PrePare: a program of enhanced prenatal services within health-maintenance organization settings.

This paper presents the conceptual framework and implementation strategies of a relationship-focused behavioral intervention for pregnant women and their families. The program, PrePare ('Prenatal Parenting'), was designed as a prenatal precursor to the pediatric health care model, Healthy Steps. PrePare includes preventive intervention elements that address parents' universal concerns about pregnancy and parenthood, as well as specific activities to support optimum pregnancy health and reduce high-risk behaviors. As described here, the program is embedded within a large not-for-profit health-maintenance organization (HMO). Delivery of the prenatal component is carried out by Healthy Steps interventionists through three home visits and telephone follow-up during mothers' second and third trimesters of pregnancy. An evaluation of program outcomes is underway. The design compares three groups of families, those who receive PrePare followed by Healthy Steps, Healthy Steps alone and a usual HMO-practice comparison. It is hypothesized that initiating expanded services during the prenatal period will lead to increases in reported patient satisfaction, provider satisfaction and organizational efficiency within the health care delivery system.

Implementation and effectiveness of a community-based health promotion program for older adults.

BACKGROUND: Because preventing functional decline in older adults is a national priority and senior centers have been identified as potentially important venues for health-promotion activities, a trial of a multicomponent disability prevention program was conducted at a senior center. METHODS: One hundred older adults were recruited for a 6-month randomized clinical trial. All members of the experimental group received an exercise intervention, nutrition counseling, and a home safety assessment. Smoking and alcohol interventions were delivered to at-risk subjects. Outcome variables included the Medical Outcomes Study Short Form (SF-36) health survey, the CES-Depression scale, bed days, and restricted-activity days. RESULTS: A single study announcement resulted in a response sufficient to recruit 100 subjects. The exercise program was well received: 85% of intervention subjects completed the 6-month program and adherence was excellent, with over 90% attendance at exercise classes. After 6 months the intervention group had significantly better scores on 7 of 8 SF-36 subscales and fewer depressive symptoms than controls. CONCLUSIONS: Senior centers may be excellent sites for community-based health promotion interventions: participation and adherence rates may be acceptable, interventions can be designed that are feasible in this setting, and these interventions appear to affect health status positively. The study program improved physical and psychosocial functioning and is a promising model for preventing functional decline through activities based at senior centers.

Recruiting African-American older adults for a community-based health promotion intervention: which strategies are effective?

INTRODUCTION: The purpose of this article is to examine the effectiveness of recruitment strategies used to recruit African-American older adults for a senior center-based health promotion trial with a 6-month exercise component. METHODS: We compared multiple strategies for recruiting participants from senior center members and other older adults residing in the surrounding predominantly African-American community. The phonathon, direct telephone recruitment by senior center leadership, is compared with traditional approaches. RESULTS: All recruiting strategies combined yielded a total of 120 participants. Phonathons involving five or six senior center board members in two half-day sessions yielded 40 participants or 33% of all participants. Strategies categorized as printed media yielded 39 participants or 33% of all participants. Strategies categorized as word-of-mouth yielded 31 participants or 26% of all participants. Remaining approaches accounted for an additional 10 participants or 8% of all participants. CONCLUSIONS: Our results support employing a multifaceted recruitment approach and demonstrate the importance of strong linkages between the research team and community leaders in conducting health promotion research in minority communities. An innovative approach, the phonathon, may be a potentially important recruitment strategy.

Measurement of overall and disease-specific health status: does the order of questionnaires make a difference?

OBJECTIVES: This study was designed to detect any effect of order when modules on disease-specific and overall health status are combined in an outcomes research questionnaire. METHODS: Men with symptomatic benign prostatic hyperplasia (BPH) were prospectively enrolled in a clinical trial of an educational intervention in Group Health Cooperative of Puget Sound, a prepaid group practice. Within the trial, 392 consecutive men were randomized to one of two versions of a baseline questionnaire. One had a 38-item module on BPH-specific health status first, followed by a 30-item module on overall health status; the other had the modules in reverse order. Scores were compared for three BPH-specific scales and eight scales measuring overall health. Data were collected in the form of self-administered questionnaires. RESULTS: Comparing the groups assigned the two versions of the questionnaire, no significant differences in scores on any of the health status scales were found. CONCLUSIONS: In this dataset, we could find no evidence of an order effect when modules on BPH-specific and overall health status were combined in different sequences.