primary school teachers teaching 9- to 12-year olds (Grades 6, 7 and 8) participated in a cross-sectional survey. The results show that it is possible to differentiate between teachers addressing three or more health issues per year versus those who address fewer based on grade level (more health issues are addressed at higher grades), perceived disadvantages, SE and staff support. The latter seems to exert the greatest influence and may be one of the most promising focus points for improvements of school health promotion in the Netherlands.(click here to hide abstract)

OBJECTIVES.: The number of healthy school interventions of unknown quality overwhelms schools. Quality is a construct that is differently interpreted by teachers and health promoters. The schoolBeat checklist for quality assessment of healthy school interventions incorporates the quality perceptions of both professional groups. To support quality improvements - and thus effectiveness - in school health promotion, this study evaluates the schoolBeat checklist. METHODS.: Twenty-nine healthy school interventions were assessed in the Netherlands, each by two health promoters and two teachers-individually and at a consensus meeting. Generalizability coefficients were calculated for the nine specific quality criteria. RESULTS.: The mean consensus score differs from the mean average individual score for two out of nine criteria. To obtain a threshold Generalizability coefficient of 0.70, the number of assessors required per criterion ranges from 1.6 to 10.8, with an average of 4.7. CONCLUSION.: Quality assessment procedures of healthy school interventions using the schoolBeat checklist require about four experienced assessors from each professional domain to facilitate reliable quality scores based on individual assessment only. Publicly available quality scores enable the inclusion of high quality interventions in school policies in order to increase the impact of school health.(click here to hide abstract)

In recent decades, school health promotion programs have been developing into whole-school health approaches. This has been accompanied by a greater understanding among health promoters of the core-business of schools, namely education, and how health promotion objectives can be integrated into this task. Evidence of the positive impact of school health promotion on health risk behavior of students is increasing. This article focuses on the processes and initial results of developing a collaborative model tailored for whole-school health in the Netherlands, named schoolBeat. The Dutch situation is characterized by fragmentation, a variety of health and welfare groups supporting schools, and a lack of sound integrated youth policies. A literature review, observations, and stakeholder consultation provided a clear picture of the current situation in school health promotion, and factors limiting a comprehensive and needs-based approach to school health. This revealed that a health promotion team within a school is fundamental to an effective approach to tailored school health promotion. A respected member of school staff should chair this team. To strengthen the link with the school care team, the school care coordinator should be a member of both teams. To provide coordinated support to all schools in a region, participating organizations decided to share advisory tasks. These tasks are included in the regular health promotion work of their staff. This means working with one advisor representing all school-health organizations per school, and using a comprehensive overview of possible support and projects promoting health. Empowering schools in needs assessments and comprehensive school health promotion is an important element of the developed approach. This article concludes with an examination of emerging issues in evaluating collaborative school health support during the first 18 months of development, and implementation and future perspectives regarding sustainable collaboration and quality improvement. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)(click here to hide abstract)

The present study examined self-regulatory and goal-conflicting processes in the avoidance of drunk driving among Greek young drivers. A total of 361 university students in Greece completed a questionnaire, using a retrospective cross-sectional survey design. One-third reported to have driven under the influence of alcohol. Although prior intentions were clearly related to actual avoidance of drunk driving, one out of five respondents had not complied with their intention. An examination of post-intentional correlates of avoidance of drunk driving among positive intenders showed that avoidance of drunk driving was positively related to alcohol limitation plans and alcohol limitation self-efficacy, whereas negative relations were found for goal conflict and behavioural willingness. The present study suggests that people should not only be motivated but also be equipped with self-regulatory strategies aiming at the avoidance of drinking. Finally, goal commitment should be enhanced by increasing the salience of the avoidance goal. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract)(click here to hide abstract)

The aim of this study was to examine the fidelity and completeness of the implementation of a school-based healthful diet promotion programme called 'Krachtvoer' (we use the Dutch title of the programme throughout this article. A possible translation is Power Food, but this does not reflect the play on words in the Dutch title), aimed at lower vocational training students aged 12-14 years. The teachers' and students' opinions of the programme were also assessed, as well as the association between these opinions and the level of implementation. Data were collected through structured teachers' monitoring reports, in-class observations and in-depth interviews with teachers. Further data were drawn from a student questionnaire included in a concurrent cluster-randomized baseline post-test experimental study evaluating the effects of the programme. The present study indicates that the teachers implemented the programme largely according to plan, that the teachers appreciated most parts of the programme and that the students who were exposed to the programme were more appreciative of their nutrition education lessons than students who followed the usual curriculum. However, programme elements that teachers did not like were often not implemented. We conclude that the Krachtvoer programme is a promising tool to encourage students in lower vocational training to adopt diets that are more healthful. The present study revealed the stronger and weaker parts of the programme and can thus guide programme improvement.(click here to hide abstract)

This study investigated the factors influencing whether high school teachers implemented HIV/AIDS education. The independent variables included constructs derived from expectancy value theories, teachers' generic dispositions, their training experience, characteristics of their interactive context and the school climate. We conducted a postal survey of 579 teachers responsible for AIDS education in all 193 public high schools in Cape Town. Questionnaires were completed and returned by 324 teachers (56% response rate) from 125 schools. Many teachers (222; 70%) had implemented HIV/AIDS education during 2003, and female teachers were more likely to have implemented than males (74% vs. 58%). The teacher characteristics associated with teaching HIV/AIDS were previous training, self-efficacy, student-centeredness, beliefs about controllability and the outcome of HIV/AIDS education, and their responsibility. The existence of a school HIV/AIDS policy, a climate of equity and fairness, and good school-community relations were the school characteristics associated with teaching HIV/AIDS. These findings demonstrate the value of teacher training and school policy formulation. They also demonstrate the value and importance of interventions that go beyond a sexual health agenda, focussing on broader school development to improve school functioning and school climate.(click here to hide abstract)

Health risk judgments are not merely based on risk statistics but also on the ease with which hypothetical events are imagined. We explored the effects of scenario information as opposed to frequency information on susceptibility perceptions regarding Chlamydia and HIV. Results showed that participants felt more susceptible to Chlamydia after reading frequency information. Scenario information only seemed to affect feelings of susceptibility in participants with no intimate relationship. No effects on perceived susceptibility for HIV were found. Results are discussed in terms of severity of the disease and defensive reactions. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract)(click here to hide abstract)

This study examined relationships between behavioral inhibition, Big Five personality factors, and anxiety disorder symptoms in non-clinical children aged 9–12 years (N = 226), using children’s self-report and parent-report data. Results indicated that behavioral inhibition is best characterized by low extraversion with a tinge of neuroticism. Further, behavioral inhibition was clearly associated with anxiety symptoms, even when controlling for the influence of Big Five personality factors (including neuroticism). These results indicate that although behavioral inhibition partly overlaps with basic personality factors, this temperament characteristic remains an important predictive variable of anxiety pathology in youths. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (from the journal abstract)(click here to hide abstract)

BACKGROUND While the health risks of using ecstasy warrant intervention development, a recent meta-analysis of determinants of ecstasy use identified a number of lacunae in the literature. Specifically, no studies were included that address behaviours other than 'using ecstasy' (e.g. 'trying out ecstasy' or 'ceasing ecstasy use'). However, because meta-analyses aim to integrate study results quantitatively, the resulting rigid exclusion criteria cause many studies to be discarded on the basis of their qualitative methodology. Such qualitative studies may nonetheless provide valuable insights to guide future research. To provide an overview of these insights regarding ecstasy use, the current study summarizes and combines what is known from qualitative and exploratory quantitative literature on ecstasy use. METHODS The databases PsycINFO and MedLine were searched for publications reporting reasons for ecstasy use and related behaviour, and the results were structured and discussed per behaviour and compared over behaviours. RESULTS Two main categories of reasons were found. The first category comprised reasons to start using ecstasy, use ecstasy, use ecstasy more often, and refrain from ceasing ecstasy use. The second category comprised reasons to refrain from starting to use ecstasy, use less ecstasy, and cease using ecstasy. Reasons for related behaviours within each of these two categories appear to differ, but not as substantially as between the two categories. A large number of reasons that were not yet explored in quantitative research emerged. CONCLUSIONS The current summary and combination of exploratory studies yields useful lists of reasons for each behaviour. Before these lists can inform interventions, however, they beg quantitative verification. Also, similarity of determinant configurations of different behaviours can be assessed by addressing determinants of several behaviours in one study. Another important finding is that meta-analytical integration of the literature may overlook important findings and implications. Thus, qualitative reviews remain useful instruments in setting the research agenda.(click here to hide abstract)

Aims: The health hazards and prevalence of ecstasy use have been documented in two decades of research, but no review reporting on potentially modifiable antecedents of use is available. The aim of this study was to integrate systematically research identifying cognitive correlates of ecstasy use. Such research has the potential to identify targets for evidence-based interventions designed to discourage use. Methods: The databases PsycINFO and MedLine were searched, inclusion criteria applied to resulting hits, and descendency and ancestry approaches applied to the selected publications. Reported associations between cognitive determinants, including intention to use and ecstasy use measures, were synthesized by calculating a weighted mean effect size, r. Results: The pattern of associations lent support both to the theory of planned behaviour (TPB) and the expectancy approach as descriptions of potentially useful determinants. Attitudes were associated most strongly with intention and use, followed by subjective norm and perceived behavioural control. Conclusions: Consideration of the strength of associations and the potential modifiability of identified cognitions suggests that evidence-based interventions to discourage ecstasy use should target negative expectancies, perceived behavioural control and anticipated regret, and consider tailoring perceived behavioural control elements. (PsycINFO Database Record (c) 2008 APA, all rights reserved) (from the journal abstract)(click here to hide abstract)

