Ensuring the success of local public health workforce assessments: using a participatory-based research approach with a rural population.

OBJECTIVES: To investigate a process for comprehensive rural public health workforce data collection, and apply this process to a competency and training needs assessment of local health department (LHD) workers in the state of Kansas, USA. STUDY DESIGN: Participatory research methods were used to determine an appropriate process for data collection. Survey instruments included the Council on Linkages public health core competencies and Columbia University public health emergency preparedness competencies. METHODS: LHD workers collaborated with the state health department to develop and pre-test training for LHD directors about the nature and purpose of the survey, as well as instructions for distributing it to their staff members. The final survey instrument included demographics, a workforce competency assessment, and an assessment of training interests, motivators and barriers. Surveys were stratified by occupational type, with employees in professional roles asked to report on additional competencies. RESULTS: All 1501 Kansas LHD employees received the needs assessment survey, and 1141 (76%) were returned. Respondents reported greater mean 'importance to job' than ability across competency domains, indicating potential training needs. Across occupational types, primary training motivators were increased competency and personal satisfaction. Barriers included lack of time, cost and family commitments. CONCLUSIONS: Using participatory research methods, the state of Kansas was able to achieve a high response rate from LHD workers. This process can serve as a model for other rural communities and organizations with limited resources. In addition, the survey results provide information about competency-oriented knowledge and training gaps of sectors of the local public health workforce, which can be used to develop training in a targeted fashion.

Does locus of control moderate the effects of tailored health education materials?

Research in health communication has shown that individually tailored health education materials are more effective than traditional or generic materials in producing changes in health-related behaviors. However, tailored materials have not been equally effective for all individuals. Because locus of control affects behavioral outcomes in other self-change interventions, its effect on individuals' responses to tailored messages is of particular interest. The present study examined differences in cognitive responses to tailored and non-tailored weight loss materials among 198 overweight individuals. Weight locus of control significantly interacted with study group (who received either tailored or non-tailored materials), suggesting that externals may respond to tailored health education materials with counter-arguments. Implications for the development and application of tailored health communication materials are discussed.

Factors associated with physical activity in women across the life span: implications for program development.

This study examined the rates and factors associated with physical activity in women of various ages. Adult women (n = 653) from four community-based family medicine clinics completed a self-administered behavioral and health questionnaire while waiting to see their physician. Findings suggested variation in physical activity over the life span, with older women performing less physical activity than younger women. Family characteristics (e.g., having children) were strongly associated with performing less structured, less intense physical activities of daily living among women 49 years and younger. Younger women reported having high self-efficacy for physical activity, but also reported the greatest numbers of barriers. Women in the oldest age category reported health as the most common motivator for physical activity, but were also least likely to perform physical activity. Interventions designed to meet the unique needs of women at different stages in their lives will potentially reduce the rate of inactivity among women. Creative, flexible strategies that incorporate physical activity into the daily routine should be used in the program development.

Effects of tailored, personalized and general health messages on physical activity.

Physical inactivity is a major public health problem. Patient education programs and materials that are customized to address the unique needs and concerns of specific patients have shown promise in changing a range of health related behavior, although findings to date for physical activity have been equivocal. In this study a randomized controlled trial was conducted among 272 adult primary care patients to compare the effectiveness of tailored, personalized and general health messages, and usual medical care in promoting leisure time physical activity (LTA) and physical activities of daily living (PADLs). Patients in the tailored group were more likely to increase PADLs than were patients in the personalized, general and control groups (65% vs. 46% vs. 56% vs. 54%) and less likely to being doing fewer PADLs at follow-up (18% vs. 38% vs. 38% vs. 38%; chi 2 = 12.2, df = 6, p = 0.056). There were no significant differences for LTAs. To help maximize the effectiveness of future tailored interventions on physical activity, studies should seek to identify the social, psychological and environmental variables that are most important to include in tailored materials.

Physician recommendations for diet and physical activity: which patients get advised to change?

BACKGROUND: National objectives and guidelines call upon physicians to help reduce the population burden of chronic diseases by advising patients to eat less fat and get more physical activity. However, studies show physicians are most likely to provide behavioral recommendations to patients who are already sick. Understanding factors that influence physicians' advising decisions can help broaden the reach of these activities. METHODS: Subjects were 915 adult patients and 27 physicians from four community-based family medicine clinics in southeastern Missouri. To participate, patients completed a self-administered behavioral and health questionnaire while waiting to see their doctor. RESULTS: Having a high body mass index was the strongest predictor of receiving advice to increase physical activity (OR = 1.6; 95% CI 1.3, 2.0), and having a high cholesterol level was the strongest predictor of receiving advice to eat less fat (OR = 1.9; 95% CI 1.5, 2.4). Neither the actual content of patients' diets nor their levels of physical activity were associated with receiving advice. CONCLUSIONS: Physicians' advising may be guided by quick but fallible heuristics that systematically exclude patients whose needs are not easily visible. This pattern misses the opportunity to reduce future needs for therapeutic counseling by taking preventive action now.

Do nutrition label readers eat healthier diets? Behavioral correlates of adults' use of food labels.

BACKGROUND: Reading and understanding nutrition labels on foods may be an important precursor to dietary change. However, little is known about how nutrition labels are used by consumers and what effect reading labels has on dietary behaviors. METHODS: This article identifies behavioral and health status correlates of nutrition label reading and describes patterns of label use among 885 adult patients from four family medicine clinics in southeastern Missouri. To participate, patients completed a self-administered survey while waiting to see their physicians. RESULTS: Analyses revealed patients eating diets lower in fat were much more likely (51% versus 26%) than patients whose diets were higher in fat to report labels influencing their food purchase decisions, as were patients eating diets higher in fruits, vegetables, and fiber. Patients with high blood pressure were 63% more likely than those with normal or low blood pressure to look for sodium on the nutrition label (odds ratio [OR] = 1.63, 95% confidence interval [CI] = 1.35, 1.97), but no more likely to look for other nutrition label information. Similarly, patients with high cholesterol were more likely than those with normal or low cholesterol to look for saturated fat (OR = 1.39, 95% CI = 1.13, 1.72) and cholesterol (OR = 1.60, 95% CI = 1.29, 1.98) on the label, but no more likely to look for other nutrition label information. CONCLUSIONS: Findings consistently supported a relationship between patients' label reading and their dietary practices.