Community Health Worker Knowledge, Attitudes, Practices and Readiness to Manage Intimate Partner Violence

Intimate partner violence (IPV) is an important public health concern with higher prevalence among women. Community health workers (CHWs) are trusted frontline public health workers that bridge gaps between communities and healthcare services. Despite their effectiveness in delivering services and improving outcomes for different chronic conditions, there is a dearth of understanding regarding CHW management of IPV. The purpose of this study is to examine knowledge, attitudes, practices, and readiness to manage IPV among a sample of CHWs (n = 152). Participants completed an online version of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS), which was modified for CHW practice. Psychometrics of the newly adapted tool, along with empirical relationships between knowledge, attitudes, and readiness to manage IPV were examined. Most sub-scales yielded moderate to high reliability (0.70 < α's < 0.97), some sub-scales had low reliability (0.57 < α's < 0.64), and construct validity was established for several of the subscales. On average, many CHWs had low scores on objective knowledge of IPV (mean = 15.4 out of 26), perceived preparation to manage IPV (mean = 3.8 out of 7), and perceived knowledge of IPV (mean = 3.7 out of 7). About 56% of CHWs indicated having no previous IPV training, 34% did not screen for IPV, and 65% were in the contemplation stage of behavior change. Multiple regression models indicated that knowledge, staff capabilities and staff preparation were significant predictors of perceived preparedness to manage IPV (all p's < 0.05). Results can inform future credentialing requirements and training programs for CHWs to better assist their clients who are victims of IPV.

Evaluation of the blinq vision scanner for detection of amblyopia and strabismus

PURPOSE

To report the results of a clinical study designed to evaluate the accuracy of the blinq pediatric vision scanner, which detects amblyopia and strabismus directly by means of retinal polarization scanning, unlike other vision screening devices, which infer possible disease based on detection of refractive risk factors.

METHODS

Subjects 1-20 years of age were prospectively enrolled in this cross-sectional diagnostic accuracy study with planned enrollment of 200. All enrolled subjects were tested by individuals masked to the diagnosis, followed by complete ophthalmologic examination by pediatric ophthalmologists masked to the screening result. Patients previously treated for amblyopia or strabismus were analyzed separately.

RESULTS

The study cohort comprised 193 subjects, 53 of whom had been previously treated, leaving 140 treatment-naïve subjects, including 65 (46%) with amblyopia or strabismus, 11 (8%) with risk factors/suspected binocular vision deficit without amblyopia/strabismus, and 64 (46%) controls. Sensitivity was 100%, with all 66 patients with referral-warranted ocular disease referred. Five patients with intermittent strabismus receiving pass results were deemed "acceptable pass" when considering patient risk factors and amblyogenic potential. Specificity was 91%, with 7 incorrect referrals. Subanalysis of children aged 2-8 years (n = 92) provided similar results (sensitivity 100%; specificity 89%).

CONCLUSIONS

In this study cohort, the blinq showed very high sensitivity and specificity for detecting referral-warranted unilateral amblyopia and strabismus. Implementation of the device in vision screening programs could lead to improved rates of disease detection and reduction in false referrals.

Digital Health Communication Common Agenda 2.0: An Updated Consensus for the Public and Private Sectors to Advance Public Health

Despite widespread use of the Internet and social media platforms by the public, there has been little organized exchange of information among the academic, government, and technology sectors about how digital communication technologies can be maximized to improve public health. The second Digital Health Promotion Executive Leadership Summit convened some of the world's leading thinkers from across these sectors to revisit how communication technology and the evolving social media platforms can be utilized to improve both individual and population health. The Summit focused on digital intelligence, the spread of misinformation, online patient communities, censorship in social media, and emerging global legal frameworks. In addition, Summit participants had an opportunity to review the original "Common Agenda" that emerged and was published after the inaugural Summit and recommend updates regarding the uses of digital technology for advancing the goals of public health. This article reports the outcomes of the Summit discussions and presents the updates that were recommended by Summit participants as the Digital Health Communication Common Agenda 2.0. Several of the assertions underlying the original Common Agenda have been modified, and several new assertions have been added to reflect the recommendations. In addition, a corresponding set of principles and related actions-including a recommendation that an interagency panel of the U.S. Department of Health and Human Services be established to focus on digital health communication, with particular attention to social media-have been modified or supplemented.