The development of theory- and evidence-based health education interventions is a complex process in which interventionists in collaboration with priority groups and stakeholders make many decisions about objectives, change techniques, intervention materials and activities, delivery modes and implementation issues. In this development process, interventionists have to find a balance between employing change techniques that should be effective in an ideal world, and intervention activities and materials that match the reality of priority populations and intervention contexts. Intervention descriptions providing information about what behaviour change techniques have been employed, do not reflect the complexity of this decision-making process. They do not reveal why interventionists have decided to include or exclude particular behaviour change techniques. They do not reveal that interventions are based not only upon considerations of health psychologists and other scientists, but also on practical and political boundaries and opportunities that set the scene for the effectiveness of change techniques. Intervention descriptions should therefore reveal not only what is included in the interventions, but also why the intervention is as it is. Intervention Mapping provides the tools that enable the production of such descriptions. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (from the journal abstract)(click here to hide abstract)

OBJECTIVES:: Recent research has shown that experiences of stigmatization have an adverse impact on the psychological well being of people living with HIV/AIDS (PLWHA). Most studies investigating this relationship employ an aggregate measure of stigma. Although this approach provides useful information about the psychological implications of HIV-related stigma in general, it neglects to acknowledge the possibility that some manifestations in specific settings may be psychologically more detrimental than others. The present study examines which specific stigma experiences are most strongly related to psychological distress across a number of social settings. METHODS:: A cross-sectional survey was administered to 667 PLWHA in the Netherlands. We examined participants' experiences of 11 manifestations of HIV-related stigma in six social settings. Linear regression analyses were conducted to determine which setting-specific manifestations best predict psychological distress after controlling for marital status, education and health status. RESULTS:: Three manifestations in family settings, namely receiving advice to conceal one's status, being avoided and being treated with exaggerated kindness, and one manifestation in healthcare settings, namely awkward social interaction, best predicted psychological distress in PLWHA. CONCLUSION:: Manifestations of HIV-related stigma vary according to setting. Certain manifestations in specific social settings impact the psychological well being of PLWHA more than others. In this study, certain experiences of stigmatization with PLWHA's families and in healthcare settings were more strongly related to psychological distress than experiences occurring in other social settings. These findings suggest that stigma reduction interventions focusing on these influential settings may benefit the psychological well being of PLWHA.(click here to hide abstract)

This study investigated the effectiveness of a targeted intervention program aimed at at-risk adolescents in a randomized clinical trial design (N = 107). This program combined intervention methods which have been proven effective in reducing drinking in young adults, such as an expectancy challenge, cognitive behavioral skill training and brief motivational feedback. Additionally, this intervention contained the new element of discussing biological, cognitive and social risk factors for developing alcohol problems. We investigated whether this seven session program was successful in changing cognitive determinants of drinking behavior and consequently in moderating alcohol use and the development of alcohol-related problems in at-risk adolescents. The intervention was effective in changing several of the targeted cognitive determinants. However, despite the changes in these cognitive determinants of drinking, the experimental group did not show a significant difference in decrease of drinking at posttest compared with the control group. The results did not yield support for any differential long term effects of the intervention. We concluded that although the present intervention successfully changed important cognitive determinants of drinking more is needed to change subsequent drinking behavior in at-risk adolescents. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract)(click here to hide abstract)

An organizational field study (N = 257) investigated employees’ acceptance of a new merit pay system as involving an assessment of whether merit pay can make their earnings more fair, compared to their earnings in the current, seniority-based pay system. We expected that improvement of unfair earnings, and consequently acceptance of merit pay, is considered likely when existing procedures that produce these earnings are unfair, because merit pay improves such procedures. We also expected improvement of unfair earnings, and increased merit pay acceptance, to be likely when employees anticipate fair performance evaluation in a new system, as indicated by fair interpersonal treatment by their supervisor. Results showed that procedural and interpersonal fairness in the existing pay system indeed moderated the relationship between fairness of current outcomes and merit pay acceptance as predicted. Implications for the introduction of merit pay in organizations and for our understanding of the different roles of procedural and interpersonal fairness in outcome evaluations are discussed. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (from the journal abstract)(click here to hide abstract)

In this article it is argued that people behave unhealthily or change their unhealthy behaviour, not primarily out of the wish to be healthy, but to feel good and positive about themselves. First it is explained that people continue to perform their health related behaviours because they feel the need to be self-consistent. Second it is demonstrated that people are motivated to reduce the self-threat which occurs when they are confronted with the negative health consequences of their own behaviour. People engage in self maintenance strategies, which may reduce self-threat without the need to change risk behaviour. Next to the wish to feel good about the self and to be self consistent over time people are motivated to develop and enhance the self. Mechanisms by which people seek self-improvement are feedback from observing others and through enactive learning. In addition, people adapt their health-related behaviour in response to contextual stimuli in order to preserve or enhance their self. In conclusion, it is demonstrated that most instances of irrationality are related to silent preverbal motives to enhance or preserve a positive self,whether this has healthy or unhealthy consequences. The implications for health promotion intervention are discussed. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract)(click here to hide abstract)

Condom use within steady and casual sexual relationships was examined among 14-16 year old Dutch adolescents from secondary school (N = 140). It was hypothesised that among adolescents sex and subsequently condom use with casual sex partners is less likely to be considered in advance, more context-dependent and less habitual; whereas the opposite is true for steady relationships. Therefore, preparatory behaviours (buying and carrying condoms and communicating about condom use) were expected to mediate the intention-behaviour relation in the context of steady relationships, but not in the context of casual sex. Results confirmed that condom use with steady sex partners was explained by preparatory behaviours, habits, and to some extent, behavioural willingness, and that preparatory behaviours mediated the intention-behaviour relationship. Condom use with casual sex partners was predicted by risk willingness and intentions, without any mediation by preparatory behaviours. The results indicate that it is essential to increase awareness among adolescents that unexpected sexual situations may occur and to train them to take preparatory actions. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract)(click here to hide abstract)

Many adolescents fail to use condoms, even when they are motivated to do so. An important reason for their failure to use condoms is that they do not prepare themselves for potential sexual encounters. The present study examined the circumstances under which Dutch adolescents were likely to prepare themselves for condom use (buying and carrying). In a sample of 399 secondary school students, including students with and without sexual experience, it was found that intended condom use was not sufficient to ensure that adolescents plan and prepare for condom use. It was found that having the goal of condom use did not necessarily result in preparatory behavior, such as condom buying and condom carrying. The data showed that action-specific social-cognitive factors of preparatory behavior explained preparatory behavior, beyond the decision to use condoms. This suggests that interventions aimed at promoting condom use should focus not only on condom use itself, but should also motivate and encourage adolescents to buy and carry condoms. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract)(click here to hide abstract)

The purpose of this study was to examine the psychological processes pertaining to sexuality and sexual risk behavior among HIV-positive men who have sex with men (MSM). The authors analyzed transcripts of 30 semistructured interviews. Findings suggest that sexual problems in HIV-positive MSM might be primarily caused by the perceived risk of transmitting HIV to others. Furthermore, safer sexual behavior seems to be related to feelings of personal responsibility for safer sex. This study illustrates that although some men might have a clear notion of personal responsibility for safer sex, contextual factors can influence whether behavior is consistent with their norms of personal responsibility. The implications of the study are discussed for the practice of HIV prevention for HIV-positive MSM. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract)(click here to hide abstract)

Determinants of intended condom use with steady and casual sex partners were examined among Dutch HIV-positive men who have sex with men (MSM) (N = 296). Given the proposition that safer sex behavior among HIV-positive people is a form of prosocial behavior, the present study extended the general framework of the Theory of Planned Behavior with Schwartz's norm-activation theory and tested the assumption that personal norms would mediate the effects of other psychosocial factors on intended condom use for anal sex. In addition, it was hypothesized that, depending on the context in which sex occurs, specific motives for unprotected anal sex may have a negative influence on intended condom use and, as such, undermine a prosocial tendency to practice safer sex. Therefore, we also investigated the influence of sexual motives for unprotected anal sex on intended condom use with steady and casual sex partners. Results indicated that the Theory of Planned Behavior adequately predicted condom use intentions (for casual sex partners and steady sex partners, the explained variance was 52% and 53%, respectively). However, our proposed model of sexual decision-making significantly improved the prediction of behavioral intentions. For steady and casual sex partners, the assumption of the mediating role of personal norms on condom use intention was con- firmed empirically. Additionally, sexual motives for unprotected anal sex exerted, as expected, a direct, negative effect on condom use intention with casual sex partners. The implications of the findings for future research and the development of HIV-prevention programs for HIV-positive MSM are discussed. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract)(click here to hide abstract)

The objective of this study was to describe the application of a systematic process--Intervention Mapping--to developing a theory- and evidence-based intervention to promote sexual health in HIV-positive men who have sex with men (MSM). Intervention Mapping provides a framework that gives program planners a systematic method for decision-making in each phase of intervention development. In Step 1, we focused on the improvement of two health-promoting behaviors: satisfactory sexual functioning and safer sexual behavior. These behaviors were then linked with selected personal and external determinants, such as attitudes and social support, to produce a set of proximal program objectives. In Step 2, theoretical methods were identified to influence the proximal program objectives and were translated into practical strategies. Although theoretical methods were derived from various theories, self-regulation theory and a cognitive model of behavior change provided the main framework for selecting the intervention methods. The main strategies chosen were bibliotherapy (i.e., the use of written material to help people solve problems or change behavior) and motivational interviewing. In Step 3, the theoretical methods and practical strategies were applied in a program that comprised a self-help guide, a motivational interviewing session and a motivational interviewing telephone call, both delivered by specialist nurses in HIV treatment centers. In Step 4, implementation was anticipated by developing a linkage group to ensure involvement of program users in the planning process and conducting additional research to understand how to implement our program better. In Step 5, program evaluation was anticipated based on the planning process from the previous Intervention Mapping steps. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)(click here to hide abstract)

