Patients' expectations of the family physician in health promotion.

This study evaluated patients' perceptions of the family practice physician's role in providing health promotion services. We distributed a questionnaire to a convenience sample of 450 patients (mean age = 40.4 years, SD = 15.8); 382 responded, yielding an 85% response rate. At least 70% of the respondents believed physicians should counsel all patients concerning yearly Pap smears, breast self-exams, and smoking cessation. A sizeable minority believed physicians should teach sex education to teens (41%), discuss social support systems with patients (41%), and discuss home-safety issues with patients (42%). The topics patients least wanted physicians to discuss were financial problems (32%) and seat-belt usage (31%). These patients thought physicians should refer them to other professionals for dental care (33%), marital problems (21%), and financial problems (20%). At least half of the respondents thought physicians should help in the following areas only if requested to do so by the patient: sexual problems (58%), sleeping difficulties (54%), and marital problems (53%). Chi-square analyses were conducted to examine differences in beliefs based on age, sex, educational level, and preventive health orientation of the respondent. We found significant differences based upon these demographic variables; however, interaction effects among the demographic variables also exist.

Family practice physicians' perceptions and practices regarding health promotion for the elderly.

This study assessed 321 family practice physicians' perceptions and practices regarding health promotion in the elderly; specifically, whether health promotion is perceived to be beneficial for this segment of the population. A random sample of 250 male and 250 female members of the American Academy of Family Physicians was surveyed. The internal reliability of the questionnaire was assessed, yielding a Cronbach alpha of .84. Respondents were 46% male and 54% female, and 67% of them had completed a residency program. Three-fourths (77%) of the respondents were between 25 and 50 years of age. The majority believed that health promotion counseling is of value to patients of all ages (88%) and that medical schools should devote more attention to preventive medicine (69%). These physicians identified lack of third-party payment, lack of sufficient staff, lack of competence in prescribing prevention programs for the elderly, and finding counseling the elderly about preventive health issues not professionally gratifying as barriers to health promotion of the elderly. All health promotion practices but one listed on the questionnaire were perceived as important by at least half the physicians. Until compensation for health promotion is available and physicians perceive themselves as competent concerning health promotion in the elderly, it is likely their clinical practices and recommendations will lag behind their favorable attitudes toward the topic.

Pediatricians' perceptions and practices regarding childhood obesity.

A 42-item Likert format questionnaire examining pediatricians' perceptions and practices concerning childhood obesity was distributed to a national random sample of 500 physicians. The overall response rate was 68%. The majority of pediatricians believed physicians are obligated to counsel parents of obese children regarding the health risks of obesity (83%), that normal weight is important to the health of children (67%), and that physicians should be role models by maintaining their normal weight (59%). However, 70% of these pediatricians believed designing programs and counseling children about weight loss was difficult, 22% felt competent in prescribing weight loss programs for children, and only 11% agreed that counseling children and parents on weight loss is professionally gratifying. At least one-half of the respondents recommended the following weight loss programs/techniques to their patients: (1) decreasing caloric consumption (84%), (2) seeing a dietitian/nutritionist (78%), (3) joining Weight Watchers (66%), (4) aerobic exercise (60%), and (5) behavior modification programs (55%). These pediatricians received most of their weight control information from medical journals (70%) and past experience (68%). We also assessed belief and attitudes concerning the effect of childhood obesity, the role obesity plays in selected diseases, and the etiology of childhood obesity.

Family practice physicians' beliefs, attitudes, and practices regarding obesity.

This study examined 318 family practice physicians' beliefs, attitudes, and practices regarding obese patients. Most physicians surveyed were aware of the health effects of obesity and that normal weight is important to the health of their patients. Beliefs, attitudes, and practices differed significantly based on the physicians' sex, weight, years in practice, and belief that counseling patients on weight loss is professionally gratifying and that most obese patients can lose significant amounts of weight. A notable number of respondents held negative or stereotypical attitudes toward obese patients (i.e., obese patients lack self-control, are lazy and sad). The most commonly recommended weight loss techniques were decreasing caloric consumption (92 percent), participating in Weight Watchers (84 percent), consulting a dietitian/nutritionist (76 percent), and aerobic exercise (75 percent). The two sources of weight control information most frequently cited were past experience (73 percent) and medical journals (71 percent). The results of this survey indicate that there is considerable room for improvement in the beliefs, attitudes, and practices of family physicians regarding obese patients.