Content and Feature Preferences for a Physical Activity App for Adults With Physical Disabilities: Focus Group Study

Background

Hundreds of thousands of mobile phone apps intended to improve health and fitness are available for download across platforms and operating systems; however, few have been designed with people with physical disabilities in mind, ignoring a large population that may benefit from an effective tool to increase physical activity.

Objective

This study represents the first phase in the development process of a fitness tracking app for people with physical disabilities interested in nontraditional sport. The aim of this research was to explore user preferences for content, appearance, and operational features of a proposed physical activity app for people with physical disabilities to inform the design of a mobile phone app for increasing physical activity.

Methods

Four focus groups were conducted with 15 adults with physical disabilities who currently participate in nontraditional, non-Paralympic sport. Data collected from the focus group sessions centered on content, functionality, and appearance of apps currently used by participants as well as preferences for a future app.

Results

Participants (mean age 35.7, SD 9.2 years) were mostly white (13/15, 87%), and all were currently participating in CrossFit and at least one other sport. Five main themes were identified. Themes included preferences for (1) workout-specific features that were tailored or searchable by disability, (2) user experience that was intuitive and accessible, (3) profile personalization options, (4) gamification features that allowed for competition with self and other users, and (5) social features that allowed increased interaction among users. Participants expressed a primary interest in having a fitness app that was designed for people with physical disabilities such that the features present in other fitness tracking apps were relevant to them and their community of adaptive athletes.

Conclusions

The results showed that features related to user experience, social engagement, and gamification are considered important to people with physical disabilities. Features highlighted by participants as most desired, from a consumer perspective, were in line with research identifying attributes of quality apps that use behavior change techniques to influence positive physical activity behavior change. Such insights should inform the development of any fitness app designed to integrate users with disabilities as a primary user base.

Utilizing Student Health and Academic Data: A County-Level Demonstration Project

Students with chronic health conditions miss more school days than their peers and are at increased risk for performing worse on standardized tests and not completing a high school degree. University-based researchers, state government leaders, and a local county school system collaborated to use existing health and academic data to (1) evaluate the strength of the relationship between health status and school performance (absenteeism, grades) and (2) describe the health status of students who are chronically absent. Analyses included descriptive statistics, chi-square tests, negative binomial regression models, and estimated marginal means. The most common health conditions among the 3,663 kindergarten through Grade 12 students were ADD (attention deficit disorder)/ADHD (attention deficit hyperactivity disorder), asthma, migraine headaches, mental health conditions, and eczema/psoriasis/skin disorders. After controlling for covariates, having asthma or a mental health diagnosis was positively associated with absences; and having an ADD/ADHD or mental health diagnosis was negatively associated with GPA (grade point average). Chronically absent students had significantly lower GPAs, and a higher number of health conditions than other students. The success of this demonstration project encourages strengthening existing collaborations and establishing new multidisciplinary partnerships to analyze existing data sources to learn more about the relationship between student health and academic achievement. Moreover, connecting health status to academic achievement might be a chief tactic for advocating for additional resources to improve the care and management of chronic disease conditions among students.

OMG U #Cyberbully! An Exploration of Public Discourse About Cyberbullying on Twitter

Cyberbullying, defined as bullying that takes place using technology, includes similar tactics found in traditional bullying as well as unique approaches such as viral repetition. Nationally, prevalence rates for cyberbullying range from 10% to as high as 40% of school-aged children, depending on the definition and measurement tool applied. The current study examines public tweets with keywords and hashtags related to cyberbullying posted during May 2016, using both human evaluation and computer examination to answer the following research questions: (1) What is the sentiment of tweets using cyberbullying keywords/hashtags? (2) What is the thematic content of the tweets? (3) What is the relationship between coding by researchers versus automated coding by Linguistic Inquiry and Word Count (LIWC) software? and (4) What is the content of the URLs attached to the tweets? A unique aspect of this study is the examination of the content of URLs included in the tweets, with the finding that the majority of the accessible URL references were to material that was positively focused. The majority of sample tweets referred to a cyberbully situation, contributed to a negative atmosphere, included references to known individuals, and suggested ongoing cyberbullying events. Results from this study suggest an opportunity for researchers, educators, and public health practitioners to use discourse on social media to inform interventions, to educate and share information, and to promote social well-being and mental health.

