Health Education Research - current issue

Communication: concepts, practice and challenges

Munodawafa, D. — 2008-05-26

Evaluation of an interactive, Internet-based weight loss program: a pilot study

Booth, A. O., Nowson, C. A., Matters, H. — 2008-05-26

The Internet can access a large number of consumers in a more cost-effective manner than other information delivery channels. In this pilot study, we assessed whether an online weight reduction program including dietary advice plus exercise (ED) was more effective in reducing weight than an exercise-only program (EX) >12 weeks. Participants were randomized to either the ED or EX group and attended a center for anthropometric measurements and dietary assessment. Both groups wore a pedometer and set weekly goals to increase daily steps through an interactive Web site. The ED group set weekly dietary goals via the Web site and received tailored e-mail assistance. Seventy-three participants commenced and 53 (73%) completed the study [EX n = 26; ED n = 27; body mass index—mean (standard deviation): 29.7 (2.5) kg m^–2, age 46.3 (10.8); 21% male]. Percent weight changes were EX, 2.1 (0.6)% and ED, 0.9 (0.6)% (P = 0.15). Both groups increased their daily steps with no difference between groups. Only the ED group significantly reduced their energy intake. Despite a greater fall in energy intake reported by the ED group and a similar increase in physical activity in both groups, setting individual dietary goals did not enhance weight loss.

Electronic monitoring and health promotion: an evaluation of the E-MOVO Web site by adolescents

de Nooijer, J., Veling, M. L., Ton, A., de Vries, H., de Vries, N. K. — 2008-05-26

The explosive increase in Internet accessibility and use offers unique opportunities for providing health information to adolescents via the Internet. The purpose of this evaluation study was to explore the opinions of adolescents regarding an Internet-based health monitoring instrument and its individually tailored electronic feedback so that recommendations for improvement can be provided. A self-administered evaluation questionnaire was completed by 672 adolescents aged 12–18 years the Dutch equivalent of the 8th and 10th grade of secondary education. Semistructured group interviews were conducted with 53 adolescents to obtain more in-depth information regarding the monitoring questionnaire and the individually tailored feedback. All the respondents preferred the electronic monitoring questionnaire to a paper and pencil questionnaire and the individually tailored feedback was appraised rather favorably. However, 28% of the respondents claimed that the information was not new to them and 39% indicated that the information failed to provide them with additional insight into their behavior. In order to increase the number of adolescents reached, we recommend (i) embedding monitoring and feedback in school curriculum, (ii) providing immediate feedback and (iii) adapting tailored messages to educational levels and age. Although several improvements can and should be made, we conclude that the Internet-based monitoring questionnaire and the individually tailored feedback were appreciated by adolescents and are therefore a promising method for engaging adolescents in health promotion.

Marketing hygiene behaviours: the impact of different communication channels on reported handwashing behaviour of women in Ghana

Scott, B. E., Schmidt, W. P., Aunger, R., Garbrah-Aidoo, N., Animashaun, R. — 2008-05-26

In 2003—04, a National Handwashing Campaign utilizing mass media and community events took place in Ghana. This article describes the results of the evaluation of the campaign in a sample of 497 women with children <5 years. The unifying message across all communication channels was that hands were not ‘truly’ clean unless washed with soap. The campaign reached 82% of the study population. Sixty-two per cent of women knew the campaign song, 44% were exposed to one channel and 36% to two or more. Overall, TV and radio had greater reach and impact on reported handwashing than community events, while exposure to both a mass media channel and an event yielded the greatest effect, resulting in a 30% increase in reported handwashing with soap after visiting the toilet or cleaning a child's bottom. Our evaluation questions wide-held belief that community events are more effective agents of behaviour change than mass media commercials, at least in the case of hygiene promotion. However, failure of mass media to reach the entire target audience, particularly in specific regions and lower socio-economic groups, and the additive effect of exposure, underscores the need to implement integrated communication programmes utilizing a variety of complementary channels.

