Developing a model of health behavior change to reduce parasitic disease in Vietnam.

Worldwide more deaths occur due to conditions that can be ameliorated by behavior change. Changing health behaviors using models popularized in non-western countries has not proven particularly successful. The purpose of this study was to test variables elicited during qualitative interviews and cultural conversations to develop a model of health behavior change from the ground up in Vietnam. Village leaders and women representatives from the Women's Committee were trained as health advocates to facilitate changes in health practices that led to parasitic and infectious diseases. The health advocates visited 156 families to assess household conditions and assist women head-of-households in applying new behaviors to water treatment, personal hygiene, proper latrining and proximity of animals to humans. Predictors that were tested were self-efficacy, social desirability, internal and external control, and outcome expectations. The correlational and regression design resulted in self-efficacy alone predicting both home hygiene and family health with a large effect size. Social desirability appears to play a different role than in western culture studies. Outcome expectations and control were not predictive. A cultural analysis of the results is included.

Cardiovascular disease knowledge and risk perception among underserved individuals at increased risk of cardiovascular disease.

BACKGROUND: Cardiovascular disease (CVD) risk factor awareness and knowledge are believed to be prerequisites for adopting healthy lifestyle behaviors. The purpose of this study was to examine knowledge of CVD risk factors and risk perception among individuals with high CVD risk. METHODS: The sample consisted of inner city and rural medically underserved patients at high risk of CVD. To be eligible for the trial, subjects were required to have a 10% or greater CVD risk on the Framingham risk score. Knowledge of CVD was assessed with a 29-item questionnaire created for this study. Subjects also rated their perception of risk as compared with individuals of their own sex and age. RESULTS: Data were collected from 465 subjects (mean [SD] age, 60.5 [10.1] years; mean [SD] Framingham risk score, 17.3% [9.5%]). The mean (SD) CVD knowledge score was 63.7% (14.6%), and mean (SD) level of risk perception was 0.35 (1.4). Men and women had similar Framingham risk scores, but women perceived their risk to be significantly higher than that of their male counterparts. Women were also more knowledgeable than men about CVD. Urban participants had significantly higher actual risks than did their rural counterparts (18.2% [10.7%] vs 16.0% [8.9%], respectively; P = .01) but were significantly less knowledgeable about heart disease and also perceived their risk to be lower. CONCLUSIONS: These results indicate a low perception of risk and cardiovascular knowledge especially among men and inner city residents. Innovative educational strategies are needed to increase risk factor knowledge and awareness among at-risk individuals.

Relationship of depression and anxiety to cancer patients' medical decision-making.

The purpose of this study was to examine the relation of depression and anxiety to cancer patients' medical decision-making. Participants were 79 rural and urban cancer patients undergoing chemotherapy. The four decisional styles of the Decisional Processing Model were the independent variables. Dependent variables were anxiety and depression, measured by Spielberger's State-Trait Anxiety and the Center for Disease Control Depression Scale, respectively. Consistent with the Decisional Processing Model, analysis suggested that patients make medical decisions by information seeking, information processing, advice following, or ruminating. Decisional style did not vary according to type or stage of cancer, prognosis, time elapsed since initial diagnosis, or whether cancer was initial or recurrent. Decisional style did not systematically vary with depression and anxiety suggesting how a person makes decisions is a stable personality trait. Thus, decision-making may follow a cognitive schema. It is likely that patients' decisional styles help to manage anxiety and depression when confronted with life-threatening illness. Implications for informed consent and patients' involvement in decision-making are discussed.

Homicidality in schizophrenia: a replication study.

This study attempted to replicate the results of R. C. Schwartz, S. Petersen, and J. L. Skaggs (2001) by testing predictors of homicidality in a new sample of participants with schizophrenia. Results of multiple regression analyses showed that manic symptoms and substance abuse were significantly positively correlated with more extreme homicidality. Global Assessment of Functioning scale ratings were significantly negatively correlated with ratings on homicidality. Finally, men displayed significantly heightened homicidality as compared with women. These findings lend support to the hypothesis that clinicians should pay particular attention to evaluating homicidality in patients who are male, have schizophrenia, who abuse substances, who show acute manic symptoms, and whose global functioning has recently declined.