Objective: The present study aimed to predict Tanzanian medical students’ Voluntary Counseling and Testing (VCT) participation intention using the Health Belief Model (HBM) as a theoretical framework. Further, differences between respondents who had previously participated in VCT and respondents who had not were assessed. Methods: Cross-sectional data were gathered from 186 Tanzanian medical students using a self-administered questionnaire. Results: Almost half of the respondents (43.3%) reported having been tested for HIV. A prediction model containing HBM and demographic variables explained 31% of the variance in VCT-participation intention. Self-efficacy, fear of being HIV-positive, and perceived susceptibility contributed significantly to the final regression model. In addition, respondents who had previously participated in VCT expressed less fear of being stigmatized and being HIV-positive than respondents who had not. Conclusion: Fear of being HIV-positive, self-efficacy, perceived susceptibility and fear of being stigmatized were associated with either VCT-participation intention or previous participation. Further, the HBM accounted for a limited proportion of the explained variance in Tanzanian students’ intention to participate in VCT. This suggests that the validity of the HBM in explaining HIV-preventive behavior in Sub-Saharan Africa should be questioned. Practice implications: Interventions promoting VCT should incorporate program elements targeting self-efficacy, fear of being HIV-positive, perceived susceptibility and fear of being stigmatized. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (from the journal abstract)(click here to hide abstract)

Objective: The treatment of obesity is universally disappointing; although usually some weight loss is reported directly after treatment, eventual relapse to, or even above, former body weight is common. In this study it is tested whether the addition of cognitive therapy to a standard dietetic treatment for obesity might prevent relapse. It is argued that the addition of cognitive therapy might not only be effective in reducing weight and related concerns, depressed mood, and low self-esteem, but also has an enduring effect that lasts beyond the end of treatment. Methods: Non-eating-disordered overweight and obese participants in a community health center (N=204) were randomly assigned to a group dietetic treatment+cognitive therapy or a group dietetic treatment+physical exercise. Results: Both treatments were quite successful and led to significant decreases in BMI, specific eating psychopathology (binge eating, weight-, shape-, and eating concerns) and general psychopathology (depression, low self-esteem). In the long run, however, the cognitive dietetic treatment was significantly better than the exercise dietetic treatment; participants in the cognitive dietetic treatment maintained all their weight loss, whereas participants in the physical exercise dietetic treatment regained part (25%) of their lost weight. Conclusion: Cognitive therapy had enduring effects that lasted beyond the end of treatment. This potential prophylactic effect of cognitive therapy is promising; it might be a new strategy to combat the global epidemic of obesity. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (from the journal abstract)(click here to hide abstract)

Obese people prefer and over consume high-fat foods. At the same time they often attempt to lose weight. In two studies we investigated relations between palatable high-fat food words and disinhibition related concepts (study 1) and palatable high-fat food words and restraint related concepts (study 2) within the semantic priming paradigm. In study 1, 24 overweight/obese and 19 healthy weight women participated. There was no association between palatable high-fat food words and disinhibition. In study 2, 27 obese and 29 healthy weight women participated. The presentation of palatable high-fat food words facilitated the accessibility of restraint related concepts as hypothesized, but independent of weight status. Clearly, early associations with palatable high-fat food words are restraint related in both healthy weight and obese people. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (from the journal abstract)(click here to hide abstract)

In two experimental studies, the authors tested written health education materials on the personal acceptance of party drug use. Following a harm reduction strategy, the materials provided information on minimizing potential hazards associated with drug use. Among users and nonusers, potential aversive effects of these materials were examined on measures of attitude, intention, and outcome expectancy toward party drug use. Participants were recruited in the city center of Maastricht, The Netherlands, in nightlife settings that were popular among young people. In the first experiment, a leaflet on ecstasy use was evaluated among ecstasy users and nonusers. Results showed neither health promoting effects, nor counterproductive results on the outcome measures. In the second experiment, the effects of two different formats (leaflet vs. infocard) about two different kinds of party drugs (ecstasy vs. GHB) were compared within a non using population. Again, results showed no positive changes on the outcome measures toward ecstasy use as a result of exposure to the ecstasy materials. However, exposure to the GHB materials resulted into a more negative attitude, toward GHB use (leaflet and infocard) and lower estimates of the likelihood of positive outcomes of use (infocard). The study's limitations and implications are discussed, including the need for experimental pretesting. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (from the journal abstract)(click here to hide abstract)

Evaluated an interactive multimedia computer game to enhance self-management skills and thereby improve asthma outcomes in inner city children with asthma. Ss (aged 7-17 yrs) were recruited from 4 pediatric practices and randomly assigned to the computer intervention condition or to the usual-care comparison. The main character in the game could match the S on gender and ethnicity. Characteristics of the protagonist's asthma were tailored to be like those of the S. Ss played the computer game as part of regular asthma visits. Time between pre- and post-test varied from 4 to 15.6 mo (mean, 7.6 mo). Analysis of covariance, with pre-test scores, age, and asthma severity as covariates, found that the intervention was associated with fewer hospitalizations, better symptom scores, increased functional status, greater knowledge of asthma management, and better child self-management behavior for those in the intervention condition. Interactions with covariates were found and are discussed in terms of variable efficacy of the intervention. (PsycINFO Database Record (c) 2002 APA, all rights reserved)(click here to hide abstract)

Describes the development of the Watch, Discover, Think and Act asthma self-management computer program for inner-city children with asthma. The intervention focused on teaching 2 categories of behaviors--asthma-specific behaviors such as taking preventive medication and self-regulatory processes such as monitoring symptoms and solving asthma problems. These asthma self-management behaviors were then linked with empirical and theoretical determinants such as skills and self-efficacy. The authors then further used behavioral science theory to develop methods such as role modeling and skill training linked to the determinants. They matched these theoretical methods to practical strategies within the computer simulation and created a culturally competent program for inner-city minority youth. Finally, they planned a program evaluation that linked program impact and outcomes to the theoretical assumptions on which the intervention was based. (PsycINFO Database Record (c) 2002 APA, all rights reserved)(click here to hide abstract)

Evaluates the school-wide effects of Safer Choices, a multicomponent, behavioral theory-based HIV, sexually transmitted disease (STD), and pregnancy prevention program on risk behavior, school climate, and psychosocial variables. 20 urban high schools were randomized, and cross-sectional samples of classes were surveyed at baseline, the end of intervention (19 mo after baseline), and 31 mo after baseline. At 19 mo, the program had a positive effect on the frequency of sex without a condom. At 31 mo, students in Safer Choices schools reported having sexual intercourse without a condom with fewer partners. The program positively affected psychosocial variables--relevant knowledge, attitudes, perceived norms, and self-efficacy--and school climate for HIV/STD and pregnancy prevention. The program did not influence the prevalence of recent sexual intercourse. School-wide changes in condom use demonstrated that a school-based prevention program can reduce the sexual risk behavior of adolescents. (PsycINFO Database Record (c) 2002 APA, all rights reserved)(click here to hide abstract)

The extent to which employees rely on the worksite exclusively for health promotion programs was examined in a cross-sectional study of 10 federal worksites. Responses were received from 3,403 of the 5,757 employees surveyed (59%). Fewer than 10% of employees exclusively used agency programs for physical fitness, nutrition, substance abuse, smoking cessation, and support group meetings. A higher percentage participated in health risk assessment (27%), health and disease risk education activities (17%), medical care services (23%), personal safety and first aid training 26%, and stress management programs (17%) only at the worksite. Men were more likely than women to participate exclusively in workplace programs. MJME: *Community-Health-Services-utilization; *Health-Promotion-utilization; *Occupational-Health-Services-utilization MIME: Cross-Sectional-Studies; Government-Agencies-statistics-and-numerical-data; Middle-Age; Sex-Factors; United-States AGE: Middle-Age(click here to hide abstract)

Better understanding of the cognitive framework for decision making among legislators is important for advocacy of health-promoting legislation. In 1994, the authors surveyed state legislators from North Carolina, Texas, and Vermont concerning their beliefs and intentions related to voting for a hypothetical measure to enforce legislation preventing the sale of tobacco to minors, using scales based on the theory of planned behavior. Attitude (importance), subjective norm (whether most people important to you would say you should or should not vote for the law), perceived behavioral control (ability to cast one's vote for the law), and home state were independently and significantly related to intention to vote for the law's enforcement. The results, including descriptive data concerning individual beliefs, suggest specific public health strategies to increase legislative support for passing legislation to restrict youth tobacco sales and, more generally, a framework for studying policy making and advocacy.(click here to hide abstract)

BACKGROUND: Tobacco use is the chief avoidable cause of death in the United States. Physicians, however, are not routinely assessing this risk and providing counseling for risk reduction. This study examines tobacco cessation counseling practices among family practice residents and explores the determinants of residents' smoking-counseling behaviors and counseling duration. METHODS: One hundred ten family practice residents (response rate = 93.2%) from four Texas residency training programs completed a survey designed to assess tobacco cessation counseling practices. RESULTS: A high proportion of residents reported that they usually or always assessed tobacco use (59.3%) and advised their patients to quit smoking (80.9%), with a lower proportion reporting specific counseling behaviors (7.3% - 21.9%), referrals (1.8%), or follow-up visits (1.8%). Year of residency, perceived effectiveness, and the interaction between perceived effectiveness and residency year were significantly associated with number of counseling behaviors, and year of residency and perceived effectiveness were significantly associated with counseling duration. CONCLUSIONS: Faculty physicians should assist residents to implement the Public Health Service-sponsored clinical practice guideline for tobacco control. There is a need to increase behavioral skills and perceived effectiveness for assessing and counseling smokers among first-year residents. MJME: *Counseling-; *Family-Practice-standards; *Internship-and-Residency-standards; *Physician's-Practice-Patterns; *Smoking-Cessation MIME: Family-Practice-education; Multivariate-Analysis; Practice-Guidelines; Questionnaires-; Texas-(click here to hide abstract)

