Taiwan's population and family planning efforts: an historical perspective.

The unprecedented decline of Taiwan's natural population increase rate from 3% in 1963 to 1.9% in 1973, attributed primarily to an increasing use of contraception, brought universal attention to one of the first and most successful national family planning programs, at a time when successes were few. Taiwan met its goal of decreasing its natural increase rate despite its young population, increasing numbers of women of childbearing ages, a strong preference for sons and a per capita income at the outset in 1963 of less than U.S.$200. Recognition of this achievement brought thousands of professionals, particularly from developing countries, to study the program firsthand: more than 3,000 during 1970--73 alone. This was matched by an avalanche of publications about the program that appeared around the world, written by practitioners, academics and others. This article tells the story of this success.

The case of the mysteriously appearing child.

The story of how a family planning postage stamp managed to get pasted on several million envelopes in Taiwan. Its chronological unfolding illustrates the complexity of applying research findings to an ongoing program in a developing country setting. The need for involving program planners early in research development, for in-service staff education, for linkage between related agencies implementing programs, and for caution in using western theoretical orientations is considered. Suggestions for discussion are provided.

Pasting your Umbrella Before the Rain: A Case Study.

This case study tells from a participant's viewpoint how the results of large-scale social surveys and demographic projections are translated into educational program objectives and, more importantly, an educational product that gears into the thinking patterns of a younger generation. Cultural, bureaucratic and political obstacles to change and how they were overcome or not are reviewed in this chronological unfolding of the development of Taiwan's first population education approach in the classroom.

Training of trainers for community primary health care workers.

Training community-based health care workers in "developing" countries is essential to improving the quality of life in both rural and urban areas. Two major obstacles to such training are the tremendous social distance gap between these community workers and their more highly-educated and upper-class trainers (often medical officers) and the didactic, formal educational system. Bridging this gap demands a participant-centered, field-oriented approach which actively involves the trainee in the design, implementation and evaluation of the training program. A description of a philosophic learning approach based on self-initiated change, educational objectives related to planning, organizing, conducting and evaluating training, and specific learning methodologies utilizing participatory learning, non-formal educational techniques, field experience, continuing feedback and learner participation are reviewed. Included are: role playing, story telling, case studies, self-learning and simulation exercises, visuals, and Portapak videotape.

Research needs in family planning program promotion.

PIP: Areas of family planning promotion which need to be further researched are identified. The effectiveness of diverse information, education, and communication approaches needs to be evaluated, feasible ways to increase contraceptive continuation rates must be identified, the relative merits of providing fieldworkers with salaries or incentives should be assessed, different styles of interactions between providers and clients should be identified and evaluated and research directed toward improving training programs, field supervision, and supply logistics should be undertaken. A number of more detailed research suggestions with special reference to Taiwan and other Asian and Pacific countries are also provided. Little is known, for example, about provider and user interaction patterns in Asia, and the impact of these patterns on contraceptive acceptance and continuance. These patterns could be analyzed using diverse research techniques ranging from observation to experimental manipulation. Despite the fact that approximately 50% of all acceptors discontinue use within 2 years, researchers tend to focus on identifying acceptor characteristics while ignoring the discontinuation process. Researcher should 1) identify the best time for providing postacceptance followup services, 2) identify training strategies which provide fieldworkers with the highest level of confidence in specific contraceptive methods, 3) experiment with the use of newspaper columns and telephone advisory services to provide users with information about side effects, 4) assess the merits of involving both partners in the contraceptive counseling process, 5) develop and evaluate postacceptance educational materials, and 6) assess the impact of various supply systems on contraceptive continuance. Another neglected area of research is the public's attitude toward different contraceptive knowledge sources. For example, receptivity to family planning messages may vary depending on wether the message is delivered by a physician or by a local trained worker. Research is also needed to assess the feasibility of using advertising approaches to encourage acceptors to switch to more effective methods of contraception. The psychosocial needs of acceptors and cultural differences in response to family planning promotional activities should also be explored. Research barriers include a lack of field-trained researchers, limited interest in family planning among scholars, inadequate government and donor support and funding, a failure to provide funds for longterm research, and inadequate communication between researchers. In Taiwan there is a need to 1) conduct more operations research; 2) make more use of previous research findings; 3) focus attention on research aimed at increasing contraceptive use among young people, improving fieldworker and client communication, and expanding the role of nongovernment agencies in family planning; and 4) develop a national population research institute.^ieng

Continuing Evaluation and Research Needs in National Family Planning Promotion: Plus a Change, Plus C'est La M me Chose.