Assistive technology needs, functional difficulties, and services utilization and coordination of children with developmental disabilities in the United States

Assistive technology (AT) enhances the ability of individuals with disabilities to be fully engaged in activities at home, at school, and within their communities-especially for children with developmental disabilities (DD) with physical, sensory, learning, and/or communication impairments. The prevalence of children with DD in the United States has risen from 12.84% in 1997 to 15.04% in 2008. Thus, it is important to monitor the status of their AT needs, functional difficulties, services utilization, and coordination. Using data from the 2009-2010 National Survey on Children with Special Health Care Needs (NS-CSHCN), we conducted bivariate and multivariate statistical analysis, which found that 90% or more of parents of both children with DD and other CSHCN reported that their child's AT needs were met for vision, hearing, mobility, communication, and durable medical equipment; furthermore, children with DD had lower odds of AT needs met for vision and hearing and increased odds for meeting AT needs in mobility and communication. Our findings outline the current AT needs of children with DD nationally. Fulfilling these needs has the potential to engender positive lifelong effects on the child's disabilities, sense of independence, self-confidence, and productivity.

Patient Education Reimbursement: An Experiment in Maine

With increasing emphasis being placed on controlling health care costs the Maine Department of Human Services decided in 1977 to undertake a three year experimental effort designed to demonstrate the potential of patient education for reducing medical care costs. Focusing on rural ambulatory care the program established formal patient education in health centers across the state. This article will cover the scope and sequence of events during the first two years with particular emphasis on the problems encountered in program planning and implementation. It will discuss some problems of rural development and includes recommendations for the reimbursement of patient education for third party programs.

Spontaneous comparisons with others in gay men's judgements of HIV risk

In studies on ‘unrealistic optimism’ (UO), when people are asked questions designed to make them compare their risk of experiencing an undesirable event with that of the average person, they tend to respond that their risk is lower. This study investigated whether comparisons of own and others’ risk also occur spontaneously, unprovoked by such questions. Gay men uninfected with HIV (n = 50) were asked to think aloud about their risk of becoming infected; their comments were audiotaped and analysed. Over half the men added comments relating to others’ risk. The phrasing of these comments and the reported basis for them are described. The men represented others’ risk as relatively high, own risk as relatively low. In the case of one-third of the men, it seemed possible to be confident that a comparison was being made. The findings suggest that comparisons of own and others’ risk do occur spontaneously and that, while the judgements made in UO studies do not capture all the characteristics of those made spontaneously, they resemble them in important ways.

Retrospective Pretest-Posttest Analysis versus Traditional Pretest-Posttest Analysis

Traditional pretest-posttest comparisons of self-report data are distorted by response-shift bias. Administration of a retrospective pretest in lieu of the traditional pretest eliminates a form of response-shift bias which distorts the comparability of pretest-posttest measurements. The present study compared the sensitivity of a retrospective pretest-posttest measurement versus a traditional pretest-posttest measurement in detecting a treatment effect for a university stress counseling program. The substitution of the retrospective pretest for the traditional pretest as the covariate in the analysis of covariance yielded the same conclusion of no treatment effect.