Effects of tailoring health messages on physical activity

Smeets, T., Brug, J., de Vries, H. — 2008-05-26

Computer-tailored printed education can be a promising way of promoting physical activity. The present study tested whether computer-tailored feedback on physical activity is effective and whether there are differences between respondents with low and high motivation to change. Respondents (n = 487) were randomly assigned to a tailored intervention group or a no information control group. Physical activity and determinants were measured at baseline and after 3 months. At post-test, the motivated respondents in the control group were more likely not to meet the recommendation for physical activity than to meet it, and motivated respondents in the experimental group were more likely to engage in transport-related activities and showed more improvement over time for the total activity score than respondents in the control group (β = 0.24, P = 0.02). Both groups improved their behaviour over time. No group differences in physical activity were found for the unmotivated respondents. The results showed that the effects of the tailored feedback were restricted to respondents who had a positive motivation to change at baseline. Possible explanations could be that unmotivated respondents were unwilling to read and process the information because they felt ‘no need to change’. Alternatively, one tailored feedback letter may not have been sufficient for this unmotivated group.

Designing effective health education materials: experimental pre-testing of a theory-based brochure to increase knowledge

Whittingham, J. R. D., Ruiter, R. A. C., Castermans, D., Huiberts, A., Kok, G. — 2008-05-26

The aim of this study is to demonstrate the usefulness of developing health education materials with a theoretical and empirical research basis. With a specific focus on increasing knowledge, the authors utilized well-researched principles in cognitive psychology to increase the message comprehension of an existing health education brochure. The brochure used was produced by a Dutch national campaign office for preventing alcohol abuse among undergraduate students. In two experimental studies, the original version of the brochure was compared with the theory-based modified version on measures of knowledge and psychosocial determinants of alcohol use among undergraduate university students. The results show significant differences in knowledge uptake between the two versions. In both experiments, the modified version elicited higher scores on knowledge uptake than the original version. These findings underscore the importance of theory in the design of health education brochures. Despite these positive findings, no differences in more proximal psychosocial determinants of behavior could be found. As a result, the authors conclude that principles in cognitive psychology should be complemented by determinant-specific theory-driven change methods if behavior change is to occur.

Internet-delivered interventions aimed at adolescents: a Delphi study on dissemination and exposure

Crutzen, R., de Nooijer, J., Brouwer, W., Oenema, A., Brug, J., de Vries, N. K. — 2008-05-26

It appears that in practice exposure to Internet-delivered behaviour change interventions, encouraging a healthy lifestyle for adolescents with regard to health risk behaviours, is quite low. There is, however, a lack of evidence-based insight into how to disseminate such interventions and how to reach optimal exposure. A more extensive exploration is therefore timely since this knowledge is crucial to improve the public health impact of such interventions. By means of a three-round Delphi study factors associated with dissemination of and exposure (first visit, stay long enough and revisit) to Internet-delivered interventions aimed at adolescents had been identified, as well as the extent to which experts agree on the importance of these factors. Results showed that there was a high rate of consensus among experts from several disciplines with regard to the importance of factors like word of mouth recommendation, the interface of the intervention and utilization of all features provided by the Internet. Experts do not agree, however, on a gold standard for successful dissemination. Overall, the results of this exploration serve as a handle for the formation of further research questions to be tested and answered in research among adolescents.

Health information styles among participants in a prostate cancer screening informed decision-making intervention

Williams-Piehota, P. A., McCormack, L. A., Treiman, K., Bann, C. M. — 2008-05-26

The purpose of this study was to assess the usefulness of a health information styles segmentation strategy in understanding audience subgroups. We examined the health information styles of men participating in a prostate cancer screening informed decision-making (IDM) intervention and assessed intervention effects on men with distinct health information styles. We classified participants into three health information style groups based on their independence in health decision making (independent versus doctor dependent) and engagement in health enhancement (active versus passive): independent active (IA), doctor-dependent active (DDA) and passive. We developed profiles of men in these groups: IAs tended to be white and more highly educated and to have greater baseline prostate cancer knowledge; DDAs were older, less healthy and more likely to have visited a doctor in the past year and passives tended to be younger, not to have had a recent prostate-specific antigen test and to have lower self-efficacy related to communication with doctors and less positive interactions with doctors. All groups significantly increased their prostate cancer knowledge after the intervention, but passives exhibited the greatest increase in knowledge at a 6-month follow-up. The health information styles segmentation strategy used in this study offers a viable framework for segmenting audiences.