A priority listing of existing health promotion research needs in large-scale family planning programs in East and Southeast Asia is presented. Areas of needed research include: family planning Provider/User Interaction; Contraceptive Use Continuation; Perceptions of Service Source; Comparative Educational and Social Marketing Approaches; and Psyco-Social Needs. Interestingly, many of the present needs were identified by researchers and program planners in national and international agencies more than a decade ago. Possible reasons for their not being implemented are discussed.

AIDS prevention programs: a critical review.

A critical review of the content of those articles published during the 1990s in this Journal provides a diversity of views about the kinds of theoretical models and typologies that are applicable to HIV/AIDS educational interventions. It also suggests the crying need to focus more of these social and behavioral models in a cultural context. This article provides a brief overview of AIDS in the U.S. and international settings, a description of the complexity of application of social and behavioral change models in their present context, and a review of the three categories of articles which have been published in the Journal: dogma, dissent, and innovation.

How Basic Beliefs about Human Life Relate to Ethical Judgments about Induced Abortion.

This survey explores family planning field workers' basic beliefs and value assessments related to a new human life and their relationship to their verbal statements of ethical judgments about induced abortion under varying circumstances. It also relates these beliefs to stated experience of abortion referrals. Implications for education and research with application to many international social issues are discussed.

Information, education and communication needs in family planning: the case of pakistan.

In spite of three decades of national family planning programmes, Pakistan's contraceptive prevalence rate was only 12 percent in 1991. Furthermore, the government family planning service delivery systems, primarily the family welfare center (FWC), cover less than 10 percent of the people in rural areas. Although there are cultural and religious constraints to social change, it can be argued effectively from recent surveys that there is a considerable need for family planning that has yet to be met. Certain barriers to, and options for, meeting this need are reviewed, particularly in terms of strengthening information, communication and education (IEC) at the community level.

Developing more effective family planning, family health and family welfare programmes: opportunities for government-NGO collaboration. Executive summary and policy implications.

PIP: In the Asia and Pacific region, national and large city governments have provided most family planning, family health, and family welfare services since the early 1950s. The leading reason for government involvement continues to be that governments have adequate resources to set up and administer large enough family planning programs to achieve government objectives of lower fertility and slower population growth. Many of these government programs have indeed increased contraceptive use, reduced population growth, and decreased fertility. On the other hand, these programs often use coercive tactics to persuade couples to accept family planning. Other negative parts of these programs are inadequate monitoring, slow to improve service quality, limited contraceptive choices, improper service provision, inadequate information for and counseling of clients, and inadequate follow up of acceptors. Some reasons for these negative aspects are insufficient resources, too much emphasis on new acceptor recruitment, lack of recognition of the importance of continuing contraceptive prevalence, and too little emphasis on client satisfaction. Nongovernmental organizations (NGOs) have also helped in the evolution of family planning, family health, and family welfare services in the Asia and Pacific regions. They have provided policy and programmatic innovations serving as new models to governments. NGOs can take the political heat off of political leaders who are anxious about those who resist family planning. NGOs tend to provide a broader mix of contraceptive services than do government programs. Increased use of working groups and expansion of operations research on NGO programs can strengthen collaboration between governments and NGOs. The working groups with specialists from government and NGOs could examine service delivery problems and propose solutions.^ieng

Getting research utilized: the taichung study revisited.

This case study describes how an action-oriented research program served as the base for national expansion of the Taiwan family planning program; what kind of organizational setup and approaches expedited getting research results utilized; and how the results were disseminated to other countries considering starting similar programs.

Research Utilization in Taiwan's Family Planning Program.

This paper deals with why the applied research carried out in the Taiwan family planning program facilitated the planned program of social change - both in the productive integration of research findings into community health education action programs and in the dissemination of these ideas to other Asian countries. A summary of the factors that assisted or hindered research utilization and an analysis of some of the especially favorable factors in the Taiwan situation are presented. The viewpoint presented is that of the Taiwan Provincial Institute of Family Planning Director and his former resident program advisor.

Applied research, evaluation and case study readings from the seventies: part 2 of a national faculty survey.

Faculty teaching in accredited graduate programs of community health education in U.S. universities were surveyed by mail to determine which articles published during the 1970's they would recommend that their colleagues read. The suggested readings were collected and abstracted and are presented herewith in annotated bibliographic form. Part 1 covering Community Health Education Policy, Theory and Social Issues appeared in the 1980-81 Volume (1:2) of this journal.