Unrealistic optimism about becoming infected with HIV: different causes in different populations

People tend to believe that their chance of experiencing undesirable events is lower and their chance of experiencing desirable events is higher than that of the average person like them. Two explanatory models of such 'unrealistic optimism' (UO) have been proposed: While the motivational account holds that UO serves the function of bringing comfort, the cognitive account holds that UO serves no particular function, being simply a by-product of normal cognitive strategies. UO for HIV infection was studied in samples of uninfected students (Study 1, n = 68) and gay men (Study 2, n = 63). In each case, participants rated either their relative likelihood of becoming infected (negative valence condition) or their relative likelihood of remaining uninfected (positive valence condition). As predicted, in Study 1 UO was greater where valence was negative and in Study 2 valence had no effect. The findings suggest that the students' UO is better explained by the motivational account, while the gay men's UO is better explained by the cognitive account. Implications for AIDS education are discussed.

Explaining gay men's unrealistic optimism about becoming infected with HIV

Among the self-justifications that gay men use when deciding to have unprotected intercourse is the thought that they are at less risk than most gay men. Two explanatory models of such 'unrealistic optimism' (UO) have been proposed: while the motivational account holds that UO serves the function of bringing comfort, the cognitive account holds that UO serves no particular function, being simply a by-product of normal cognitive strategies. This study tested the prediction, derived from the motivational account, that highlighting the salience of the self-other comparison should increase UO. Gay men uninfected with HIV ( n = 122) estimated both their own risk of contracting various health problems - among them, becoming infected with HIV - and that of the average gay man. The purported aim of collecting the data was varied, so as to either make the self-other comparison central to the aim or render one of the two types of estimate irrelevant to the aim. No effect on UO was found. It seems that the cognitive account provides a better explanation than does the motivational account of at least that form of UO measured in this study. Implications for AIDS education are discussed.

Twenty-five years of professional liability in pediatric ophthalmology and strabismus: the OMIC experience

PURPOSE

To summarize the claims statistics of the Ophthalmic Mutual Insurance Company (OMIC) in the field of pediatric ophthalmology and strabismus (POS).

METHODS

Internal OMIC case summaries and defense counsel case evaluations of all claims in the field of POS closed between December 1, 1988, and February 19, 2013 were retrospectively analyzed.

RESULTS

A total of 140 claims were closed over the 25-year study period, of which 44 were closed with an indemnity payment. Claims related to strabismus and retinopathy of prematurity (ROP) were most common, and claims related to ROP resulted in the highest indemnity and expense payments. Issues related to follow-up represented the most significant risk factor among system-related claims.

CONCLUSIONS

Claims in pediatric ophthalmology and strabismus were infrequent but associated with three times higher average indemnity payments relative to all claims paid by OMIC during the course of the study.

Association between an Internet-Based Measure of Area Racism and Black Mortality

Racial disparities in health are well-documented and represent a significant public health concern in the US. Racism-related factors contribute to poorer health and higher mortality rates among Blacks compared to other racial groups. However, methods to measure racism and monitor its associations with health at the population-level have remained elusive. In this study, we investigated the utility of a previously developed Internet search-based proxy of area racism as a predictor of Black mortality rates. Area racism was the proportion of Google searches containing the "N-word" in 196 designated market areas (DMAs). Negative binomial regression models were specified taking into account individual age, sex, year of death, and Census region and adjusted to the 2000 US standard population to examine the association between area racism and Black mortality rates, which were derived from death certificates and mid-year population counts collated by the National Center for Health Statistics (2004-2009). DMAs characterized by a one standard deviation greater level of area racism were associated with an 8.2% increase in the all-cause Black mortality rate, equivalent to over 30,000 deaths annually. The magnitude of this effect was attenuated to 5.7% after adjustment for DMA-level demographic and Black socioeconomic covariates. A model controlling for the White mortality rate was used to further adjust for unmeasured confounders that influence mortality overall in a geographic area, and to examine Black-White disparities in the mortality rate. Area racism remained significantly associated with the all-cause Black mortality rate (mortality rate ratio = 1.036; 95% confidence interval = 1.015, 1.057; p = 0.001). Models further examining cause-specific Black mortality rates revealed significant associations with heart disease, cancer, and stroke. These findings are congruent with studies documenting the deleterious impact of racism on health among Blacks. Our study contributes to evidence that racism shapes patterns in mortality and generates racial disparities in health.