Understanding tailoring in communicating about health

Hawkins, R. P., Kreuter, M., Resnicow, K., Fishbein, M., Dijkstra, A. — 2008-05-26

‘Tailoring’ refers to any of a number of methods for creating communications individualized for their receivers, with the expectation that this individualization will lead to larger intended effects of these communications. Results so far have been generally positive but not consistently so, and this paper seeks to explicate tailoring to help focus future research. Tailoring involves either or both of two classes of goals (enhancing cognitive preconditions for message processing and enhancing message impact through modifying behavioral determinants of goal outcomes) and employs strategies of personalization, feedback and content matching. These goals and strategies intersect in a 2 x 3 matrix in which some strategies and their component tactics match better to some goals than to others. The paper illustrates how this framework can be systematically applied in generating research questions and identifying appropriate study designs for tailoring research.

Applying cognitive response testing in message development and pre-testing

Lapka, C., Jupka, K., Wray, R. J., Jacobsen, H. — 2008-05-26

Pre-testing messages with audience members is a critical step in the creation of effective health information. Quantitative methods for message testing have limited effectiveness, as they cannot reveal complications with language and comprehension. Cognitive response testing (CRT), a form of qualitative research, allows the interviewer to probe for deeper understanding of comprehension and language by asking participants to paraphrase items, discuss thoughts or emotions that come to mind and offer suggestions for improvement. This study explores the usefulness of CRT in message development and testing, adding to the literature regarding qualitative methods in public health. CRT was employed to evaluate health messages on two topics—bioterrorism and influenza vaccination. This technique effectively identified message terminology and concepts that respondents found unfamiliar or confusing, providing the framework needed for message revision. Commonly misunderstood words were replaced and confusing concepts were explained in the revised messages, making pre-tested messages more likely to be appropriate for the intended audience. These findings are consistent with previous research that establishes the usefulness of CRT in the evaluation and development of health-related messages and surveys.

Encouraging the right women to attend for cervical cancer screening: results from a targeted television campaign in Victoria, Australia

Mullins, R., Wakefield, M., Broun, K. — 2008-05-26

The study assessed whether a mass media campaign could encourage women who were overdue for a Papanicolaou (Pap) test to have one, without prompting unnecessary early re-screening. A telephone survey of a representative sample of 1000 Victorian women aged 25–65 years assessed recall of the advertisement and intention to act after seeing it. The television advertisement was recalled by 61.5% of women. Significantly more who said ‘I mean to have a test every two years, but I usually leave it longer’ indicated they would have a Pap test more often as a result of seeing the advertisement (63%), than women who had Pap tests every 1 (6%) or 2 (12%) years. Negative binomial regression analysis on data from the Victorian Cervical Cytology Registry from the middle of 2002 to the end of 2004 showed that during the campaign the number of Pap tests conducted increased by 18% (coeff = 0.169, df < 0.029). The rate increased most among those due or overdue for a Pap test. In a population with a high level of awareness of cervical screening, it is possible to run a mass media campaign to encourage screening which is specific to women whose test is due or overdue.

Prevention and screening efficacy messages in newspaper accounts of cancer

Moriarty, C. M., Stryker, J. E. — 2008-05-26

The news media are a primary source of cancer prevention and detection information for the general public, but little is known about the content of cancer prevention and detection messages in mainstream media. This study examines how cancer prevention and screening efficacy messages are presented in cancer news media coverage. Efficacy messages provide information about skills related to prevention and screening behaviors. Analysis of cancer-related stories in 44 major US daily newspapers during 2003 (n = 2448) reveals that efficacy messages were rarely present in cancer stories. Efficacy messages were less likely to appear in stories that had a ‘local’ angle, but efficacy messages were more likely to appear in stories that contained ‘mobilizing information’ (additional resources for readers) or stories that mentioned highly preventable cancers (lung, skin, esophagus and bladder). The discussion includes a theory of norms for effectively influencing cancer-related behaviors through news reports. Implications of this work extend to the lack of efficacy messages when highly detectable cancers are mentioned, thus the lack of actionable information when health risks are presented, and a dearth of efficacy messages when localized information is present, each of which represent key areas for encouraging health journalists to include more efficacy statements.

