"I would get real people involved": The perspectives of end users in policymaking.

The implementation of health care services is important for public health. Although the current literature provides much insight into the perspectives of policymakers in charge of such implementations, we know very little about the perspectives of end users. Our study addresses this gap by exploring the perspectives of cancer survivors with regard to the notion of forming a cancer coalition. We found health communication to be highly important and much desired among cancer survivors. Policymakers should include end users in planning and decision-making, and focus on communicating the purposes and benefits of an initiative to end users.

Plain Language to Communicate Physical Activity Information: A Website Content Analysis.

Plain language techniques are health literacy universal precautions intended to enhance health care system navigation and health outcomes. Physical activity (PA) is a popular topic on the Internet, yet it is unknown if information is communicated in plain language. This study examined how plain language techniques are included in PA websites, and if the use of plain language techniques varies according to search procedures (keyword, search engine) and website host source (government, commercial, educational/organizational). Three keywords ("physical activity," "fitness," and "exercise") were independently entered into three search engines (Google, Bing, and Yahoo) to locate a nonprobability sample of websites ( N = 61). Fourteen plain language techniques were coded within each website to examine content formatting, clarity and conciseness, and multimedia use. Approximately half ( M = 6.59; SD = 1.68) of the plain language techniques were included in each website. Keyword physical activity resulted in websites with fewer clear and concise plain language techniques ( p < .05), whereas fitness resulted in websites with more clear and concise techniques ( p < .01). Plain language techniques did not vary by search engine or the website host source. Accessing PA information that is easy to understand and behaviorally oriented may remain a challenge for users. Transdisciplinary collaborations are needed to optimize plain language techniques while communicating online PA information.

Neighborhood walkability and physical activity among older women: Tests of mediation by environmental perceptions and moderation by depressive symptoms.

Features that enhance neighborhood walkability (higher population density, street connectivity and access to destinations) are associated with higher levels of physical activity among older adults. The perceived neighborhood environment appears to mediate associations between the objective built environment and physical activity. The role of depressed mood in these associations is poorly understood. We examined the degree to which depressive symptoms moderated indirect associations between the objective neighborhood environment and physical activity via the perceived neighborhood environment in older women. We analyzed data on 60,133 women (mean age = 73.1 ±â€¯6.7 years) in the U.S. Nurses' Health Study cohort who completed the 2008 questionnaire. Self-reported measures included the Geriatric Depression Scale, perceived presence of recreational facilities, retail destinations, sidewalks, and crime, and participation in recreational physical activity and neighborhood walking. We created an objective walkability index by summing z-scores of intersection and facility counts within 1200-meter residential network buffers and census tract-level population density. We used multiple regression with bootstrap-generated 95% bias-corrected confidence intervals (BC CIs) to test for mediation and moderated mediation. Objective walkability was associated with 1.99 times greater odds of neighborhood walking (95% BC CI = 1.92, 2.06) and 1.38 times greater odds of meeting physical activity recommendations (95% BC CI = 1.34, 1.43) via the perceived neighborhood environment. These indirect associations were weaker among women with higher depressive symptom scores. Positive associations between objective neighborhood walkability and physical activities such as walking among older women may be strengthened with a reduction in their depressive symptoms.

The observed and perceived neighborhood environment and physical activity among urban-dwelling adults: The moderating role of depressive symptoms.

RATIONALE: Physical environmental features of neighborhoods are associated with physical activity, but the influence of mental health factors, such as depression, on these associations is poorly understood. OBJECTIVE: We examined whether the perceived neighborhood environment mediated associations between the observed neighborhood environment and physical activity, and whether these associations were moderated by depressive symptoms. METHODS: Data consisted of systematic social observations of 343 neighborhoods and resident surveys. Participants' (N = 2969) mean age was 41.9 ± 16.2 years, 60.2% were female, and 67.9% were non-White. We conducted multiple linear regression and tests for mediation and moderated mediation. RESULTS: Observed recreation facilities, commercial destinations, physical disorder, and physical deterioration were indirectly associated with walking via perceived neighborhood environment variables. Observed recreation facilities was indirectly and positively associated with leisure-time physical activity via perceived park access, and indirectly and inversely associated with walking and leisure-time physical activity via perceived traffic danger, but only among participants with low depressive symptom scores. Observed recreation facilities was indirectly and inversely associated, and observed physical disorder and physical deterioration were indirectly and positively associated with walking via perceived disorder, but only among participants with high depressive symptom scores. CONCLUSION: Depressive symptoms affected the strength and direction of associations between the observed neighborhood environment and physical activity via residents' perceptions.

A Qualitative Comparison of Susceptibility and Behavior in Recreational and Occupational Risk Environments: Implications for Promoting Health and Safety.