The Days Are Long and the Years Are Short

Among the most memorable lessons I learned from my father was based on a comment he often made when I was young: “The days are long and the years are short.” During a year as President of the Society for Public Health Education (SOPHE), there were many days that seemed to go on forever; but in retrospect, the entire year seems to have flown by in the blink of an eye. During this year, SOPHE has accomplished much for its members through its annual meetings, publications, and social media presence. Perhaps as important, SOPHE has continued to make an indelible mark on the profession of health education. Whether by launching new initiatives through its cooperative agreements with the U.S. Centers for Disease Control and Prevention, ensuring ongoing training for in-service health educators or by continuing to work on unification of the profession in negotiations with the American Association for Health, Physical Education, Recreation, and Dance, SOPHE continues to innovate. There remains much to be done; the challenges continue; and the opportunities are rich for the future of health education.

Primary care physicians' cancer screening recommendation practices and perceptions of cancer risk of Asian Americans

Asian Americans experience disproportionate incidence and mortality rates of certain cancers, compared to other racial/ethnic groups. Primary care physicians are a critical source for cancer screening recommendations and play a significant role in increasing cancer screening of their patients. This study assessed primary care physicians' perceptions of cancer risk in Asians and screening recommendation practices. Primary care physicians practicing in New Jersey and New York City (n=100) completed a 30-question survey on medical practice characteristics, Asian patient communication, cancer screening guidelines, and Asian cancer risk. Liver cancer and stomach cancer were perceived as higher cancer risks among Asian Americans than among the general population, and breast and prostate cancer were perceived as lower risks. Physicians are integral public health liaisons who can be both influential and resourceful toward educating Asian Americans about specific cancer awareness and screening information.

Oral health literacy: at the intersection of K-12 education and public health

The link between a student's health and their ability to learn is well-established. Schools are the intersection of public health programs, dental care, and self-care. This position affords them a unique role and opportunity to enhance health literacy, including oral health literacy. This paper explores the potential of K-12 school programs and the dental profession to address oral health literacy, and, in so doing, provide future participants with essential skills to promote their oral health.

Assets, challenges, and the potential of technology for nutrition education in rural communities

OBJECTIVE

To examine assets of and challenges to getting adequate nutrition and physical activity among low-income rural residents, and the potential for technology to provide health education.

METHODS

Environmental scans and community stakeholder interviews were conducted in 5 rural counties in Maryland. During environmental scans, stakeholders guided tours around each county to explore community services and resources for nutrition, physical activity and technology. In-depth interviews with stakeholders (n=58) focused on nutrition, physical activity, and technology issues.

RESULTS

Low-income residents both benefit from and face challenges in rural settings. Besides attitude and knowledge barriers, lack of affordable resources and public transportation contributed to inattention to nutrition and physical activity. Stakeholders' reactions to a proposed Internet-based intervention were mostly favorable, but questions emerged about providing computers and Internet to individual families.

CONCLUSIONS AND IMPLICATIONS

Internet-based education may be a viable option to help low-income rural residents overcome barriers to nutrition and physical activity.

Rural eHealth nutrition education for limited-income families: an iterative and user-centered design approach

Background

Adult women living in rural areas have high rates of obesity. Although rural populations have been deemed hard to reach, Internet-based programming is becoming a viable strategy as rural Internet access increases. However, when people are able to get online, they may not find information designed for them and their needs, especially harder to reach populations. This results in a “content gap” for many users.

Objective

User-centered design is a methodology that can be used to create appropriate online materials. This research was conducted to apply a user-centered approach to the design and development of a health promotion website for low-income mothers living in rural Maryland.

Methods

Three iterative rounds of concept testing were conducted to (1) identify the name and content needs of the site and assess concerns about registering on a health-related website; (2) determine the tone and look of the website and confirm content and functionality; and (3) determine usability and acceptability. The first two rounds involved focus group and small group discussions, and the third round involved usability testing with individual women as they used the prototype system.

Results

The formative research revealed that women with limited incomes were enthusiastic about a website providing nutrition and physical activity information targeted to their incomes and tailored to their personal goals and needs. Other priority content areas identified were budgeting, local resources and information, and content that could be used with their children. Women were able to use the prototype system effectively.