OBJECTIVE: To determine whether the implementation of the Put Prevention Into Practice (PPIP) office-based system would increase the delivery rates of specific clinical preventive services among demonstration clinics. METHODS: Chart review was conducted before (n=372) and 33 to 39 months after (n=376) the implementation of the PPIP office-based system in two community health centers and three family practice residency programs in Texas. The population included all adult patients aged > or = 19 years who had presented to the clinic during the study periods. RESULTS: Documentation of timely cholesterol screening increased from 70% to 84%; smoking assessment, from 56% to 80%; for women, up-to-date Papanicolaou smear, from 70% to 81%; annual mammograms (women aged > or =51), from 30% to 48%; and up-to-date tetanus-diphtheria immunizations, from 19% to 59%. For adults aged > or =66 years, documentation of pneumococcal immunization increased from 22% to 48%, while influenza immunizations improved, although not significantly (45% to 49%). Blood pressure screening was almost universal (99%) at baseline and at 33- to 39-month follow-up. CONCLUSION: PPIP system changes were associated with an observed increase in delivery of selected clinical preventive services. MJME: *Community-Health-Centers-standards; *Family-Practice-standards; *Guideline-Adherence-statistics-and-numerical-data; *Office-Visits; *Physician's-Practice-Patterns-statistics-and-numerical-data; *Preventive-Health-Services-utilization MIME: Aged-; Community-Health-Centers-utilization; Counseling-utilization; Follow-Up-Studies; Health-Services-Research; Immunization-utilization; Logistic-Models; Mass-Screening-utilization; Medical-Audit; Middle-Age; Practice-Guidelines; Preventive-Health-Services-standards; Program-Evaluation; Texas- AGE: Aged; Middle-Age(click here to hide abstract)

By altering dietary behaviors, nutrition interventions during adolescence have the potential of affecting children at that time and later in life. The majority of interventions implemented in the teen years have occurred in schools, but other intervention sites have included after-school programs, summer camps, community centers, libraries, and grocery stores. Programs with successful outcomes have tended to be behaviorally based, using theories for the developmental framework; included an environmental component; delivered an adequate number of lessons; and emphasized developmentally appropriate strategies. One planning method that can be used in the development of nutrition interventions is Intervention Mapping. The steps of Intervention Mapping include conducting a needs assessment, developing proximal program objectives, mapping appropriate strategies and methods to address the objectives, planning the program design, planning program adoption and implementation, and evaluation. The use of intervention-planning techniques, coordination of nutrition and physical education interventions, using technological advances such as CD-ROMs, incorporation of policy changes into intervention efforts, and dissemination of effective programs are all trends that will influence the future development of effective nutrition programs for adolescents. MJME: *Adolescent-Behavior-psychology; *Adolescent-Health-Services-organization-and-administration; *Adolescent-Nutrition; *Health-Promotion-organization-and-administration; *Program-Development MIME: Adolescent-; Adolescent-Behavior-physiology; Food-Habits; Marketing-of-Health-Services; Models,-Psychological; Needs-Assessment; Nutritional-Requirements; Persuasive-Communication; Program-Evaluation AGE: Adolescent(click here to hide abstract)

AIMS: This is a review of articles on sexual behaviour of school students in sub-Saharan Africa published between 1987 and 1999. The objective was to describe what is known in this regard and identify gaps in knowledge. METHODS: Literature search using electronic databases and a thumb search of relevant journals identified 47 articles reporting sexual behaviours of school-based young persons aged between 14 and 24 years. RESULTS: The findings indicate a relatively low number of articles when one considers the scope of the problems related to adolescent sexual behaviour in the region; high prevalence rates of sexual intercourse; infrequent use of condoms and other contraceptives; and significant proportions of adolescents who have two or more lifetime sexual partners. More data are needed on the extent to which adolescents engage in non-penetrative sexual behaviour and penetrative sex other than heterosexual vaginal intercourse; characteristics of the sexual partners of adolescents; and proximal psychosocial antecedents of sexual behaviour and consistent risk-reduction behaviours. CONCLUSIONS: Cultural influences on sexual behaviour, the sensitivity of such research in adolescent populations, and the opportunity afforded by school systems for intervention suggest a need for additional exploratory and methodological studies. Placing such information firmly within sociocultural contexts in which young people are raised will better inform effective interventions that both delay the onset of sexual intercourse and encourage use of risk reduction strategies.(click here to hide abstract)

Evidence-based health promotion programmes are based on empirical data and theory. While a broad range of social and behavioural science theories are available, the actual application of these theories in programme design remains a real challenge for health promotion planners. Intervention Mapping describes a protocol for the development of theory- and evidence-based health promotion programmes. It provides guidelines and tools for the selection of theoretical foundations and underpinnings of health promotion programmes, for the application of theory, and for the translation of theory in actual programme materials and activities. This article presents the protocol and elaborates on the application of theory, using examples from successful intervention programmes. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract)(click here to hide abstract)

The aim of this study was to gain insight into the extent to which health education text writers apply writing principles derived from cognitive psychological theory. Seventeen professional text writers of health education materials participated in a qualitative study, consisting of a rewriting task combined with a think-aloud procedure and a semistructured interview. The verbal data were explored carefully in light of seven text coherence principles that have proven effective in cognitive psychological research to increase text comprehension. Findings indicate text writers vary in their ideas and use of coherence principles to make a text comprehensible. It is argued that the health education profession can benefit greatly from knowledge about cognitive text processing and cognitive coherence principles for realizing effective comprehension of written health education messages.(click here to hide abstract)

Self-evaluation is crucial to mental and social well-being. It influences aspirations, personal goals and interaction with others. This paper stresses the importance of self-esteem as a protective factor and a non-specific risk factor in physical and mental health. Evidence is presented illustrating that self-esteem can lead to better health and social behavior, and that poor self-esteem is associated with a broad range of mental disorders and social problems, both internalizing problems (e.g. depression, suicidal tendencies, eating disorders and anxiety) and externalizing problems (e.g. violence and substance abuse). We discuss the dynamics of self-esteem in these relations. It is argued that an understanding of the development of self-esteem, its outcomes, and its active protection and promotion are critical to the improvement of both mental and physical health. The consequences for theory development, program development and health education research are addressed. Focusing on self-esteem is considered a core element of mental health promotion and a fruitful basis for a broad-spectrum approach. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)(click here to hide abstract)

Research into the effects of fear-arousal on precautionary motivation and action is reviewed. Current models do not adequately distinguish between emotional (i.e., fear arousal) and cognitive (i.e., threat perception) responses to fear appeals and, in general, are not well supported. Evidence suggesting that (1) coping appraisals arc more powerful predictors of precautionary action than threat perception and that (2) fear control processes may interfere with precautionary motivation, recommends cautious and limited use of fear appeals in health promotion. It seems likely that fear arousal is less important in motivating precautionary action than perceptions of action effectiveness and self-efficacy. Moreover, perceived personal relevance may be critical to the emotional and cognitive impact of threat information. Available findings are surnmarised in the form of a process model that highlights the potential complexity of fear arousal effects. Sequential measurement of fear arousal, other than by self-report, is recommended in studies seeking to clarify these effects. (PsycINFO Database Record (c) 2002 APA, all rights reserved)(click here to hide abstract)

Health promotion should be evidence-based, needs driven, subject to evaluation, and ecological in perspective. How can this be achieved in the context of school-based sex education? Adopting new behaviors and giving up old habits involves common decision-making, planning, motivational control, and goal prioritization processes. Consequently, despite the particular nature of sexual behavior, models of cognitive change applied to other health-related behaviors also apply to the promotion of safer sex practice. Young people are less likely to have unprotected sexual intercourse if they have acquired a variety of social skills relevant to dealing with romantic and sexual relationships. Many of these social skills and the methods employed to facilitate their development are also important to the promotion of other health behaviors. However, teaching social skills relevant to sexual behavior in classroom settings requires specialist expertise both in program design and in delivery by teachers or facilitators. Theory- and evidence-based programs designed to promote such skills and modified on the basis of effectiveness evaluations are most likely to have an impact on the rate of pregnancies and sexually transmitted infections among young people. Yet, such programs may not be used in schools because of policy and cultural constraints. When this is the case, optimally effective health promotion cannot be delivered. Health promoters should acknowledge these challenges and facilitate the adoption and implementation of effective sexual health promotion programs by targeting communities and legislators.(click here to hide abstract)

Most quality improvement or change management interventions are currently designed intuitively and their results are often disappointing. While improving the effectiveness of interventions requires systematic development, no specific methodology for composing intervention strategies and programmes is available. This paper describes the methodology of systematically designing quality of care improvement interventions, including problem analysis, intervention design and pretests. Several theories on quality improvement and change management are integrated and valuable materials from health promotion are added. One method of health promotion-intervention mapping-is introduced and applied. It describes the translation of knowledge about barriers to and facilitators of change into a concrete intervention programme. Systematic development of interventions, although time consuming, appears to be worthwhile. Decisions that have to be made during the design process of a quality improvement intervention are visualised, allowing them to serve as a starting point for a systematic evaluation of the intervention.(click here to hide abstract)

Examined determinants of intended condom use with casual and steady sex partners among drug users. The aim of the study was to find out whether anticipated regret and psychopathology represent additional factors in explaining condom use behaviour, on top of the constructs defined in traditional psychosocial models of behaviour. A questionnaire measuring intentions, attitude, beliefs, personal norm, subjective norm, descriptive norm, self-efficacy and anticipated regret toward condom use with steady and casual sex partners, and the Symptom Checklist 90 (to measure dimensions of psychopathology) were handed out to 150 Dutch drug users. Results show that intended condom use with steady sex partners was mainly predicted by self-efficacy, personal norm and anticipated regret. Lower feelings of hostility and a more positive personal norm, subjective norm and attitude significantly predicted intended condom use with casual sex partners. The results also show that intended condom use with steady sex partners seems to result from anticipating possible barriers, whereas condom use with casual sex partners is largely a matter of having safe sex norms. Practical implications of this study for AIDS-preventive campaigns are also discussed. (PsycINFO Database Record (c) 2009 APA, all rights reserved)(click here to hide abstract)