Although internal factors that influence risk are frequently studied to understand human behavior, external factors, including social, cultural, and institutional factors, should be better utilized to inform ways to efficiently target, tailor, and promote safety messaging to at-risk populations. Semi-structured interviews obtained data from 37 motorcyclists and 18 mineworkers about their risk perceptions and behaviors within their respective dynamic environments. A comparative thematic analysis revealed information about external factors that influence risk perceptions and behaviors. Results support the importance of qualitative approaches for assessing and targeting individuals' risk perceptions and behaviors. In addition, segmenting at-risk subgroups within target populations and tailoring messages for these at-risk groups is critical for safety behavior modification. Practitioners should utilize strategic, culture-centric risk communication that takes into account external factors when determining when, who, and what to communicate via health promotion activities to more accurately disseminate valid, empathetic, and engaging communication with a higher level of fidelity.

Correlates of Trail Use for Recreation and Transportation on 5 Massachusetts Trails.

BACKGROUND: Promoting use of community trails is a recommended strategy for increasing population levels of physical activity. Correlates of walking and cycling for recreation or transportation differ, though few studies have compared correlates of trail-based physical activity for recreation and transportation purposes. This study examined associations of demographic, social, and perceived built environmental factors with trail use for recreation and transportation and whether associations were moderated by age, gender, and prior trail use. METHODS: Adults (N = 1195) using 1 of 5 trails in Massachusetts responded to an intercept survey. We used multiple linear and logistic regression models to examine associations with trail use. RESULTS: Respondents' mean age was 44.9 years (standard deviation = 12.5), 55.3% were female, and 82.0% were white. Age (longer-term users only), trail use with others, travel time to the trail, and trail design were significantly associated with use for recreation (P < .05). Age, gender, trail safety (longer-term users only), travel time to the trail, trail design (younger users only), and trail beauty were associated with use for transportation (P < .05). CONCLUSIONS: Some common correlates were found for recreational and transportation trail use, whereas some variables were uniquely associated with use for 1 purpose. Tailored strategies are suggested to promote trail use for recreation and transportation.

From research to self-reflection: learning about ourselves as academics through a support group's resistance to our intervention.

Purdue University's Center for Healthcare Engineering developed a computer-assisted technology hub (CATHUB) designed to aid individuals with disabilities. Upon realizing the lack of input from the very individuals they were trying to help, Marifran approached the developers of CATHUB and offered to engage a group of amputees to aid in the design and implementation of the hub. In this essay, Courtney and Marifran recount, each from their own perspective, their experiences working with Amputees in Action as participants in their research project. Ultimately the researchers discovered their research agenda was not compatible with the amputees' needs, resulting in enlightened self-reflection by the researchers and abandonment of the research project.

The message development tool: a case for effective operationalization of messaging in social marketing practice.

That messages are essential, if not the most critical component of any communicative process, seems like an obvious claim. More so when the communication is about health--one of the most vital and elemental of human experiences (Babrow & Mattson, 2003). Any communication campaign that aims to change a target audience's health behaviors needs to centralize messages. Even though messaging strategies are an essential component of social marketing and are a widely used campaign model, health campaigns based on this framework have not always been able to effectively operationalize this key component, leading to cases where initiating and sustaining prescribed health behavior has been difficult (MacStravic, 2000). Based on an examination of the VERB campaign and an Australian breastfeeding promotion campaign, we propose a message development tool within the ambit of the social marketing framework that aims to extend the framework and ensure that the messaging component of the model is contextualized at the core of planning, implementation, and evaluation efforts.

Center for Disease Control's Diethylstilbestrol Update: a case for effective operationalization of messaging in social marketing practice.

The Center for Disease Control's (CDC) Diethylstilbestrol (DES) Update, a campaign to educate people who may have been exposed to the drug DES, is framed on the premises of the social marketing model, namely formative research, audience segmentation, product, price, placement, promotion, and campaign evaluation. More than that, the campaign takes a critical step in extending the social marketing paradigm by highlighting the need to situate the messaging process at the heart of any health communication campaign. This article uses CDC's DES Update as a case study to illustrate an application of a message development tool within social marketing. This tool promotes the operationalization of messaging within health campaigns. Ultimately, the goal of this project is to extend the social marketing model and provide useful theoretical guidance to health campaign practitioners on how to accomplish stellar communication within a social marketing campaign.

Online physical activity information: will typical users find quality information?

