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.

The value of partnerships in state obesity prevention and control programs.

State health departments funded by the Centers for Disease Control and Prevention's Nutrition, Physical Activity, and Obesity Program collaborate with multiple partners to develop and implement comprehensive obesity prevention and control programs. A mixed-methods evaluation of 28 state programs over a 5-year period assessed states' progress on program requirements, including developing statewide partnerships and coordinating with partners to support obesity prevention and control efforts. States with greater partnership involvement leveraged more funding support for their programs, passed more obesity-related policies, and were more likely to implement obesity interventions in multiple settings.

Measuring patient-centered communication in cancer care: a literature review and the development of a systematic approach.

Patient-centered communication (PCC) is a critical element of patient-centered care, which the Institute of Medicine (Committee on Quality of Health Care in America, 2001) promulgates as essential to improving healthcare delivery. Consequently, the US National Cancer Institute's Strategic Plan for Leading the Nation (2006) calls for assessing the delivery of PCC in cancer care. However, no comprehensive measure of PCC exists, and stakeholders continue to embrace different conceptualizations and assumptions about how to measure it.

Translating medical evidence to promote informed health care decisions.

Objective: To examine the effects of a community-based intervention on decisions about prostate-specific antigen (PSA) screening using multiple measures of informed decision making (IDM).

Data Sources/study Setting: Nonequivalent control group time series design collecting primary data in late 2004 and 2005.

Study Design: We developed a multimodal intervention designed to convey the medical uncertainty about the benefits of PSA screening and early treatment and the limited predictive ability of both the PSA test and pathological specimens collected from prostate biopsy.

An evaluation of health communication materials for individuals with disabilities developed by three state disability and health programs.

Background: Health communication increasingly has been recognized as an important part of public health practice that can help raise awareness of potential health risks, influence attitudes and beliefs, and motivate individuals to change unhealthy behaviors. Yet, few health communication messages exist that target people with disabilities. An evaluation was conducted to assess the relevance and usefulness of health communication materials developed by or disseminated in, or both, three state disability and health programs.

The association between funding for statewide programs and enactment of obesity legislation.

Objective: As part of a national effort to prevent and control obesity, the Centers for Disease Control and Prevention's (CDC's) Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases (NPAO) provides funding to states to improve access to healthful food and increase opportunities for physical activity. The CDC also provides funding to states to build Coordinated School Health (CSH) programs across agencies and within schools to help reduce chronic disease risk factors. This paper investigates the possible role of these programs in state policy change.

Tailoring messages to individual differences in monitoring-blunting styles to increase fruit and vegetable intake.

Objective: To examine whether messages matched to individuals' monitoring-blunting coping styles (MBCS) are more effective in increasing fruit and vegetable intake than mismatched messages. MBCS refers to the tendency to either attend to and amplify, or distract oneself from and minimize threatening information.

Design/setting: Randomly assigned messages were tailored to resonate with either monitors or blunters and delivered at baseline, 1 week, 2 months, and 3 months later.

Behind Closed Doors: What Happens when Patients and Providers Talk about Prostate-Specific Antigen Screening?: Survey of the Effects of a Community-Based Intervention.

Background: : Prostate-specific antigen (PSA) screening is controversial because of uncertainty about whether it reduces mortality and whether the potential benefits outweigh the harms. Given these uncertainties, many medical associations recommend using an informed decision-making (IDM) process for making decisions about PSA screening, so that men can make well informed decisions that reflect their values and preferences.

Objective: : The aim of this paper was to describe the communication exchange between men and their providers regarding PSA screening and the outcomes associated with having a discussion about screening from the patient perspective.

Communication message strategies for increasing knowledge about prostate cancer screening.

Background: This community-based intervention study examined the effects of 2 different message strategies for presenting information about the prostate specific antigen (PSA) test.

Methods: A quasi-experimental longitudinal design with 2 intervention and 1 control group.

Results: Knowledge increased significantly among participants who received either version of the intervention message and remained elevated at 12 months.

Bridging the digital divide by increasing computer and cancer literacy: community technology centers for head-start parents and families.

This article describes the establishment of two community technology centers affiliated with Head Start early childhood education programs focused especially on Latino and African American parents of children enrolled in Head Start. A 6-hour course concerned with computer and cancer literacy was presented to 120 parents and other community residents who earned a free, refurbished, Internet-ready computer after completing the program. Focus groups provided the basis for designing the structure and content of the course and modifying it during the project period.

