The prediction of accurate contraceptive use from attitudes and knowledge.

A framework of the relationship between knowledge, attitudes, and behavior was described in the context of couple's use of birth control. It was hypothesized that when knowledge of behavioral enactment is present, attitudes and beliefs about susceptibility to pregnancy will be predictive of accurate use of the diaphragm. Respondents were 111 women who participated in a three-wave panel design focusing on diaphragm use. Analyses indicated that the level of knowledge about what a woman should do to use the diaphragm correctly was high. Correct knowledge, however, did not translate into accurate behavior. Motivational factors focusing on attitudes, perceived susceptibility to pregnancy, and normative factors were also relevant.

PIP: This study sought to predict and understand the behavioral criterion for accurate contraceptive usage using knowledge and attitudinal variables as major predictors. Building on the research of Fishbein into the prediction of aggregated behaviors over time (multiple act criteria), accurate use of contraception is conceptualized as an aggregation of many acts over time. Fishbein's framework is also extended to include the variables of perceived susceptibility to pregnancy and the influence of the male partner's attitude toward contraception. The subjects of the study were 111 family planning (FP) clients who identified the diaphragm as their major contraceptive during the eight-month test period. The sample was approximately divided between new users, restarters, and continuing users. Two follow-up interviews were used to measure accuracy of use, attitude toward method, attitude toward becoming pregnant, perceived susceptibility to pregnancy, partner attitude, and knowledge. Analyses were performed to detect the presence of selection, retention, and testing biases (nothing of significance was found). It was found that the women had high and persistent knowledge about proper use of a diaphragm. This knowledge did not ensure accurate behavior, however. Women were influenced by motivational factors such as relative contraceptive utility (attitude toward the diaphragm and toward becoming pregnant), perceived pregnancy susceptibility, and perceived partner attitude. This latter affected accuracy through its intermediate effects on relative contraceptive utility. Inaccurate use was most often associated with failure to check for holes and failure to apply additional spermicide if intercourse was repeated. These behavioral failures are less likely to result in contraceptive failure than other factors for which high accuracy was observed (length of time inserted or use of spermicide). These findings suggest that motivational and knowledge factors play a role in ensuring correct contraceptive usage and should receive the attention of FP counselors.

Reflections from The Robert Wood Johnson Foundation on The Program to Strengthen Primary Care Health Centers.

Given the modest amount of resources provided by the Foundation through The Program to Strengthen Primary Care Health Centers, the grantees undertook a high level of activity. Perhaps centers were aided by the momentum and focus of the Program in addition to financial resources. Such grants seem to move longer-range projects onto the daily agendas of managers. It might be worthwhile to convert some portion of federal community health center funding to support financial and managerial innovations. Generally, positive evaluation findings should encourage centers to explore some of the demonstrated initiatives. Evolution and innovation are considered key to the survival of primary care health centers.

Providing treatment to persons with mental illness. A commentary on the Robert Wood Johnson Foundation program on chronic mental illness.

The Robert Wood Johnson Foundation Program (RWJF) on Chronic Mental Illness (CMI) was launched in 1984 to help communities improve the care of people with CMI. Nine communities were funded to develop centralized mental health authorities offering a broad continuum of services. Experts and others who worked on this project learned from their experience that it is possible to produce dramatic improvements in community-based services for people with CMI and other chronic health conditions.