Community health education literature from the seventies: a field practitioner survey.

A national sample of community health education practitioners in the United States was surveyed by mail and asked to select five articles published during the 1970's they would recommend that their colleagues read. The study was conducted in late 1979 after a comparable national survey of university health education faculty by Cernada and Chen (International Quarterly of Community Health Education, 1:2 and 2:1). The recommended readings were collected and abstracted, and are presented in annotated bibliographic form. A comparison of practitioner and academic selections is in preparation.

Verbal judgments of Taiwanese family planning field workers about induced abortion.

Four hundred female governmental family planning field workers in Taiwan were asked by questionnaire whether women should or should not have an induced abortion under certain circumstances. Major findings were that although most workers were favorable to induced abortion under most circumstances, many were unfavorable when marital status, parity, and contraceptive usage of the woman were considered. Furthermore, cumulative judgment scales were shown to exist which have important implications for program approaches elsewhere.

Beyond family planning: incentives in taiwan.

Two large-scale, long-term research projects to test the feasibility of using positive and non-coercive incentives to encourage having fewer children and spacing were carried out in Taiwan during the 1970s. The results of these long-term projects are presented. The Educational Savings Plan, begun in 1971, provided financing for the secondary school education of children whose parents had limited family size to no more than three children. The Spacing Incentive Plan, begun in 1975, encouraged prolonging the interval between first and second births to at least three years by providing free birth delivery of the second child. Although both were less successful than anticipated, much was learned about the social, economic, and practical difficulties of program implementation.

Community health education literature from the seventies: a field practitioner survey-part 2.

A national sample of community health education practitioners in the United States was surveyed by mail and asked to select five articles published during the 1970's that they would recommend their colleagues read. The study was conducted in late 1979 after a comparable national survey of university health education faculty by Cernada and Chen (International Quarterly of Community Health Education, 1:2 and 2:1). The recommended readings were collected and abstracted, and are presented in annotated bibliographic form. This annotated bibliography follows up on the collection published in Volume 4, Number 4, of the International Quarterly of Community Health Education which covered Community Health Education Policy, Theory, and Social Issues-its focus is on Applied Research, Evaluation, and Case Studies.

Eating attitudes, dieting, and bulimia among junior high school students.

Students in a western New England (U.S.) junior high school (ages 11-15) were surveyed in 1986 to identify attitudes and behaviors about eating and dieting which might foster disordered eating habits. Although few students met official criteria for disordered eating habits, at least 12 percent did practice dieting and 28 percent were frequently preoccupied with the desire to be thinner and/or were terrified of being overweight. One-quarter of girls (vs. only 3.2% of boys) mistakenly classified themselves overweight. Perception of one's own weight seems to be more highly correlated with measures of eating attitude and behavior than does actual weight. Differences also were found in how males and females viewed their own weight although both dieted to about the same extent. Females also were more interested in having school classes on eating and dieting. Recommendations were made for prevention and education regarding eating disorders among this age group.

An evaluation of a biofeedback smoking education program.

This study was designed to evaluate the efficacy of a biofeedback smoking education program in influencing students' smoking behavior and attitudes. It included a total of 486 secondary students in suburban Boston area, 293 in experimental group and 193 in control group. The biofeedback package included a cardiotach, digital thermometer, tremor tester, and an Ecolyzer. The educational program lasted six days in each school. The questionnaire included variables taken from Horn's Smoking Model and the Health Belief Model. The completion rate for both pre-test and post-test was 84.4 per cent for experimental group and 76.9 per cent for control group. The results showed that the experimental program was effective in bringing about a significant change in smoking behavior and belief variables of health consequences of smoking, personal relevance, perceived severity, capability for cessation, and perceived salience. Discussion was made regarding the efficacy of the underlying theory of the biofeedback method as an educational aid in health education and as an innovative smoking education initiative.

A survey of eating/dieting attitudes and bulimic behavior among university undergraduate women.

A random sample of female undergraduates at a large New England state university was surveyed by mail in 1983 to determine their attitudes and behavior relating to eating, dieting, and body weight. Results indicated dissatisfaction with and negative attitudes about eating habits and body weight. Forty-five percent had ever experienced uncontrolled binge-eating; 18 percent had a combination of bulimia symptoms, and 10 percent had used self-induced vomiting for weight control. The health education needs and interests of these students also were assessed and recommendations for university programs were made.