Developing tailored immunization materials for concerned mothers

Gust, D. A., Kennedy, A., Wolfe, S., Sheedy, K., Nguyen, C., Campbell, S. — 2008-05-26

The objectives of this study were to (i) identify ‘Worried’ and ‘Fencesitter’ mothers through the use of screening questions; (ii) obtain detailed information from participants about their attitudes and beliefs regarding vaccines and their interactions with their child's main health care provider, including availability of immunization information; (iii) solicit comments on draft educational materials that were developed specifically for this study and (iv) solicit comments on revised educational materials. Focus groups of mothers were conducted in two phases (Phase 1: n = 17 groups; Phase 2: n = 12 groups) and in three cities across the United States. Phase 1 focus group discussions suggested that perceived necessity and safety of vaccines contributed to mothers’ attitudes about having their child receive immunizations. Participants relied on their children's main health care provider for immunization information; however, mothers often perceived that providers did not supply enough information about vaccinations. In Phase 2, comments on the revised educational materials (brochures) were generally positive, with many mothers noting that the new brochures provided more relevant information and conveyed it in a respectful way. Science-based tailored immunization materials may assist health care providers in addressing unique information needs and may improve vaccine acceptance among specific types of mothers.

Reasons, assessments and actions taken: sex and age differences in uses of Internet health information

Ybarra, M., Suman, M. — 2008-05-26

The Internet is transforming the way in which consumers approach their health care needs. Sex and age are influential aspects of one's health as well as disease risk and are thus integral components of the emerging picture of health information seekers. Using data from Surveying the Digital Future, Year 4, a nationally representative, longitudinal telephone survey of Americans 12 years of age and older (n = 2010), we examine the reasons for, assessments of and actions taken as a result of health information found online among men and women and older and younger people. Although we tend to think of the Internet as a young person's technology, the percent of adults 60 years of age and older is similar to that of adolescents using the Internet as a health care information resource, thus suggesting an untapped opportunity with online interventions for older adults. Nonetheless, as age increases so too does the report of frustration with the experience. Men are more likely to report a positive seeking experience than women. Differences in Internet use fail to explain these observed sex and age differences in the seeking experience. Across the spectrum of age, sex and Internet skill, Internet health information seeking appears to enhance the patient–provider relationship.

Effectiveness of health-promoting media literacy education: a systematic review

Bergsma, L. J., Carney, M. E. — 2008-05-26

Media literacy education to promote health among youth involves them in a critical examination of media messages that promote risky behaviors and influence their perceptions and practices. Research on its effectiveness is in its infancy. Studies to date have been conducted with more or less rigor and achieved differing results, leaving many questions about effectiveness unanswered. To elucidate some of these questions, we conducted a systematic review of selected health-promoting media literacy education evaluation/research studies, guided by the following research question: What are the context and process elements of an effective health-promoting media literacy education intervention? Based on extensive analysis of 28 interventions, our findings provide a detailed picture of a small, 16- to 17-year (1990 to July 2006) body of important research, including citation information, health issue, target population/N/age, research design, intervention length and setting, concepts/skills taught, who delivered the intervention and ratings of effectiveness. The review provides a framework for organizing research about media literacy education which suggests that researchers should be more explicit about the media literacy core concepts/skills they are including in their interventions, and should more carefully address who delivered the intervention with what fidelity, in what setting, for how long and utilizing what pedagogical approach.

Can even minimal news coverage influence consumer health-related behaviour? A case study of iodized salt sales, Australia

Li, M., Chapman, S., Agho, K., Eastman, C. J. — 2008-05-26

Lack of iodine in the diet can cause a spectrum of conditions, known as iodine deficiency disorders (IDD). While iodized salt has been retailed in Australia since the 1960s, sales have remained low, at ~10% of total edible salt sales. Salt has never been promoted, advertised or discounted by retailers or manufacturers. Extensive news coverage of health issues has often been shown to influence consumer behaviour. But can even modest news coverage generate changes in consumer health-related behaviour? We report a significant increase (5.2%) in national iodized salt sales after a brief period of television and newspaper reports about IDD and the benefits of using iodized salt during and after the Australian National Iodine Nutrition Study in 2003 and 2004. We conclude that even brief news media exposure can influence health-related decisions.