Determining consumer preferences for a cash option: Arkansas survey results.

As long-term care (LTC) expenditures have risen, policymakers have sought ways to control costs while maintaining consumer satisfaction. Concurrently, there is increasing interest within the aging and disability communities in consumer-directed care. The Cash and Counseling Demonstration and Evaluation (CCDE) seeks to increase consumer direction and control costs by offering a cash allowance and information services to persons with disabilities, enabling them to purchase needed assistance. The authors present results from a telephone survey conducted to assess consumer preferences for a cash option in Arkansas and describe how findings from the four-State CCDE can inform consumer information efforts and policymakers.

Black Americans' perceptions of cancer. A study utilizing the Health Belief Model.

The purpose of this study was to determine black adults' knowledge and perceptions of cancer by utilizing the Health Belief Model. The subjects were obtained by randomly selecting 11 churches from a list of 33. There were 769 black adults who responded to the survey (64 percent response rate). Mean age of respondents was 44.3 years, SD = 14.7. Only 29 percent were able to correctly identify all seven of the American Cancer Society warning signs; 13 percent were unable to identify any warning signs. One in four believed it was likely they would develop cancer sometime in their life, and 42 percent believed blacks were more susceptible to cancer than whites. Forty-one percent believed most people who get cancer will die from it. Perceived barriers to treatment included cost and pain. A large number of significant differences (P < .01) were found when responses were examined in relation to the sex, educational level, and age of the subjects.

A preliminary investigation of inner city adolescents' perceptions of guns.

Three hundred seventy-seven African-American and 201 white adolescents, primarily of low socioeconomic status, were surveyed on perceptions of guns. Chi-square analyses found significant differences by gender and ethnicity. African-American males were more likely to have a pistol at home (47%); both African-American males and females were more likely to have known someone who took a gun to school (57% and 47%) and to have personally known someone who had been shot (87% and 91%). Differences between African-American and white adolescents and between males and females regarding gun control, gun safety, and consequences of gun use are described.

Instrument validity and reliability in three health education journals, 1980-1987.

Investigators examined how often validity and reliability measures were reported for research articles in three health education journals: Health Education, Health Education Quarterly, and the Journal of School Health. Articles published from 1980 to 1987 were considered in the analysis. Of the 611 articles published by Health Education during the period used for analysis, 128 (21%) met the criteria of a research article. Reliability was reported for 22 (17%) articles, and validity was reported for 78 (61%) articles. Health Education Quarterly published 212 articles; 74 (35%) were research articles. Reliability was reported for 16 (21%) articles and validity was reported for 40 (54%) articles. The Journal of School Health published 778 articles, of which 243 (31%) were research articles. Reliability was reported for 62 (25%), and validity was reported for 164 (67%) of the research articles. A chi-square test found a significant difference among the number of research articles published by the journals. Chi-square tests also found significant differences among the journals in the proportion of research articles that reported reliability information and the proportion that reported validity. A significant trend was noted for Health Education Quarterly and the Journal of School Health; the proportion of research articles that reported validity and reliability increased over time for both publications.

Elementary school principals' perceptions of childhood obesity.

This survey assessed school principals' perceptions regarding childhood obesity and the schools' role in dealing with the problem. A randomly selected group of 300 school principals was obtained from the National Association of Elementary School Principals; 227 (76%) administrators returned the questionnaire. Fifty-one percent of the principals believed normal weight was important to child health. Although 35% believed schools were not doing enough to alleviate childhood obesity, responses suggested principals oppose schools becoming obesity treatment centers. They do not believe teachers or parents would support such programs. They perceived the school's role to be educational and referral in nature. However, they supported elimination of "junk food" machines (71%) and provision of low calorie lunches (60%). They believed school nurses play the most important role in treating childhood obesity at school.

Black and white adolescents' perceptions of their weight.

