Agents of change: how do complementary and alternative medicine providers play a role in health behavior change?

BACKGROUND: Recent investigations indicate that complementary and alternative medicine (CAM) use may be conducive to health behavior change. OBJECTIVE: The goal of this study was to investigate how this change occurs. METHODS: Using Social Cognitive Theory and Self-determination Theory as guiding frameworks, we surveyed a convenience sample of 216 CAM consumers abouttheir CAM therapy and iors and conducted focus groups with 36 CAM consumers. RESULTS: Consumers reported encouragement from providers and improved energy resulting from treatments as reasons for making health behavior changes. Multivariate analysis showed that increased odds of self-reported dietary change were significantly associated with increasing body awareness as a result of therapy, endorsing the statement that sustained improvement for their health conditions required self-care, using an acupuncturist, and being 44 years or younger. Comparable results were found for exercise change, except using an acupuncturist was a significant negative predictor and age was not significant. Focus group findings echoed these themes. CONCLUSION: This initial investigation into how CAM providers may play a role in health behavior change suggests that provider support, increased responsibility for one's health, and the CAM treatments themselves contribute to behavior change, although additional research in this area is warranted.

Socio-cultural factors that foster use and abuse of alcohol among a sample of enlisted personnel at four Navy and Marine Corps installations.

Rates of heavy drinking are consistently higher among U.S. military personnel than among civilians, particularly among young male personnel. In addressing drinking in the military, more information is needed on contextual factors influencing drinking to better understand the conditions that lead to or facilitate drinking. Results from 15 focus groups conducted with enlisted personnel at 2 Navy and 2 Marine Corps installations as part of formative research for an alcohol abuse prevention trial are reported in this article. The study explored the "drinking climate" of each installation in terms of shared attitudes and recognized norms regarding alcohol use and installation personnel's general understanding of policies concerning alcohol consumption. Analysis revealed several contextual factors that add to our understanding of drinking behaviors.

Building company health promotion capacity: a unique collaboration between Cargill and the Centers for Disease Control and Prevention.

BACKGROUND: The US Centers for Disease Control and Prevention (CDC) helps protect the health and safety of all people. The workplace can be used to reach millions of workers and their families with programs, policies, and benefits that promote health. We describe a CDC-led project to build Cargill's workplace health promotion capacity and identify the importance of a company liaison in the public-private relationship. CONTEXT: The project goals were to engage diverse Cargill personnel, conduct a workplace health assessment, aid in the development of a workplace health program action plan, and develop Cargill's internal capacity using knowledge and skill-building. METHODS: CDC partnered with Cargill on a workplace health promotion project to build Cargill's capacity. A multicomponent assessment was conducted to determine priority employee health issues, stakeholder meetings were held to engage and educate Cargill management and employees, and technical assistance was provided regularly between CDC and Cargill. CONSEQUENCES: Identifying a company liaison to work with an external assessment team is critical to building capacity for a successful workplace health project. This relationship creates an understanding of company culture and operations, facilitates access to key stakeholders and data, and provides opportunities to enhance capacity and sustainability. INTERPRETATION: Employers undertaking workplace health promotion projects should identify a senior-level person to serve as the company health leader or liaison and who can devote the time necessary to build trusting relationships with partners to ensure project success. This person is valuable in facilitating communications, data collection, logistical support, troubleshooting, and influencing employer workplace health practices.

Family-based detection for hereditary hemochromatosis.

The purpose of this study was to examine motivators for and barriers to family-based detection for hereditary hemochromatosis (HH). HH patients (n = 60) and HH siblings (n = 25) participated in one-on-one or group interviews. Patients and siblings understood that HH "runs in families," but not that siblings are at higher HH risk than other family members. Patient motivators included concern for siblings' health, seriousness of untreated HH, and doctor's encouragement to tell siblings that they need to seek diagnostic testing. Siblings were motivated by the seriousness of HH. Barriers included lack of symptoms, belief that HH was rare, and assumption that their doctor would have mentioned the risk of HH. Family-based detection continues to be a feasible part of an overall public health strategy to promote early detection of HH. Greater awareness of HH and its potential consequences, especially among high-risk groups, provides an additional potential avenue for public health action.