Conclusions

This research demonstrated that user-centered design strategies can help close the “content gap” for at-risk audiences.

Thought processes associated with reluctance in gay men to be tested for HIV

This study explored the thought processes that are associated with reluctance in gay men to be tested for HIV antibodies. The sample comprised 97 men who had not been tested for at least four years; 69 had never been tested. They were asked to imagine that someone had suggested that they be tested very soon and to identify, from the list provided, any negative thoughts prompted by this suggestion. The most commonly reported thoughts were that testing was unnecessary because risks had not been taken, that it was unnecessary because there were no symptoms, and that there was no urgency to be tested. Data were explored by means of factor analysis and comparisons across subgroups differing in risk level. The results are interpreted as indicating the use of rationalizations to buttress a decision not to be tested, the powerful influence on HIV decision-making exerted by salient perceptible features, and the ‘status quo bias’. Techniques that could be used to encourage testing in gay men are discussed.

Assessment of the nutrition and physical activity education needs of low-income, rural mothers: can technology play a role?

The purpose of this study was to examine the perceptions of low-income, rural mothers regarding their need for nutrition and physical activity education and the role of technology in addressing those needs. Quantitative and qualitative research was combined to examine the nature and scope of the issues faced by this target population. Women who were currently receiving food stamps and had children in nursery school to eighth grade were recruited through a state database to participate in a telephone survey (N = 146) and focus groups (N = 56). Low-income, rural mothers were aware of and practiced many health behaviors related to nutrition and physical activity, but they faced additional barriers due to their income level, rural place of residence, and having children. They reported controlling the fat content in the food they cooked and integrating fruits and vegetables but showed less interest in increasing fiber consumption. They reported knowing little about physical activity recommendations, and their reported activity patterns were likely inflated because of seeing housework and child care as exercise. To stretch their food budget, the majority reported practicing typical shopping and budgeting skills, and many reported skills particularly useful in rural areas: hunting, fishing, and canning. Over two-thirds of the survey respondents reported computer access and previous Internet use, and most of those not yet online intended to use the Internet in the future. Those working in rural communities need to consider technology as a way to reach traditionally underserved populations like low-income mothers.

The impact of Internet use for weight loss

With rising rates of obesity and obesity-related health problems, finding additional means to help reduce obesity is critical. This review examined the impact of the Internet as a medium to deliver weight loss programs. Specifically, the review examined the public's interest, the availability and the known efficacy of Internet-based weight loss programs. Findings showed that the general public is turning to the Internet for diet and fitness information and has reported that information they found online has impacted their behaviour. Little is known about who is interested in using the Internet for weight loss and what their experiences have been. The programs most readily available to the general consumer tend to vary widely in quality, with few efficacy studies. However, researchers have shown that efficacious programs have been delivered via the Internet. Successful online programs included a structured approach to modifying energy balance, the use of cognitive-behavioural strategies such as self-monitoring, and individualized feedback and support. Implications include developing strategies to increase distribution of programs with known efficacy, determining the applicability of effective programs for diverse audiences, conducting media literacy education for the general public, and continued research into understanding who may be best served by online weight loss programming.

A systematic review of evaluation in formal continuing medical education

INTRODUCTION

Physicians spend a considerable amount of time in Continuing Medical Education (CME) to maintain their medical licenses. CME evaluation studies vary greatly in evaluation methods, levels of evaluation, and length of follow-up. Standards for CME evaluation are needed to enable comparison among different studies and to detect factors influencing CME evaluation.

METHODS

A review of the CME evaluation literature was conducted on primary research studies published from January 2000 to January 2006. Studies assessing only satisfaction with CME were excluded, as were studies where fewer than 50% of the participants were practicing physicians. Thirty-two studies were included in the analyses. Determinations were made about evaluation methods, outcome measures, and follow-up assessment.