This article presents the development of a theory- and evidence-based AIDS prevention program targeting Dutch drug users and aimed at promoting condom use. The emphasis is on the development of the program using a five-step intervention development protocol called intervention mapping (IM). Preceding Step 1 of the IM process, an assessment of the HIV problem among drug users was conducted. The product of IM Step 1 was a series of program objectives specifying what drug users should learn in order to use condoms consistently. In Step 2, theoretical methods for influencing the most important determinants were chosen and translated into practical strategies that fit the program objectives. The main strategy chosen was behavioral journalism. In Step 3, leaflets with role-model stories based on authentic interviews with drug users were developed and pilot tested. Finally, the need for cooperation with program users is discussed in IM Steps 4 and 5.(click here to hide abstract)

This review examines the current state of knowledge on the effectiveness of HIV prevention interventions with respect to sexual behavior among the population of drug users. The review focuses specifically on the relation between intervention methods found to be effective and the underlying theory. Electronic searches were conducted and supplemented by publications gathered through other channels. The studies were reviewed for (1) study design, (2) evident use of theory in intervention development, (3) clear targeting of determinants, (4) description of the study or studies, and (5) evaluation of the behavioral goals and targeted determinants. For each study, a description is given of: (1) the size and nature of the sample; (2) the retention rate; (3) the study design; (4) the nature of the intervention programs, including theoretical methods, practical strategies and theoretical background; (4) the measures of variability. The most successful intervention methods were modeling, skill building and social support enhancement. The results show that a limited number of interventions were effective in changing sexual risk behavior among drug users. Future HIV/AIDS interventions should build on the strengths discussed. (PsycINFO Database Record (c) 2009 APA, all rights reserved)(click here to hide abstract)

In many Western societies, drug users are accountable for heterosexual transmission of HIV. Although various studies have shown that safe sex is not a common practice among drug users, there is still little understanding of the factors that determine their use of condoms in their sexual relationships with steady or casual partners. The objective of this study is to gain more insight into the determinants of drug users' condom use with steady and casual sex partners. In a study conducted among 103 Dutch drug users (mean age 34 yrs), the participants indicated their intentions, vulnerability, attitude, personal norms, subjective norms, descriptive norms, self-efficacy and response efficacy regarding condom use with steady and casual partners. The results showed that some drug users had borrowed used syringes and that most drug users practice unsafe sex, especially with steady partners. Most drug users were hardly motivated to start using condoms. The study further showed that antecedents of condom use differ with regard to steady sex partners and casual sex partners. Self-efficacy and subjective norms were predictors of intentions to use condoms with steady partners; intention to use condoms with casual partners was only predicted by self-efficacy. (PsycINFO Database Record (c) 2009 APA, all rights reserved)(click here to hide abstract)

Tested efficacy of a cystic fibrosis (CF) self-management program on improving knowledge, self-efficacy (SEF), self-management behavior, health, and quality of life for 104 patient-primary caregiver dyads from the intervention site CF center and 95 from the usual care comparison center. CF patients ranged from under 1 yr to 18 yrs of age. The intervention targeted behavioral capability, SEF, and outcome expectations. Parents, young and older children, and adolescents received separate materials on respiratory, nutrition and malabsorption, communication, and coping issues. Significant intervention effects were found on caregiver, adolescent, and child knowledge; caregiver and adolescent total self-management; Child Behavior Checklist total score; parent coping; the modified NIH score; NIH pulmonary Factor 1; and the Brasfield total score. Significant interaction effects were evident in SEF scores for caregivers and children. (PsycINFO Database Record (c) 2002 APA, all rights reserved)(click here to hide abstract)

The practice of health education involves three major program-planning activities: needs assessment, program development, and evaluation. Over the past 20 years, significant enhancements have been made to the conceptual base and practice of health education. Models that outline explicit procedures and detailed conceptualization of community assessment and evaluation have been developed. Other advancements include the application of theory to health education and promotion program development and implementation. However, there remains a need for more explicit specification of the processes by which one uses theory and empirical findings to develop interventions. This article presents the origins, purpose, and description of Intervention Mapping, a framework for health education intervention development. Intervention Mapping is composed of five steps: (1) creating a matrix of proximal program objectives, (2) selecting theory-based intervention methods and practical strategies, (3) designing and organizing a program, (4) specifying adoption and implementation plans, and (5) generating program evaluation plans. (PsycINFO Database Record (c) 2002 APA, all rights reserved)(journal abstract)(click here to hide abstract)

The creative challenge of health education for chronic illnesses is the translation of theory-based intervention methods into practical strategies that can be organized into a logical series of learning activities to influence changes in environmental, cognitive, or behavioral factors. A case example describing the development and implementation of a comprehensive health-education intervention for the self-management of cystic fibrosis (CF) is presented. The design of intervention strategies began with an assessment of the educational needs for self-management of CF, followed by specification and validation of particular self-management behaviors. Behavioral and learning objectives then were formulated for each of the self-management behaviors. Constructs from social learning theory considered to be important influences on specified self-management behaviors in CF were identified. Taking into consideration the learning needs of the target population and the practical constraints of the system for providing health care, various intervention methods then were devised based on social learning theory. Lastly, the intervention methods chosen were translated into strategies organized into a series of practical learning activities for CF patients and their families. The process described here should prove useful to others who are planning and developing comprehensive health education programs for self-management of chronic illnesses. MJME: *Cystic-Fibrosis-rehabilitation; *Patient-Education-organization-and-administration; *Program-Development; *Self-Care-methods MIME: Adaptation,-Psychological; Adolescent-; Child-; Child,-Preschool; Cystic-Fibrosis-psychology; Family-psychology; Learning-; Organizational-Objectives; Patient-Care-Planning-organization-and-administration; Psychological-Theory; Teaching-Materials AGE: Adolescent; Child; Child,-Preschool(click here to hide abstract)

Performance objectives for the self-management of cystic fibrosis (CF) were developed and subjected to a two-stage content validation. A multidisciplinary team of health care professionals generated a list of 149 medical and adjustment performance objectives. Behaviors included monitoring symptoms and judging their significance, treating symptoms and communicating with health care providers about symptoms and treatment plans. In the first stage a panel of experts in the medical and behavioral aspects of CF rated each behavior. In general, the eleven panelists rated the 149 behaviors as somewhat important or important (mean 2.6, S.D. 0.17, on a 3-point scale). In the second stage, 84 of 155 CF center directors rated all behaviors as somewhat important or important (mean 2.9, S.D. 0.23). Specific behaviors related to medical regimens were more consistently rated as important than were those related to psychosocial adjustment. The performance objectives provide a framework for developing and evaluating health education programs for the self-management of CF in order to promote optimum health and adjustment. MJME: *Cystic-Fibrosis-nursing; *Goals-; *Patient-Care-Planning; *Patient-Compliance; *Self-Care MIME: Evaluation-Studies; Patient-Care-Team; Patient-Education; Reproducibility-of-Results(click here to hide abstract)

As health promotion methods are proven effective, the diffusion and widespread implementation of successful programs can significantly reduce behaviors that pose risks to health within a targeted population. The Smart Choices Diffusion Project developed and evaluated a dissemination intervention program that targeted 128 school districts in east Texas. The project employed a theory-based model to disseminate information about a proven tobacco prevention program to opinion leaders in each district. These opinion leaders were asked to personally communicate the program information within their district using a videotape and printed materials, and advocate for program adoption. In addition to personal communication, a newsletter linked school districts. Opinion leaders in 52% of the districts showed the videotape, which modeled program adoption. A quasi-experimental design was used to evaluate the impact of the dissemination phase on teachers' and administrators' readiness to adopt a tobacco prevention program. Evaluation of the dissemination phase revealed no differences between the intervention and comparison districts in a district's readiness to adopt a tobacco prevention program. However, in intervention districts where school administrators viewed the videotape, the administrators were more likely to perceive the innovative program as having a relative advantage and to perceive their district's organizational and social environment as supportive of adopting the program. MJME: *Administrative-Personnel-psychology; *Diffusion-of-Innovation; *Faculty-; *Health-Education-organization-and-administration; *School-Health-Services-organization-and-administration; *Smoking-prevention-and-control MIME: Adult-; Attitude-to-Health; Middle-Age; Models,-Psychological; Program-Evaluation; Videotape-Recording AGE: Adult; Middle-Age(click here to hide abstract)

The first year of the Texas Triagency Coalition Smoke-Free Class of 2000 project (SFC2000) in Texas was evaluated using a descriptive model developed from diffusion theory. Tobacco-prevention education (TPE) materials were to be made available to all first grade teachers within the state. A random sample survey of 213 teachers indicated that 96 (44.7%) had received the materials. Adoption and implementation were high. By May of 1989, 64.2% of those teachers receiving materials had adopted and already implemented the program, and 25.3% had adopted and intended to use the materials. Almost all (96.8%) of those teachers who received the kit indicated that they would maintain the first grade program in the coming school year. Of respondents to a 1 year follow-up survey, 41.1% used it the first year only, 27.3% used it both years, 12.5% used it only in year 2 and 18.2% did not use it either year. Of those receiving the kits, 48% indicated that they had not previously taught TPE and thus were introduced to the concept of TPE through the SFC2000 kits. Receptivity was highest (over 90% agreement) for including TPE in elementary school curricula, with fewer teachers strongly agreeing with items tapping personal involvement with TPE. This evaluation of a statewide component of a national initiative reinforces the need to consider the dissemination and implementation of materials when planning large-scale interventions and evaluating their impact. MJME: *Health-Education-methods; *Health-Promotion-methods; *Smoking- MIME: Adult-; Child-; Faculty-; Follow-Up-Studies; Program-Evaluation; Questionnaires-; Schools-; Smoking-Cessation; Teaching-Materials; Texas- AGE: Adult; Child(click here to hide abstract)