Evidential preferences: cultural appropriateness strategies in health communications

2008-05-26

While there is widespread agreement that communication programs and materials will be more effective when they are ‘culturally appropriate’ for the populations they serve, little is known about how best to achieve this cultural appropriateness. The specific strategies used to realize the potential of culturally appropriate communication take many forms. This paper discusses an approach to assessing and understanding the presentation of statistical information (an evidential strategy) to enhance the perceived relevance of communications targeted to older African American men and women. Formative research on African Americans’ attitudes and knowledge of colorectal cancer explored preferences for presentation of statistical data. Focus group interviews elicited participants’ (n = 49) thoughts and attitudes on and anticipated behavioral response to five strategies for presenting cancer data and evidence—general, race specific, disparity, social math and framing ~5-year probability of death or survival. A description is provided of the application of this approach to the development of a colorectal cancer campaign for African Americans. This strategy may prove useful in understanding and structuring the presentation of targeted cancer evidence that could result in more effective health communication.

Information technology in health promotion

Lintonen, T. P., Konu, A. I., Seedhouse, D. — 2008-05-26

eHealth, the use of information technology to improve or enable health and health care, has recently been high on the health care development agenda. Given the vivid interest in eHealth, little reference has been made to the use of these technologies in the promotion of health. The aim of this present study was to conduct a review on recent uses of information technology in health promotion through looking at research articles published in peer-reviewed journals. Fifteen relevant journals with issues published between 2003 and June 2005 yielded altogether 1352 articles, 56 of which contained content related to the use of information technology in the context of health promotion. As reflected by this rather small proportion, research on the role of information technology is only starting to emerge. Four broad thematic application areas within health promotion were identified: use of information technology as an intervention medium, use of information technology as a research focus, use of information technology as a research instrument and use of information technology for professional development. In line with this rather instrumental focus, the concepts ‘ePromotion of Health’ or ‘Health ePromotion’ would come close to describing the role of information technology in health promotion.

Developing a consumer evaluation tool of weight control strategy advertisements on the Internet

Luevorasirikul, K., Gray, N. J., Anderson, C. W. — 2008-05-26

To develop two evaluation tools for weight loss and weight gain advertisements on the Internet in order to help consumers to evaluate the quality of information within these advertisements. One hundred websites identified by Internet search engines for weight loss and weight gain strategies (50 websites each) were evaluated using two specific scoring instruments, developed by adapting questions from the ‘DISCERN’ tool and reviewing all related weight control guidelines and advertising regulations. The validity and reliability of the adapted tools were tested. Our evaluation tools rated the information from most websites as poor quality (70%). In the case of weight loss strategies, statements about rapid (18%) and permanent (28%) weight loss caused concern as well as lack of sensible advice about dieting and a lack of product warnings (84%). Safety concerns relating to weight gain products were the lack of warnings about side effects in products containing steroids and creatine (92%). The adapted tools exhibited acceptable validity and reliability. Quality of information within weight control advertisements on the Internet was generally poor. Problems of false claims, little advice on healthy ways to modify weight and few warnings on side effects have been highlighted in this study.

Promoting health-enhancing physical activity in the primary school: a pilot evaluation of the BASH health-related exercise initiative

Fairclough, S. J., Stratton, G., Butcher, Z. H. — 2008-05-26

The ‘Be Active Stay Healthy’ (BASH) health-related exercise (HRE) programme was delivered to Year 5 students (age 9–10 years) in two primary schools situated in the same area of a northwest England town. BASH aims to improve students’ participation in and knowledge of HRE through structured physical activities. Fifty-five students completed pre- and post-programme HRE knowledge and understanding questionnaires. Moderate to vigorous physical activity (MVPA) levels of 13 students were assessed using accelerometers during two contrasting lessons focusing on optimal activity levels (active) and cognitive learning (cognitive). Mean percentage of correct questionnaire answers improved from 60.8 to 83.8% (P = 0.0001, effect size (ES) = 1.44), and questionnaire performance was significantly better among students in one of the schools (P = 0.017, ES = 0.72). Boys engaged in MVPA for 11% more time than girls during the active lessons (P = 0.0006, ES = 1.21) but MVPA during cognitive lessons was similar. The BASH programme has potential to use structured physical activity as a medium to enhance students’ HRE knowledge, particularly in relation to the fundamental understanding of healthy and active lifestyles. HRE knowledge may differ between schools, even when they are similarly sized and located, with analogous student catchment areas. Recommendations for the future delivery and evaluation of the programme are made.