RESULTS

Only 2 of 32 reviewed studies addressed all evaluation levels: physician changes in knowledge and attitudes (level 2), practices (level 3), and improved patient health status (level 4). None of the studies using self-developed instruments (n = 10) provided reliability and validity information. Only 6 studies used validated scales. Twenty studies had a follow-up period of 6 months or less, and 11 had a follow-up period between 1 and 2 years.

DISCUSSION

A gold standard for evaluating the effectiveness of CME would include assessment of all 4 levels of evaluation. A valid, reliable, and adaptable CME evaluation questionnaire addressing variables in the second level is needed to allow comparison of effectiveness across CME interventions. A minimum 1-year postintervention follow-up period may also be indicated to investigate the sustainability of intervention outcomes.

A systematic review of evaluation in formal continuing medical education

INTRODUCTION

Physicians spend a considerable amount of time in Continuing Medical Education (CME) to maintain their medical licenses. CME evaluation studies vary greatly in evaluation methods, levels of evaluation, and length of follow-up. Standards for CME evaluation are needed to enable comparison among different studies and to detect factors influencing CME evaluation.

METHODS

A review of the CME evaluation literature was conducted on primary research studies published from January 2000 to January 2006. Studies assessing only satisfaction with CME were excluded, as were studies where fewer than 50% of the participants were practicing physicians. Thirty-two studies were included in the analyses. Determinations were made about evaluation methods, outcome measures, and follow-up assessment.

RESULTS

Only 2 of 32 reviewed studies addressed all evaluation levels: physician changes in knowledge and attitudes (level 2), practices (level 3), and improved patient health status (level 4). None of the studies using self-developed instruments (n = 10) provided reliability and validity information. Only 6 studies used validated scales. Twenty studies had a follow-up period of 6 months or less, and 11 had a follow-up period between 1 and 2 years.

DISCUSSION

A gold standard for evaluating the effectiveness of CME would include assessment of all 4 levels of evaluation. A valid, reliable, and adaptable CME evaluation questionnaire addressing variables in the second level is needed to allow comparison of effectiveness across CME interventions. A minimum 1-year postintervention follow-up period may also be indicated to investigate the sustainability of intervention outcomes.

A vision for doctoral research training in health behavior: a position paper from the American Academy of Health Behavior

OBJECTIVE

To establish and disseminate the position of the American Academy of Health Behavior (The Academy) on doctoral research training.

METHODS

A collaborative process involving the Work Group on Doctoral Research Training with input from The Academy membership led to the development of the guidelines described herein.

RESULTS

A set of guidelines is provided that describe the process of learning to be a scholar/researcher and the outcomes of learning the practice of health behavior research.

CONCLUSIONS

The doctoral students who are to become the stewards of our field should be prepared to engage in scholarship that creates new knowledge, uses research to transform practice, and effectively communicates research findings.

Development of an expert system knowledge base: a novel approach to promote guideline congruent asthma care

Existing guidelines for the clinical management of asthma provide a good framework for such tasks as diagnosing asthma, determining severity, and prescribing pharmacological treatment. Guidance is less explicit, however, about establishing a patient-provider partnership and overcoming barriers to asthma management by patients in a way that can be easily adopted in clinical practice. We report herein the first developmental phase of the "Stop Asthma" expert system. We describe the establishment of a knowledge base related to both the clinical management of asthma and the enhancement of patient and family self-management (including environmental management). The resultant knowledge base comprises 142 multilayered decision rules that describe clinical and behavioral management in three domains: 1) determination of asthma severity and control; 2) pharmacotherapy, including prescription of medicine for chronic maintenance, acute exacerbation, exercise pretreatment, and rhinitis relief; and 3) patient self-management, including the process of intervening to facilitate the patient's asthma medication management, environmental control, and well-visit scheduling. The knowledge base provides a systematic and accessible approach for intervening with family asthma-related behaviors.

