The "heartscore" program: a case study in limited evaluation.

In greater Youngstown, Ohio coronary heart disease (CHD) is the number one cause of death and disability. Moreover, mortality rates from CHD are higher in this region than in any other part of Ohio. In response to the obvious need for risk reduction programs in this area the "Heartscore" program was created. Heartscore is a hospital-based community health promotion effort designed to help decrease the incidence of death and disability resulting from CHD by increasing the public's awareness of risk factors and the ways that they can be controlled. A total of 2,135 people took part in Heartscore. Resources for a comprehensive evaluation of the Heartscore program were scarce, therefore only a limited evaluation of the screening programs was conducted. Even a limited evaluation, however, can produce useful results. This article describes Heartscore giving particular attention to how information gathered during the evaluation of the screenings is being used to fine-tune Heartscore and to plan more specific interventions.

Education for job safety and health.

The Federal Occupational Safety and Health Act of 1970 (OSHAct), while emphasizing the importance of engineering controls, explicitly recognizes the salience of worker behavior to the prevention of injury and illness by mandating training in job safety and health. Selected research findings from the published literature illustrate that: (1) reliable behavioral procedures that took advantage of existing engineering controls improved the health protection of workers, (2) changes in environmental conditions were effected through changes in worker behavior, and (3) changes in the social environment favorable to the adoption of safe behavior resulted from training and motivation programs. At present individuals who are responsible for workplace health education rarely have appropriate training in this area. Until individuals with special training in health education enter this field it is unlikely that education will achieve its potential as a method for combatting occupational illness and injury.

Workplace health promotion/protection: correlates of integrative activities.

A synthesis of health promotion and health protection is becoming a national and international priority. A national survey based on a random sample of occupational health professionals was conducted. Results are presented for objectives and activities in three categories: administrative, health education, and integrative. Respondents (N = 385) were grouped by discipline: nurse, health educator, physician, industrial hygienist, and "other." The groups were markedly different in their choice of "most important" educational program objective (knowledge, attitude, or behavior change). Integrative activities (synthesizing health promotion and protection) were most strongly correlated with heavy involvement in administrative and health education activities. Support of unions, employees, and managers for both health protection and health promotion was also correlated with integrative activities. Differences among disciplines indicate a need for convincing some currently practicing occupational health professionals of the value of the synthesis of health promotion and protection in work sites.

Workplace health education. Principles in practice.

The application of psychological principles that lead to the acquisition of skills, knowledge, attitudes, and behaviors for improving safety and health conditions in the work environment is illustrated by case examples. The emergent pattern of successful occupational health education can be described as a process consisting of instruction, psychological reinforcement, and establishment of new norms of safe behavior for workers. To realize maximum effect from education programs, occupational physicians and other occupational health professionals should upgrade and expand their understanding of health education as well as their health education skills.

Worker Training in Job Safety and Health: how do we know it Works?

Two methods of occupational disease and injury prevention specifically required by Federal law are education and training of workers in job safety and health. Basic assumptions underlying these strategies are that they will increase safe behavior thereby reducing health risk. However, questions continue to arise regarding the effect of ongoing training as a preventive measure and, therefore, about the practical usefulness of these assumptions. The purpose of this study was to examine the extent to which evaluations of ongoing training programs can provide information to test the basic assumptions. A self-administered mail survey concerning the evaluation practices of occupational health professionals responsible for the evaluation of health and safety training programs was conducted. Results suggest that for many evaluations the information collected is inappropriate for the uses to which it is put. Furthermore, the results also suggest that measurement validity is a problem. Thus, in effect, we have no way of knowing whether or not the majority of training programs are effective.

Workplace health education: results from a national survey.

A national survey of individuals responsible for workplace health education was conducted by self-administered mailed questionnaire. The present analysis examines the responses to the questions on the types of health education activities undertaken and the prior training in health education of those responsible for this work. Results suggest that interest and activity in workplace health education is increasing but that there is a serious lack of training in health education on the parts of those responsible for this work.

The evaluation of health and safety training.

A national survey of individuals responsible for health and safety training at the workplace was conducted by self-administered mailed questionnaires in 1982-83. This analysis examines the responses to the questions on evaluation. Descriptive data on the extent to which health and safety training programs are being evaluated, the types of evaluation that are done, and the technical approaches used are presented. Results suggest that the majority of current training programs are being evaluated in some way, but also that a substantial portion of these evaluations are not rigorous and do not validly assess the extent to which training is effective.

An adaptation of Bigge's classification of learning theories to health education and an analysis of theory underlying recent health education programs.

This paper attempts to examine the practice of health education from the perspective of learning theory. Examples of recent health education programs are discussed in this context. It is suggested that, in general, health education and program rationales are firmly rooted in learning theory, but that goals, educational interventions, and evaluation methods are not always consistent with the learning theory apparently underlying the program. Furthermore, it is suggested that such inconsistencies are relevant to many controversial issues in health education and may have considerable impact on policy development.

Status and control in voluntary community health planning groups.

A field study was conducted to examine the relative control of provider and consumer members of HSA Project Review Committee. Three project review committees chosen at random during a single HSA review cycle were observed throughout the decision-making process using Interaction Process Analysis. Results indicated that there were no significant differences in control between the provider and consumer members when considered as subgroups of the review committees. Findings also confirm the critical role of the chairperson in the organization and function of the group. It can be concluded that the occupational prestige of provider or consumer members is not imported into the planning situation to a sufficient degree to allow either the provider or consumer subgroup to dominate the planning process. Innovations in health care planning such as long-term education in health planning, group processes, and related issues should be attempted to enhance the effectiveness of these groups.