This study evaluated physical activity Web sites to determine quality, accuracy, and consistency with principles of the extended parallel process model (EPPM). Three keyword searches were conducted using 4 search engines to find a sample of N = 41 Web sites. Three raters evaluated the Web sites using the JAMA benchmarks to assess quality and American College of Sports Medicine and Centers for Disease Control and Prevention recommendations for physical activity to determine accuracy, as well as checking for inclusion of EPPM variables. Data were analyzed using descriptive statistics and analysis of variance with least squares means. Only 22% of the sites were high quality, none were highly accurate, and most were consistent with the EPPM. Quality ratings were weakly associated with accuracy. Educational and .net sites were rated significantly higher in quality and accuracy, and government sites were most consistent with the EPPM. Quality Web sites were more often found by using Yahoo and Google. "Exercise" yielded more accurate results, whereas "physical activity" and "fitness" produced more Web sites consistent with the EPPM. It is encouraging that most sites incorporated EPPM concepts; however, quality and accuracy were poor, leaving physical activity information seekers at risk for disease and injury.

Health communication instruction: toward identifying common learning goals, course content, and pedagogical strategies to guide curricular development.

Health communication is a vibrant and growing area of the communication discipline, with an abundance of theoretically grounded scholarship and practical application at many levels. Despite this growth, there has yet to be a published description of health communication pedagogy that could identify common conceptual approaches and teaching practices. To help address this gap, an online survey of health communication instructors at 77 colleges and universities throughout the United States was conducted. The questionnaire elicited information about the general characteristics of the institutions and the courses, learning goals, content areas, teaching strategies, and pedagogical practices. Key limitations are highlighted and some recent systematic curricular programs are then presented.

Toward a typology of confidentiality breaches in health care communication: an ethic of care analysis of provider practices and patient perceptions.

Confidentiality should be a fundamental right of patients in a health care setting. However, health care providers who take an oath to uphold confidentiality often neglect this basic patient right. Breaching confidential health information is a serious ethical problem and a communication issue that, historically, has received limited empirical, theoretical, or practical attention. The goals of this project were to frame this issue from an ethic of care perspective, define the concept of a confidentiality breach, identify the types of confidentiality breaches being communicated in health care organizations, and understand how patients perceive these breaches. Based on interviews with 51 patients and observations of health care providers, a definition and typology of confidentiality breaches emerged. Theoretical and practical implications also became evident.

Applying public health strategies to primary immunodeficiency diseases: a potential approach to genetic disorders.

Primary immunodeficiency (PI) diseases are a group of primarily single-gene disorders of the immune system. Approximately 100 separate PI diseases have been described, but <20 probably account for >90% of cases. Although diverse, PI diseases share the common feature of susceptibility to infection and result in substantial morbidity and shortened life spans. Most important, prompt diagnosis and treatment can now lead to life-saving treatment and result in marked improvements in the quality and length of life for persons with PI diseases. In November 2001, a workshop was convened by CDC in Atlanta, Georgia, to discuss ways to improve health outcomes among persons with PI disease. A multidisciplinary panel of persons knowledgeable in PI diseases and public health met to identify and discuss public health strategies that can be applied to PI diseases and possibly for other genetic disorders. A systematic assessment based on the established public health framework was applied to the growing group of PI diseases, whose diverse genetic mutations span multiple components of the immune system but all lead to increased incidence and severity of infections. During the meeting, specialists in clinical immunology, public health, genetics, pediatrics, health communication, and ethics from state and federal agencies, academic centers, professional organizations, and advocacy foundations discussed the four components of the public health framework as they relate to PI diseases. These four components include 1) public health assessment (application of traditional public health methods to assess the occurrence and impact of PI diseases on communities); 2) population-based interventions (development, implementation, and evaluation of screening tests administered to newborns and clinical algorithms for early recognition of symptomatic persons to facilitate the earliest possible diagnosis and treatment for PI diseases); 3) evaluation of screening and diagnostic tools (to ensure their quality and appropriateness for identification of patients with PI diseases); and 4) communication (communication with and information dissemination to health-care providers and the public to facilitate prompt and appropriate diagnosis and intervention). The working group's deliberations focused on challenges and opportunities, priority research questions, and recommendations for future action for these four components. These recommendations, developed by workshop participants, will be useful to medical and public health professionals who are evaluating methods to increase recognition of PI diseases and other genetic disorders.

Impact of HIV test counseling on college students' sexual beliefs and behaviors.

OBJECTIVE: To compare the health beliefs and risky sexual behaviors of college students who did and did not seek HlV testing. METHODS: A survey was administered, and testing sessions were content analyzed. RESULTS: There were no significant differences in health beliefs, but students surveyed perceived themselves to be invulnerable to HIV/AIDS despite unsafe sexual behaviors. Sexual behaviors varied with students who sought HIV testing practicing more unsafe vaginal and oral intercourse. Assessment of the intervention suggested that counseling sessions were influential in persuading students to rethink their health beliefs and change their risky sexual behaviors. CONCLUSION: Testing can be used as both a prevention tool and a way to determine college students' HIV status.