'I'm less at risk than most guys': gay men's unrealistic optimism about becoming infected with HIV

Among the self-justifications that gay men use when engaging in high-risk sex is the thought that they are less at risk than most gay men. Two explanatory models of such 'unrealistic optimism' (UO) have been proposed: while the motivational account holds that UO arises because it serves the function of bringing comfort, the cognitive account holds that UO serves no particular function, being simply a by-product of normal cognitive strategies. This study investigated predictions derived from the motivational account. Gay men uninfected with HIV (n = 88) answered two test questions, requiring them to estimate, respectively, their own risk of becoming infected and that of the average gay man. The questions were presented in the two possible orders, and were either separated or not separated by unrelated filler material. The great majority of the men (89%) exhibited UO. Neither question order nor the interpolation of filler material affected responses to either test question. The results were inconsistent with the motivational account, but explicable in terms of the cognitive account. It seems that the cognitive account provides the better explanation of at least that form of UO measured in this study. Implications for AIDS educators are discussed.

The promise and challenge of eHealth interventions

OBJECTIVE

To discuss how health behavior researchers can use the Internet to study and intervene on health behavior.

METHODS

Describe how the Internet is increasingly able to offer a viable medium for health behavior intervention and the challenges and opportunities inherent in conducting online interventions and research.

RESULTS

The challenges of eHealth include coping with the additional demands of development, finding ways to reach "hard-to-reach" audiences, and maintaining privacy and security while monitoring participant use.

CONCLUSIONS

Health behavior researchers and interventionists need to learn to apply eHealth tools to extend their ability to study and influence health behavior.

Research collaboratories: their potential for health behavior researchers

OBJECTIVE

To discuss how online collaboratories can improve the effectiveness and efficiency of research conducted in multiple sites.

METHODS

We describe how online collaboratories offer a flexible infrastructure for health behavior researchers, and describe the strengths and weaknesses of such tools and the lessons learned from several systems.

RESULTS

Although virtual collaboration requires a technology infrastructure achieved at some cost, including access, connectedness, bandwidth, and technology literacy, the potential benefits to health behavior researchers are extensive.

CONCLUSIONS

The range of technical skills and level of comfort with technology are variable in most groups. However, technology tools are just one aspect of the fully realized collaboratory. Ultimately it is the human skills for collaboration rather than the technical excellence of the infrastructure that signals the potential for success.

The effects of mood states on the AIDS-related judgements of gay men

In two studies, the effects of induced mood on the AIDS-related judgements of gay men were investigated. Participants were induced into a positive, neutral, or negative mood by recall of affect-laden autobiographical memories; they then made AIDS-related judgements. In Study 1 (n=30), the men indicated their level of agreement with statements expressing optimism about the efficacy of antiretroviral treatments for HIV/AIDS. Those induced into a positive mood indicated stronger agreement than did those induced into a neutral or negative mood. In Study 2 (n=83), participants read brief descriptions of men they did not know and estimated the likelihood that they were HIV-infected. Each sketch highlighted one characteristic of the man described. There were two versions of each sketch (e.g., the versions of the sketch highlighting intelligence described the man either as very intelligent or as very unintelligent), given to different participants. Stereotype use was inferred if significantly different estimates were given for the two versions of a sketch. Reliance on stereotypes was found most often in the positive mood condition and least often in the negative mood condition. The findings are consistent with, and suggest explanations for, earlier correlational evidence that, in gay men of the age group studied, sexual risk-taking is associated with a positive mood. Suggestions are made for how AIDS educators might address the contributions of mood states to sexual risk-taking.

Evaluation of interventions for gay men: two desiderata

This paper was presented in a session at the AIDS Impact conference devoted to a debate on the methods that should be used to evaluate educational interventions. The paper highlights two desiderata for evaluation of interventions directed at gay men. First, the view is presented that there is no acceptable substitute for assessing the effect of an intervention on gay men's sexual behaviour (rather than, for example, their AIDS-related attitudes or beliefs). This view is justified in terms of (a) the differences that exist between AIDS-related thinking in the cold light of day and during actual sexual encounters; and (b) the often faulty nature of intuitions about the factors that contribute to sexual risk-taking and the ways in which it might be reduced. Second, it is argued that the randomized control study design represents the best means for ensuring that interventions will be as effective as possible. Criticisms which have been made of this design are discussed and the conclusion drawn that they do not amount to a strong case against it.