Discussions about preventive services: a qualitative study.

BACKGROUND: Elderly minority patients are less likely to receive influenza vaccination and colorectal cancer screening than are other patients. Communication between primary care providers (PCPs) and patients may affect service receipt. METHODS: Encounters between 7 PCPs and 18 elderly patients were observed and audiotaped at 2 community health centers. Three investigators coded transcribed audiotapes and field notes. We used qualitative analysis to identify specific potential barriers to completion of preventive services and to highlight examples of how physicians used patient-centered communication and other facilitation strategies to overcome those barriers. RESULTS: Sharing of power and responsibility, the use of empathy, and treating the patient like a person were all important communication strategies which seemed to help address barriers to vaccination and colonoscopy. Other potential facilitators of receipt of influenza vaccine included (1) cultural competence, (2) PCP introduction of the discussion, (3) persistence of the PCP (revisiting the topic throughout the visit), (4) rapport and trust between the patient and PCP, and (5) PCP vaccination of the patient. PCP persistence as well as rapport and trust also appeared to facilitate receipt of colorectal cancer screening. CONCLUSION: Several communications strategies appeared to facilitate PCP communications with older patients to promote acceptance of flu vaccination and colorectal cancer screening. These strategies should be studied with larger samples to determine which are most predictive of compliance with prevention recommendations.

Promising practices in promotion of healthy weight at small and medium-sized US worksites.

INTRODUCTION: We developed a new evaluation method to identify promising practices for promoting healthy weight among employees at small and medium-sized worksites. METHODS: We used a structured rating and selection process to select 9 worksites with approximately 100 to 3,000 employees from a pool of worksites with health promotion programs reputed to be exemplary. A site visit over 2 sequential half-days at each site included interviews with senior management, program staff, vendors, and wellness committees; observation guided by a written environmental assessment; and structured review of program data on health outcomes of wellness program participants. The team corroborated findings from interviews, observations, and reviews of aggregate data on health outcomes of participants. Using the site visit reports, the project team and a separate panel of experts identified worksite health promotion practices that were promising, innovative, feasible to implement in a variety of settings, sustainable, and relevant for public health. RESULTS: Innovative practices included peer coaching, wellness screening coupled with motivational interviewing and follow-up, free access to fitness facilities, and incentives such as days of paid leave for participation in wellness programs. Introduction of incentives was associated with higher participation rates. To build the business case for their programs, staff at several worksites used aggregate data on decreases in high blood pressure, serum cholesterol concentrations, and body weight in longitudinal samples of program participants. CONCLUSION: The evaluation method identified promising practices implemented at small and medium-sized worksites to promote healthy weight and related favorable health outcomes.

Couples' notions about preconception health: implications for framing social marketing plans.

PURPOSE: To understand couples' notions of preconception health (PCH) and to inform the development of social marketing plans focused on PCH. APPROACH/DESIGN: We used a social marketing perspective to understand how couples considered PCH as a product, its potential price, how it should be promoted, and in what type of places it should be promoted. These variables are typically referred to as the four social marketing P's. SETTING: Telephone interviews with couples recruited from a national database. PARTICIPANTS: A total of 58 couples (116 individuals) were segmented by five couple segments based on pregnancy planning intention and current parental status in which the wife or partner was 18 to 44 years of age. The five segments were combined into three categories: couples who were planning pregnancies, couples who were not planning pregnancies, or couples who were recent parents (interconception). METHOD: Couple-based structured interviews lasting approximately 45 to 60 minutes were conducted via telephone. Questions inquired about couples' experience with PCH and the four social marketing P's. RESULTS: Commonalities existed across the four social marketing P's for the different couple segments. Notable couple-related themes that emerged included the importance of couple communication, support, and relationship quality. PCH was more relevant for couples planning a pregnancy, but nonplanning couples understood the benefits of PCH and related behaviors. CONCLUSION: Couples may be an important target audience when considering social marketing approaches for PCH. Many couples perceived the relevance of the issue to important aspects of their lives, such as health, family, and their relationships.