OBJECTIVE: To determine state legislators' perceptions about health and tobacco lobbyists, their frequency of contact with these lobbyists, and the amount of campaign contributions from health professional organisations and the tobacco industry. DESIGN: Cross-sectional study. SUBJECTS: State legislators from North Carolina, Texas, and Vermont (USA), serving in 1994. MAIN OUTCOME MEASURES: Perceptions about lobbyists representing the tobacco industry, non-profit health organisations, and state medical societies with respect to their credibility, importance as sources of information, and persuasiveness; extent of lobbying activities; campaign contributions from health professional organisations and the tobacco industry. RESULTS: Almost all legislators reported that medical society and non-profit health organisation lobbyists are credible on tobacco issues and just over half believed that these lobbyists are important sources of information. More legislators said they could be persuaded by medical and health lobbyists than by tobacco lobbyists. Although health professional Political Action Committees (PACs) gave campaign contributions to more state legislators, and gave higher amounts on average, than tobacco PACs, legislators reported less contact with medical society lobbyists than tobacco lobbyists about tobacco issues. CONCLUSIONS: State legislators have positive attitudes toward lobbyists for non-profit health organisations and state medical societies regarding tobacco issues. These groups may be an underused resource for educating legislators about tobacco control measures. MJME: *Legislation,-Drug; *Lobbying-; *Plants,-Toxic; *Smoking-legislation-and-jurisprudence; *Smoking-prevention-and-control; *Tobacco- MIME: Cross-Sectional-Studies; Health-Policy-legislation-and-jurisprudence; North-Carolina; Policy-Making; Societies,-Medical; Texas-; Vermont-(click here to hide abstract)

Describes the development of a Dutch smoking prevention project which integrated qualitative and quantitative research methods. Combining the 2 methods in a spiral approach resulted in a synergistic effect because of the interaction of both approaches. Results of both methods suggest that qualitative methods enhanced the generation of ideas and theories. Qualitative methods were used to formulate ideas for improving quantitative data gathering, analyzing and comparing ideas with respect to program development, and for testing the internal validity of a quantitative design. The quantitative method enabled testing of results in different groups and detecting detailed differences. The major advantage of using both methods is that this provided feedback between assumptions and data, thus enhancing comparison of results. (PsycINFO Database Record (c) 2002 APA, all rights reserved)(click here to hide abstract)

The predictive validity of state legislators' behavioral intentions in relation to their votes on tobacco control legislation was assessed by using the theory of planned behavior (I. Ajzen, 1991). Intentions to vote for cigarette tax increases were measured through interviews in the summer of 1994. A bill containing cigarette tax increases was considered about 8 months later. Votes were compared with intentions and were found to be consistent for 78% of these legislators (N = 120). Multiple logistic regression analyses showed a strong independent relationship between intentions and voting and a similar effect of political party; results suggested but did not confirm that votes were predicted by interactions between intentions and perceived control. Legislator surveys that use this conceptual model can provide results relevant to understanding tobacco policy development. MJME: *Motivation-; *Politics-; *Smoking-legislation-and-jurisprudence MIME: Adult-; Health-Policy-legislation-and-jurisprudence; Internal-External-Control; Middle-Age; Smoking-prevention-and-control; Taxes-legislation-and-jurisprudence; Vermont- AGE: Adult; Middle-Age(click here to hide abstract)

BACKGROUND: This study analyzed influences on state legislators' decisions about cigarette tax increase votes using a research strategy based on political science and social-psychological models. METHODS: Legislators from three states representing a spectrum of tobacco interests participated in personal interviews concerned with tobacco control legislation (n = 444). Measures of potential predictors of voting intention were based on the consensus model of legislative decision-making and the theory of planned behavior. Multiple logistic regression methods were used to identify social-psychological and other predictors of intention to vote for cigarette tax increases. RESULTS: General attitudes and norms concerning cigarette tax increases predicted legislators' intention to vote for cigarette tax increases. More specific predictors included perceptions of public health impact and retail sales impact of cigarette tax increases. Constituent pressure was the strongest perceived social influence. Political party and state also were strong predictors of intention. Results were consistent with related research based on political science models. CONCLUSIONS: Legislators' votes on cigarette tax increases may be influenced by their perceptions of positive and negative outcomes of a cigarette tax increase and by perceived constituent pressures. This research model provides useful insights for theory and practice and should be refined in future tobacco control research. MJME: *Policy-Making; *Politics-; *Smoking-legislation-and-jurisprudence; *Taxes-legislation-and-jurisprudence MIME: Middle-Age; Public-Health-legislation-and-jurisprudence; Public-Policy; Smoking-economics; Smoking-prevention-and-control; Socioeconomic-Factors; United-States AGE: Middle-Age(click here to hide abstract)

OBJECTIVES: This study describes state legislators' knowledge, attitudes, and voting intentions with regard to tobacco-related issues. METHODS: A cross-sectional survey of state legislators was conducted in North Carolina, Texas, and Vermont in 1994. RESULTS: Most legislators agreed that secondhand smoke can cause lung cancer in nonsmokers, and a majority believed that smokers are addicted to nicotine. More than 75% stated that they would support a measure to enforce laws preventing tobacco sales to youth. A majority of Texas and Vermont legislators supported an increase in the state cigarette excise tax; 43% of North Carolina legislators would support an increase if revenues were directed toward tobacco farmer diversification. CONCLUSIONS: State legislators believe tobacco to be addictive, and they support policies to protect youth from tobacco. Support for other legislative measures differs significantly across states. MJME: *Politics-; *State-Government; *Tobacco-Industry-legislation-and-jurisprudence MIME: Cross-Sectional-Studies; Knowledge-; North-Carolina; Smoking-legislation-and-jurisprudence; Taxes-legislation-and-jurisprudence; Texas-; United-States; Vermont-(click here to hide abstract)

INTRODUCTION: Put Prevention Into Practice (PPIP) is a program designed to improve the delivery of clinical preventive services by primary care providers, through the use of specific office materials for providers and clinic staff, as well as an educational booklet for patients. The purpose of this study was to identify potential predictors of successful initiation of PPIP among 9 Texas public health clinics participating in a demonstration project funded by the Texas Department of Health (TDH). METHODS: The PRECEDE model was utilized as a theoretical framework for the study. A qualitative, case study methodology was employed, with structured interviews and open-ended questions asked of each site's PPIP personnel. Information from the sites' report to the TDH on the number of charts containing PPIP forms was also used for purposes of data triangulation. RESULTS: Sites that initiated PPIP successfully were characterized by a medium patient load, the ability to serve low-resource populations, prior attempts to implement categorical programs, existence of a philosophy of prevention, and pre-implementation planning. Barriers to successful initiation were identified as systems-related, patient-related, and staff-related. CONCLUSIONS: We identified factors that might predict the successful initiation of PPIP in public health primary care settings. Implications of present findings for implementation of similar health promotion programs in clinical settings are discussed. MJME: *Preventive-Health-Services; *Primary-Health-Care-methods MIME: Attitude-of-Health-Personnel; Data-Collection; Models,-Theoretical; Patient-Compliance; Preventive-Medicine; Program-Evaluation; Texas-(click here to hide abstract)

Fifty state and local coalitions that carry out the Smoke Free Class of 2000 program of the American Cancer Society, American Heart Association and American Lung Association were surveyed in 1990. Almost all (95%) rated themselves moderately or very active and a total of 88 900 second grade teachers were estimated to have received the materials. The availability of funds, competing priorities, lack of coordination, differences in agency service areas and personnel availability were most frequently cited as areas of concern to the coalitions. Personnel barriers and formality of coalition structure were independently related to perceived coalition effectiveness and, with the number of elementary schools, to perceived coalition activity. General recommendations, that were accepted upon completion of the assessment, included (1) formalization of agreements, mission statements, and goals and objectives, (2) attention to group formation and identification, and (3) clarification of national coalition expectations. MJME: *Health-Care-Coalitions-organization-and-administration; *Smoking-Cessation MIME: Data-Collection-methods; Health-Education; Health-Services-Research-organization-and-administration; Preventive-Health-Services-organization-and-administration; Program-Evaluation; United-States; Voluntary-Health-Agencies(click here to hide abstract)

Three successive cross-sectional surveys were used to measure the impact of a restrictive smoking policy on employee smoking patterns, perceived exposure to environmental tobacco smoke, attitudes about the policy, and smoking-related norms in a large decentralized state agency. No significant change was detected in smoking prevalence, the proportion of smokers attempting to quit, or the total daily consumption of cigarettes by smokers. The daily consumption of cigarettes at work decreased significantly, from 16.9% to 4.9% smoking 15 or more cigarettes per day. The proportion of respondents bothered every day by coworkers' smoke dropped from 21.8% to 3.8%. Following policy implementation, the interaction between smokers and nonsmokers about smoking decreased. The findings suggest that restrictive work site smoking policies are effective at decreasing exposure to environmental tobacco smoke, but not, at least in the short run, at lowering smoking prevalence. Also, the decreased interaction regarding smoking may have the unintended consequence of reducing the perceived pressure on smokers to quit. MJME: *Attitude-; *Employment-; *Public-Policy; *Smoking- MIME: Blacks-; Cross-Sectional-Studies; Hispanic-Americans; United-States; Whites-(click here to hide abstract)