Black and white adolescents' perceptions of their weight were examined in this study. A 22-item questionnaire on weight perceptions and weight control was administered to 341 adolescents from two inner city schools in the midwest (138 black and 193 white students). Students were classified as thin, normal, or heavy based on National Health Survey data on height and weight measurements for youth ages 12-17. Significant differences (p less than .05) occurred in how the heavy black and white males and females perceived their weight in comparison to actual weight. All heavy white females perceived they were heavy, in comparison to only 40% of heavy black females; 78% of heavy white males labeled themselves heavy vs. 36% of heavy black males. Thin black and white females were dieting and exercising to lose weight and thin white males were exercising to lose weight. Black males were significantly more likely to believe emotions did not affect their weight when compared to white males. Black females believed exercise levels accounted for their weight, while white females attributed their weight to eating habits. Beliefs about exercise and eating contributed 23% to the variance found in perceived weight status of black males. White males believed access to food and their emotions accounted for their perceived weight. Leading sources of weight control information regardless of ethnicity were television, family members, friends and magazines for females; males used TV, family members, and athletic coaches.

Differences in black and white adolescents' perceptions about cancer.

This study determined if black and white adolescents differed significantly in cancer knowledge, attitudes, and beliefs. Using the Health Belief Model, a 97-item questionnaire was developed by the researchers and completed by 573 black and 297 white junior and senior high school students from a large, midwest school district. Chi-square analyses yielded nine significant differences (p less than .01) between blacks and whites on cancer knowledge (etiology, warning signs, and prevention techniques). Further significant differences were found when items comprising the separate Health Belief Model subscales were analyzed. Blacks and whites differed significantly on cues to action (one item), perceived susceptibility (two items), perceived severity (one item), perceived barriers (two items), perceived benefits (three items), and interpersonal relationships (three items). Blacks and whites received cancer information from the same sources, with the exception of books, which was reported more by blacks.

School nurses' perceptions of childhood obesity.

A random sample of 250 nurses from the American School Health Association membership were sent a questionnaire concerning childhood obesity; 88% responded. Most (85%) believed normal weight was important to children's health and that school nurses should be role models by maintaining normal weight (77%). Most also believed counseling children and their parents about weight loss was difficult (71%) and that schools need to do more to alleviate childhood obesity (65%). At least 75% believed all schools should offer a comprehensive health curriculum with units on nutrition and weight control. Likewise, all schools should eliminate "junk food" machines and make special low-calorie lunches available. Only 25% felt competent to prescribe weight loss programs for children, and only 30% found counseling about weight loss professionally gratifying. One-fourth believed, that with proper guidance, children could lose significant amounts of weight or maintain that weight loss. The nurses believed in the importance of normal weight, but appeared skeptical of children's abilities to lose weight as well as their own abilities to provide children with guidance to do so. Finally, they perceived a need for schools to be more active and involved in dealing with childhood obesity.

Urban black and white adolescents' physical fitness status and perceptions of exercise.

The modified Harvard Step Test and a 70-item questionnaire based on the Health Belief Model (HBM) were given to 257 high school students, 154 blacks, and 93 whites. Mean age of students was 16.0 years (SD = 1.1) for whites and 15.8 years (SD = 1.1) for blacks. Though more blacks than whites were in poor physical condition (51% females and 27% males vs. 35% females and 16% males, respectively), the difference was not statistically significant. A high level of concurrence existed between individuals in good physical condition and those who stated they regularly exercised, but this agreement was more pronounced among white students (73% vs. 62% for black students). White students were significantly more knowledgeable than black students on the exercise knowledge subscale. No significant differences existed between black and white students on any other HBM subscales. When subscale scores for those in good versus poor physical condition were compared, significant differences were found on all subscales except the perceived benefits subscale. Analysis of individual questionnaire items which best predicted whether one was in poor or good physical condition found four items accounted for 38% of variance in black students, and seven items accounted for 52% of variance in white students.

School counselors' knowledge of eating disorders.

The purpose of this study was to examine school counselors' knowledge of adolescent eating disorders, specifically anorexia and bulimia nervosa. Participants were drawn from the national membership of the American Association of School Counselors; they were requested to complete a 43-item questionnaire on eating disorders. Of the 500 participants randomly selected, 337 (67%) returned usable questionnaires. There were 220 female and 117 male counselors; the mean age was 45.2 years. The majority held a master's degree and counseled high school students; the mean number of years they had been school counselors was 12.2. When asked how competent they were in helping students with eating disorders, 11% rated themselves as very competent, 49% believed they were moderately competent, and 40% believed they were not very competent. The majority (75%) did not believe it was their role to treat students with eating disorders; they were instead referred to an eating disorders program (40%), their parents (34%), or a psychiatrist or other physician (34%). The majority of counselors (72%) had encountered anorexic or bulimic students; the most common method of discovering students with a problem was by being informed by fellow students (35%). The majority of respondents were very knowledgeable regarding the signs and symptoms of anorexia and bulimia nervosa. Examination of their general knowledge of eating disorders revealed that they knew more about anorexia than bulimia. The two sources of eating disorders information utilized by at least half of the respondents were professional journals (70%) and workshops/professional conferences (56%).