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.

A new evaluation tool to obtain practice-based evidence of worksite health promotion programs.

Introduction: The Centers for Disease Control and Prevention developed the Swift Worksite Assessment and Translation (SWAT) evaluation method to identify promising practices in worksite health promotion programs. The new method complements research studies and evaluation studies of evidence-based practices that promote healthy weight in working adults.

Methods: We used nationally recognized program evaluation standards of utility, feasibility, accuracy, and propriety as the foundation for our 5-step method: 1) site identification and selection, 2) site visit, 3) post-visit evaluation of promising practices, 4) evaluation capacity building, and 5) translation and dissemination.

Promoting fruit and vegetable intake through messages tailored to individual differences in regulatory focus.

Background: Researchers must identify strategies to optimize the persuasiveness of messages used in public education campaigns encouraging fruit and vegetable (FV) intake.

Purpose: This study examined whether tailoring messages to individuals' regulatory focus (RF), the tendency to be motivated by promotion versus prevention goals, increased the persuasiveness of messages encouraging greater FV intake.

Method: Participants (n = 518) completed an assessment of their RF and were randomly assigned to receive either prevention- or promotion-oriented messages.

Development and validation of an instrument to measure resources and support for chronic illness self-management: a model using diabetes.

Purpose: Few comprehensive and practical instruments exist to measure the receipt of self-management support for chronic illness. An instrument was developed to measure resources and support for self-management (RSSM) for the survey component of the evaluation of the Robert Wood Johnson Foundation's Diabetes Initiative. It includes items to measure an ecological range of RSSM.

Health information styles among participants in a prostate cancer screening informed decision-making intervention.

The purpose of this study was to assess the usefulness of a health information styles segmentation strategy in understanding audience subgroups. We examined the health information styles of men participating in a prostate cancer screening informed decision-making (IDM) intervention and assessed intervention effects on men with distinct health information styles. We classified participants into three health information style groups based on their independence in health decision making (independent versus doctor dependent) and engagement in health enhancement (active versus passive): independent active (IA), doctor-dependent active (DDA) and passive.

Validation of a scale for the assessment of food cravings among smokers.

Weight gain associated with smoking cessation impedes attempts to quit smoking and may lead to obesity. One factor that might contribute to weight gain is cravings for sweet or rich foods. To date, no reliable measure exists for evaluating these cravings.

Need for cognition and message complexity in motivating fruit and vegetable intake among callers to the cancer information service.

This field experiment examined the impact of an individual's need for cognition (NFC; the tendency to enjoy thinking deeply about issues), complex versus simple messages, and the interaction of NFC and message type on encouraging fruit and vegetable consumption. Callers to the Cancer Information Service of the National Cancer Institute (N=517) were asked to participate in the experiment at the end of their call. Individual NFC was assessed, and participants were assigned randomly to receive a telephone message promoting fruit and vegetable consumption that was either complex and multifaceted or simple and straightforward.

Matching health messages to monitor-blunter coping styles to motivate screening mammography.

This study examined whether providing messages matched to women's monitor-blunter coping styles is effective in encouraging mammography utilization. Female callers to a cancer information hotline were assessed at the end of their regular telephone call and classified as monitors or blunters. A randomly assigned message promoting mammography utilization, tailored for monitors or blunters, was delivered on the telephone, and a similarly tailored brochure and refrigerator magnet were mailed to participants immediately after their call.

Casting health messages in terms of responsibility for dietary change: increasing fruit and vegetable consumption.

Objective: To compare the effectiveness of messages emphasizing the importance of either personal or social responsibility for dietary behavior change in increasing fruit and vegetable intake.

Design/setting: Randomly assigned individually or socially oriented messages were delivered at baseline, 1 week, and 2 and 3 months later. Telephone surveys were conducted at baseline and 1 and 4 months later.

Matching health messages to information-processing styles: need for cognition and mammography utilization.

The use of tailored health communications has become a favored technique for persuading individuals to engage in health behaviors, such as screening mammography. This experiment examined the impact of tailoring persuasive health communications to one aspect of individuals' information-processing styles, that of the need for cognition (NFC), the enjoyment of thinking deeply about issues. To determine whether messages matched to an individual's NFC are more influential than mismatched messages, 602 women who called the Cancer Information Service (CIS) of the National Cancer Institute were asked to participate in an experiment at the end of their service call.