The present study examined the prevalence, correlates, and perceived impact of smoking policies among private employers and public agencies in Texas. An identical survey instrument was administered to two groups of Texas employers: a random sample of private industries and all state agencies (excluding universities). Response rates were 62% (n = 420) for private industries and 73% (n = 130) for public agencies. Fifty-two percent of state agencies and 53% of private employers reported having a smoking policy, with the majority of policies having been implemented since 1986. Concern about employees' health or comfort was the most important reason for implementing a policy for both state agencies and private employers. Both groups believed that implementation of a policy resulted in fewer complaints from employees and less smoking in the workplace but had less impact on productivity or morale. This study on the prevalence of smoking policies in the workplace is the first to document that the majority of surveyed employers have a restrictive smoking policy in place. In addition, this study found minimal differences in the prevalence, rationale, and perceived benefits of smoking policies between private employers and state agencies. MJME: *Public-Policy; *Smoking- MIME: Industry-; Questionnaires-; Texas-(click here to hide abstract)

A qualitative survey on the collaborative experiences of colleges and universities, state-level organizations, and school districts related to comprehensive school health programs in 12 states found four primary collaborative outcomes: training, consultation, research, and networking. Five common dimensions of collaboration also were identified: interpersonal and organizational interactions, level of awareness and understanding of comprehensive school health programs, organizational priorities and reward systems, political forces, and availability and sharing of resources. The potential for such linkages to advance comprehensive school health programs remains largely untapped. Recommendations for developing such collaborations are presented. MJME: *Interinstitutional-Relations; *School-Health-Services-organization-and-administration MIME: Data-Collection; Government-Agencies; Health-Education; Health-Planning; United-States; Universities-(click here to hide abstract)

This study investigates the implementation of a restrictive smoking policy in decentralized worksites. A model which includes four elements--concept, context, process, and outcomes--is used as a framework for identifying characteristics that influence implementation. The organization studied was a state human services agency with approximately 400 worksites spread across 12 geographic regions. Quantitative data collection included three cross-sectional surveys of employees and supervisors administered before and after the date the policy became effective. Qualitative data were collected from three sources, including written comments on surveys, focus groups, and structured interviews with supervisors and top administrators. Tabular analyses and one-way analyses of variance were used to analyze quantitative data. Qualitative data were examined for key themes and have been used to elucidate findings. Those characteristics related to concept, context, and process which appeared to have the strongest influence on expected and unexpected outcomes of the restrictive smoking policy were degree of policy restrictiveness, job characteristics, perceived level of participation in formulation and implementation, and support of supervisors responsible for day to day enforcement. In particular, in this decentralized organization, lack of participation was found to underlie many of the problems experienced in implementation. The practical implications for developing and implementing a worksite restrictive smoking policy are discussed. MJME: *Health-Services-Research-methods; *Occupational-Health-Services-standards; *Smoking-Cessation MIME: Cross-Sectional-Studies; Health-Services-Research-standards; Interviews-; Models,-Theoretical; Occupational-Health-Services-organization-and-administration; Organizational-Objectives; Organizational-Policy; Outcome-Assessment-Health-Care; Patient-Compliance(click here to hide abstract)

Reviews the empirical and theoretical evidence for the feasibility and desirability of directing preventive interventions at HIV-positives (HIV+s). Research data on the behavior and motivation of HIV+s suggests that the differences between HIV+s and HIV-negatives and those who are unaware of their HIV status are not large. However, specific determinants of behavior, such as responsibility for others or the risk of superinfection, have seldom been measured. Effective interventions targeting at HIV+s and focussing on prevention are lacking. Fear of increased stigmatization has been used as an argument against focussing prevention activities at HIV+s. It is asserted that this argument is theoretically not correct: positive coping with HIV may invite positive reactions. It is concluded that HIV+s should be chosen as a special target group for additional planned preventive interventions. Effective interventions should be developed on the basis of theory and evidence about the specific determinants of risk behavior of HIV+: protecting oneself for superinfection and protecting one's partner. (PsycINFO Database Record (c) 2002 APA, all rights reserved)(click here to hide abstract)

The authors outline their method of working when developing theory-based and data-based intervention programs to promote health and behavioral self-regulation. The authors begin by elaborating on the concept of self-regulation in the field of health education. Finally the authors discuss how they select appropriate theories and the 3 approaches they used in their working method. (PsycINFO Database Record (c) 2002 APA, all rights reserved)(click here to hide abstract)

Describes how a process evaluation was used to measure "what happened" during an HIV/AIDS prevention program for farm workers in Zimbabwe. The intervention was developed according to the Paulo Freirian theory of Social Change and the Ecological Model for health promotion. In the 1st stage of the program, innovative methods were used to encourage appraisal of vulnerability to HIV/AIDS through activities which raised critical thinking and dialogue. In the next phase, emphasis was placed on developing cognitive and attitude change in the target group. Self-protective behavior was encouraged through condom use and an increase in self-efficacy with respect to negotiating safe sex. In the last stage of the intervention, efforts were made to create a climate for maintenance of behavior and socially responsible action within the community. The process evaluation provided insight into factors which, when aggregated, provided an overview of a program whose successes and failures may have been determined by issues outside the scope of the intervention. The effect of seasonal fluctuations of labor, income, and farming activity on program activity, patterns of STD, and condom demand were marked. The authors argue that the intervention was only partially implemented as planned. (PsycINFO Database Record (c) 2002 APA, all rights reserved)(click here to hide abstract)

A variety of primary prevention strategies are used in HIV prevention programs in Africa. However, these are often developed through intuition and the theoretical basis for many interventions is limited to the knowledge/attitude model. This article illustrates how research findings from a base-line survey are combined with P. Freire's (1983) social change theory and the Ecological Model for Health Promotion to develop a participatory intervention for HIV/AIDS prevention in farm workers in Zimbabwe. The article addresses the need to focus attention on the process of change at the interpersonal level, organizational and policy levels of the community. Dialogue is central to the range of strategies proposed for the intervention. The effect will be measured through process and outcome evaluation. (PsycINFO Database Record (c) 2002 APA, all rights reserved)(click here to hide abstract)

Presents the development and pilot testing of a self-management education program for parents of preschool children (aged 0-4 yrs) with asthma, involving general practitioners, asthma nurses, community nurses, and doctors of child health centers. The program contains 4 manuals, 1 for each group of health care providers, and a booklet for parents. The manuals identify the educational tasks per discipline and regulate referral from one discipline to another, while the booklet provides written information for parents. Representatives from both the target population and the providers of the education were involved in needs assessment surveys. A pilot study with 50 parents was conducted to test the efficacy of the program during group sessions. The variables measured (knowledge, attitude, self-efficacy, and self-management behaviors) improved significantly from pre- to posttest. (PsycINFO Database Record (c) 2002 APA, all rights reserved)(click here to hide abstract)

Settings--community, worksite, schools, and healthcare sites--constitute an important dimension of health education/health promotion policy and programs and for research about program needs, feasibility, efficacy, and effectiveness. These settings vary in the extent of coverage of and relationships with their respective constituencies, valued outcomes, and quantity and quality of evidence about the effectiveness of setting-specific and cross-setting programs. Main sources of evidence for program efficacy and effectiveness are summarized, leading to the conclusion that strides have been made toward building a strong evidentiary base for health education/health promotion in these settings. Gaps in research exist, especially for diffusion of effective programs, new technologies, the influence of policy, relations between settings, and approaches to marginal and special subgroups. Recommendations are offered for cross-setting and within-setting research related to intervention. MJME: *Health-Education-trends; *Health-Promotion-trends; *Health-Services-Research-trends; *Social-Environment MIME: Community-Health-Services-trends; Health-Behavior; Health-Policy-trends; Life-Style; Outcome-and-Process-Assessment-Health-Care(click here to hide abstract)

This paper describes development of Padres Trabajando por la Paz, a violence prevention intervention for Hispanic parents to increase parental monitoring. The intervention was developed using an innovative new program planning process: intervention mapping. Theory and empirical evidence broadly defined performance objectives and determinants of parental monitoring. These objectives were further refined through group and individual interviews with the target parent group. Learning objectives for the intervention guided the content of the intervention that used modeling as the primary method and role model stories as a strategy delivered through newsletters. Stage-matching members of the target population for their readiness to implement the parental monitoring behaviors further refined the social cognitive message design strategies. Intervention mapping provides an explicit theory- and data-driven guide for intervention development that maximizes intervention impact for a specific target population. MJME: *Hispanic-Americans; *Parent-Child-Relations; *Schools-; *Violence-prevention-and-control MIME: Adolescent-; Pilot-Projects; Texas-; Urban-Population AGE: Adolescent(click here to hide abstract)

This paper presents the results of theory-based intervention strategies to increase the adoption of a tobacco prevention program. The adoption intervention followed a series of dissemination intervention strategies targeted at 128 school districts in Texas. Informed by Social Cognitive Theory, the intervention provided opportunities for districts to learn about and model themselves after 'successful' school districts that had adopted the program, and to see the potential for social reinforcement through the knowledge that the program had the potential to have an important influence on students' lives. The proportion of districts in the Intervention condition that adopted the program was significantly greater than in the Comparison condition (P < 0.001). Stepwise logistic regression indicated that the variables most closely related to adoption among intervention districts were teacher attitudes toward the innovation and organizational considerations of administrators. Recommendations for the development of effective strategies for the diffusion of innovations are presented. MJME: *Decision-Making,-Organizational; *Diffusion-of-Innovation; *Health-Education-organization-and-administration; *School-Health-Services-organization-and-administration; *Smoking-prevention-and-control MIME: Administrative-Personnel-psychology; Attitude-to-Health; Faculty-; Logistic-Models; Organizational-Policy; Program-Evaluation(click here to hide abstract)