Perceptions of family practice residents regarding health care and poor patients.

The purpose of this study was to assess residents' beliefs about the poor. Residents from eight different Ohio residency programs completed the questionnaire (N = 130). No significant differences were found in beliefs about the poor based on resident age, year of residency training, size of the community in which the resident was raised, and percentage of low-socioeconomic-status patients cared for. Most residents perceived the welfare system as lacking; 83 percent agreed the poor are caught in a "cycle of poverty," 82 percent agreed welfare benefits cause the poor to be dependent upon the system, and 48 percent believed indigent women become pregnant and have babies so they can collect welfare support. Conversely, only one in four residents believed that most poor people become poor as a result of lack of effort on their part, and one in five believed that society is coddling the poor. The majority of residents believed that poor patients are more likely than others to miss appointments without canceling (73 percent), more likely to be late for appointments (51 percent), and less knowledgeable about their illnesses (80 percent). One in four residents believed that poor patients tend not to appreciate the work of physicians and nurses, and 43 percent claimed that the poor are more difficult patients. The majority of residents believed that the poor are unlikely to practice preventive health behaviors (72 percent) or to be compliant with their medical regimen (60 percent). Finally, 41 percent believed that poor patients usually care less than others about their own health status.

Nurses' perceptions regarding health care and the poor.

To assess hospital staff nurses' perceptions regarding the poor and their health care a total of 240 nurses were selected from 6 of 8 area hospitals to participate in the study (40 nurses from each institution). Of the 240 nurses selected, 192 nurses completed the questionnaire (80% return rate). The majority of the sample believed the poor were caught in a "cycle of poverty" (84%) which implies they believe the poor cannot help being poor. However, some of the nurses in this sample also held "victim blaming" attitudes, i.e., poor women become pregnant to collect welfare (58%), the poor live well on welfare (35%), and a person's poverty is due to advantages squandered (27%). About one-third of the nurses agreed poor patients do not receive equivalent quality of care when compared to nonpoor patients and that transferring patients to another hospital due to an inability to pay was very common. Ten percent agreed assisting the poor in becoming well was a waste of medical care as they would be back again soon with another problem. Over half the sample believed the poor were not likely to engage in preventive health behaviors (66%) nor be compliant with their medical regimens (52%). Such attitudes should be studied to see if they affect communication between the poor and their nurse caregivers.

Parents' beliefs about cholesterol and its effects on their children.

A random sample of parents of primary grade children (N = 500) was obtained from two higher socioeconomic-status suburban elementary schools. The respondents (n = 277) were well educated (92% attended or graduated from college), white (92%), primarily higher in socioeconomic status (79% earned more than $50,000/year), and female (70%). Two-thirds of the parents believed that all elementary school children should have their cholesterol levels checked, 70% believed high cholesterol in children was serious, yet only 21% believed their child would develop a high cholesterol level. To control their children's cholesterol level, the majority of parents (73%) made lifestyle changes for their children since the majority believed high cholesterol levels would clog arteries (95%) and cause heart disease (90%). Parents most often received their information on cholesterol from magazines (73%), newspapers (62%), and physicians (52%).

Comparison of three antismoking interventions among pregnant women in an urban setting: a randomized trial.

This study examined smoking cessation and cigarette reduction of indigent inner city pregnant women (n = 193) who completed one of three interventions: a special video program based on their perceptions of the effects of smoking during pregnancy, the American Lung Association's "Freedom From Smoking For You and Your Baby" program, or the usual physician's advice. Six percent of the women quit smoking, and 43% reduced the number of cigarettes they smoked. There were no significant differences among the three groups for either the number who quit smoking or who reduced the number of cigarettes smoked.