(from the chapter) focuses on the process of how health promotion programs are diffused throughout a given population / from a health promotion perspective, these programs or innovations may be viewed as either individual health behavior changes or specific programs designed to influence health behavior / both types of innovations will be discussed . . . but the emphasis will be placed on the latter, exploring theory and practice in methods to increase impact through greater diffusion /// the first section provides definitions, reviews theory, and gives examples of how the diffusion process can be applied to health promotion / the second section presents a four-stage model and discusses how social learning theory can be applied to designing intervention to influence the diffusion process / in the third section, a case study is provided to illustrate how a specific health promotion program moved from a demonstration research project to a widely diffused program (PsycINFO Database Record (c) 2002 APA, all rights reserved)(click here to hide abstract)

One hundred and ninety-nine patients and their primary caregivers at two metropolitan cystic fibrosis centers participated in a clinical trial to evaluate the effectiveness of a health education program designed to help improve self-management skills for the care of CF. The baseline data from the study was used to test a structural model that hypothesized the relationship between educational, behavioral, and health status variables. Controlling for the effects of all other variables, including demographic, self-efficacy (confidence in being able to perform a behavior) was the most important educational factor predicting self-management behavior for monitoring and treating respiratory problems. Knowledge about the management of CF was only related to the ability of caretakers to apply coping skills to problems associated with CF. The more caretakers reported performing monitoring behaviors the more likely they were to report performing self-management treatment behaviors. The findings suggest that educational interventions that focus on increased knowledge alone are not likely to be effective in improving self-management behavior for CF. Based on the structural model analyses, it is recommended that educational programs for CF patients and families address increased self-efficacy and improved monitoring skills to influence the improvement of self-management treatment for CF. MJME: *Cystic-Fibrosis-prevention-and-control; *Cystic-Fibrosis-psychology; *Knowledge,-Attitudes,-Practice; *Models,-Educational; *Models,-Psychological; *Patient-Education-organization-and-administration; *Self-Care-psychology MIME: Adaptation,-Psychological; Adolescent-; Caregivers-education; Caregivers-psychology; Child-; Child,-Preschool; Cross-Sectional-Studies; Cystic-Fibrosis-complications; Factor-Analysis,-Statistical; Family-psychology; Health-Status; Infant-; Program-Evaluation; Self-Concept AGE: Adolescent; Child; Child,-Preschool; Infant(click here to hide abstract)

Uses social learning theory to design intervention strategies within the dissemination, adoption, implementation, and maintenance phases of the diffusion process of a school-based tobacco prevention program to different school districts. Given that individuals learn not only through their own experiences but through observing the behavior and subsequent reinforcement of others, social learning strategies include modeling, incentives, guided mastery, self-application of acquired skills, and social contracting. The maintenance phase involves different types of incentives for teachers, school administrators, and district administrators to move from implementation to institutionalization. (PsycINFO Database Record (c) 2002 APA, all rights reserved)(click here to hide abstract)

Presents results of a survey of 956 Dutch public and private secondary school teachers, exploring the determinants of adoption of classroom-based AIDS education. Teachers were divided into biology, social studies, religion, or health educators/student counselors. Findings showed that teachers' decision making was strongly related to highly specific adoption-related beliefs of outcome beliefs, subjective norms, and self-efficacy. Adoption was related to more generic dispositions, sense of responsibility and sexual morality, and environmental conditions, such as school policy and frequency of collegial interaction about HIV instruction. Past experience with AIDS education appeared to be positively associated with teachers' intentions and related determinants. It is concluded that additional support needs to address teachers' anticipated ideological and practical constraints, with mass media interventions and responsive in-person assistance. (PsycINFO Database Record (c) 2002 APA, all rights reserved)(click here to hide abstract)

698 Dutch secondary school teachers intending to provide classroom AIDS education completed a questionnaire regarding their awareness knowledge about and adoption of 4 nationally disseminated AIDS curricula. Knowledge acquisition was dependent on diffusion networks within schools. Transition from awareness knowledge to adoption seemed to be mediated by perceived instrumentality, subjective norms, perceived colleague behavior, and Ss' sexual morality. Preferences for using a certain curriculum were related to the same variables, although financial costs became slightly more important. It is suggested that effective dissemination strategies should combine development of validated materials with clear instruction for implementation; focused mass media communication; close collaboration of curriculum designers, linking agents, and teachers; and access to in-person assistance. (PsycINFO Database Record (c) 2002 APA, all rights reserved)(click here to hide abstract)

(from the chapter) provides a brief history of the development of Social Learning Theory [SLT], descriptions of key concepts, and two examples of how the theory has been used to design health education programs /// by incorporating a concern for environment, people, and behavior, SLT provides a framework for designing and implementing comprehensive behavior change programs (PsycINFO Database Record (c) 2002 APA, all rights reserved)(click here to hide abstract)

The Child and Adolescent Trial for Cardiovascular Health (CATCH) was the largest school-based field trial ever sponsored by the National Institutes of Health. The trial demonstrated positive changes in the school food service and physical education program, as well as in students' cardiovascular health behaviors. Because the CATCH intervention programs were implemented in 56 schools (in 4 states) that were typical of schools throughout the US, their reception by schools and degree of implementation provide evidence about their feasibility for schools nationally. Extensive process evaluation data were collected from students, teachers, school food service personnel, and physical education specialists throughout the 3 school years of the CATCH intervention. Four of the CATCH programs--school food service, physical education, classroom curricula, and home programs--were assessed over the 3 school years. The process data provide information on participation, dose, fidelity, and compatibility of the CATCH programs in the intervention schools for these programs. High levels of participation, dose, fidelity, and compatibility were observed for the four programs during the 3 school years. (PsycINFO Database Record (c) 2002 APA, all rights reserved)(click here to hide abstract)

Conducted a cross-sectional survey of the determinants of consistent condom use of 1,018 pupils (12-19 yrs old) of 18 Dutch secondary schools. The survey is based on the theory of reasoned action and self-efficacy theory. Focus was on the impact of experience of sexual intercourse on attitudes, perceived social influences, and self-efficacy assessments regarding condom use because of AIDS. Results clearly indicate that, besides attitudes toward condom use, subjective social norms and self-efficacy expectations were important determinants of intended use. Furthermore, intercourse experience had a negative impact on attitudes and perceived social norms regarding condom use. (PsycINFO Database Record (c) 2007 APA, all rights reserved)(click here to hide abstract)

Evaluated the effects of an AIDS/sexually transmitted diseases (STDs) curriculum for 2,430 9th and 10th-graders in the Netherlands. Curriculum development was based on (1) theorybased need assessments among students and teachers, (2) pilot testing of databased and theorybased methods and materials, and (3) cooperation between researchers and students, teachers, and gatekeepers within the school system. Using a quasiexperimental design, program effects on students' attitudes, beliefs, and sexual behavior were compared with those of current AIDS/STD education practice. Results indicate that the experimental curriculum had a stronger favorable impact on students' attitudes and beliefs regarding using condoms consistently. Regarding sexual risk behavior, a differential curriculum effect could be demonstrated. (PsycINFO Database Record (c) 2002 APA, all rights reserved)(click here to hide abstract)

(from the chapter) when developing health education one is confronted with a variety of decisions regarding the content of the educational message, the target groups, the media, and so on / perhaps one of the most difficult steps is the translation of knowledge about behavioural determinants into feasible interventions using current fundamental insights from the behavioural sciences, especially social psychology, sociology and communication sciences / [this] chapter addresses this issue, describing systematic development of AIDS education for Dutch secondary schools / special attention will be paid to a spiral approach to data gathering in which qualitative and quantitative methods are combined . . . and to the need for cooperation between researchers, practical workers, teachers and students (PsycINFO Database Record (c) 2002 APA, all rights reserved)(click here to hide abstract)

To change the driving behavior of mail-van drivers so as to encourage energy saving, a program was developed and implemented in the Netherlands Postal and Telecommunications Services (PTT). Based on empirical analysis, 3 approaches were used to influence driving behavior: providing information, providing task assignment and control, and providing feedback on gasoline consumption. The effectiveness of the program was tested in a field experiment. Attitudes, social norms, and reported behavior changed, and energy savings of more than 7% were achieved, compared with a control group. From an economic point of view, further implementation in the PTT organization could be attractive. (PsycINFO Database Record (c) 2002 APA, all rights reserved)(click here to hide abstract)

Discusses the importance to community health of both personal and environmental conditions and presents a multilevel intervention model for practical use in influencing both conditions. The Multilevel Approaches Toward Community Health (MATCH) model consists of 4 phases: (1) health goals selection, (2) intervention planning, (3) intervention, and (4) evaluation. Applications of MATCH to hypertension, coronary heart disease, and unintentional injuries are included to show how the model can be used. Strengths of MATCH are identified, including its applicability to a wide variety of community health topics, settings, and target groups; its accommodation of a variety of intervention methods and theoretical approaches; and its focus on matching appropriate interventions to desired objectives. (PsycINFO Database Record (c) 2002 APA, all rights reserved)(click here to hide abstract)

Regret and disappointment (DIS) are emotions that can be experienced in response to an unfavorable outcome of a decision. Previous research suggests that both emotions are related to the process of counterfactual thinking. The present research extends this idea by combining it with ideas from regret and DIS theory. The results show that regret is related to behavior-focused counterfactual thought in which the decision-maker's own actions are changed, whereas DIS is related to situation-focused counterfactual thought in which aspects of the situation are changed. In Study 1, 130 Ss were asked to recall an autobiographical episode of either a regretful or a disappointing event. When asked to undo this event, regret Ss predominantly changed their own actions, whereas DIS Ss predominantly changed aspects of the situation. In Study 2 all 50 Ss read a scenario in which a person experiences a negative event. Ss who were instructed to undo the event by changing the person's actions reported more regret than DIS, while Ss who were instructed to undo the event by changing aspects of the situation reported more DIS than regret. Study 3 replicated the findings from Study 2 with a different scenario, and a design in which regret and DIS were measured between rather than within Ss. (PsycINFO Database Record (c) 2009 APA, all rights reserved)(click here to hide abstract)