S. Stephen Kegeles

Children's Health Beliefs and Acceptance of a Dental Preventive Activity

In a study of participation in a school-based preventive dental program, the relationship between childrens beliefs about health and their participation did not follow predictions of the Health Belief Model. Further, perceived efficacy was the only belief altered by an introduction to the program, despite the fact that some children participated in group discussions designed to change other health beliefs as well. The similarity of these data to other data on health beliefs of children and adults is cited. It is suggested that health beliefs are difficult to change and are often unrelated to behavior. It is also suggested that health beliefs and behavior might be parallel developments in the individual that need not be causally related.

Education for breast self-examination: Why, who, what, and how?

Analysis of the continuing controversy about the value and effectiveness of breast self-examination is provided and suggestions are made about the kinds of data needed to establish its effectiveness. Research data about characteristics of women who perform breast self-examination regularly and those who do not and about the usefulness of mass communication, group efforts, and individual approaches to obtain regular and correct self-examination are assessed. Research and educational efforts focusing on six activities are needed: (a) obtaining regular and correct breast self-examination practice by women, (b) reducing delay by women after suspicious findings, (c) teaching physicians to do correct breast examinations, (d) reducing delay by physicians in referring suspicious cases to surgeons, (e) reducing womens delay after referral, and (f) teaching surgeons to do breast examinations correctly and reducing their delay in beginning treatment. Most of the research reported deals with regularity of breast self-exam, while some deals with correctness. The only intraindividual variables that have differentiated consistently among regular and less-regular BSE practitioners have been knowledge and confidence of ability. Very little research has been carried out on the other five activities and is therefore sorely needed. Suggestions for desirable educational efforts in each of these six areas are made.

Who Volunteers for a Breast Self-Examination Program? Evaluating the Bases for Self-Selection

Interest in a free breast self-examination (BSE) teaching program offered to a patient population (n=1590) was assessed, and a follow-up survey of refusers undertaken to determine difference between participants and refusers. Fifty-one percent of the known, eligible women patients expressed interest in the program and 24% ultimately had the teaching. Participants differed from refusers most notably in terms of less previous experience with BSE, more family history of cancer, a longer relationship with their physicians, and different health beliefs. They state more confidence in the effectiveness of breast cancer detection and treatment, less fear and embarrassment, and more personal and physician responsibility for health outcomes, as measured by the Health Locus of Control Scales. Self-selection thus seems rationally based on the kind of program and the needs of the women. Such self-selection can be cost- effective in delivering health education to the people most in need of it and most likely to benefit from it.

Motivational techniques for increasing acceptance of preventive health measures.

Recent recommendations for prevention and treatment of chronic diseases emphasize long-term modification of patient health activities. Thus far, the public has accepted these recommendations only moderately. In a schoolbased topical fluoride program, urban and suburban seventh-graders were offered three fluoride treatments at five-and-a-half-month intervals. During the program, students were exposed to one of three techniques for increasing motivation to take part in preventive treatment programs: 1) information-alone, 2) information-plus-small rewards, 3) information-plus-group-discussion. “Information” refers to a slide show/demonstration designed to communicate information about tooth decay, fluorides, and the treatment program. Results indicated that 62 per cent of eligible students received all three fluoride applications during the 11-month period. However, the reward technique achieved significantly greater participation than either group discussion or information-alone. The major difference between rewards and information-alone was in motivating children to obtain parental permission, while the difference between rewards and group discussion was both in motivating children to obtain permission and in motivating them to return for second topical treatment. There were few important differences between urban and suburban students in overall compliance or in response to the motivational techniques.

Adolescents' health beliefs and acceptance of a novel preventive dental activity: A further note☆☆☆

As part of two new school-based experiments, the dental health beliefs of adolescents were measured by questionnaires that emphasized personal and vicarious dental experiences. Premeasured beliefs showed zero order or negative relationships with adherence to at-home mouthrinsing in both a 1-year experiment and in the first year of a 2-year experiment; neither premeasured beliefs, nor new measures of beliefs obtained at the end of the first year, predicted adherence in the second year of the 2-year program. Behavior in the first year was inversely related to beliefs obtained at the end of that year. These new data, along with those collected as part of two earlier experiments which measured beliefs in a different manner, representing a total population of over 1500 subjects, cast doubt on the value of the Health Belief Model in either predicting or helping to explain behavior of adolescents in novel disease preventive programs.

Acceptance by children of a daily home mouthrinse program.

Abstract This paper reports on the effects of an experiment which compares three motivational conditions to influence seventh grade urban and suburban children to use an acidulated topical mouthrinse at home each day over 20 weeks. The three conditions are information (control), rewards and group discussion. Analysis is made of volunteering, bringing in parental permission slips and picking up ten bottles of mouthrinse at two-week intervals. The key findings are as follows: (1) The rewards condition was significantly superior to the group discussion condition and to the information condition. (2) The group discussion condition was significantly inferior to the information condition. (3) Whether a child was from an urban or suburban school did not significantly affect staying in the program until the end. Neither did school location affect the number of bottles picked up. (4) Most children used a maximal number of doses of mouthrinse while they remained in the program whether they dropped out early or late. Neither motivational condition nor location affected average number of doses used. (5) On a temporal basis, (a) a higher % of children in the rewards than in the information condition volunteered, obtained parental permission, and picked up bottles at seven of the ten pickup periods; (b) a higher % of children in the rewards than in the discussion condition picked up bottles beginning at bottle handout number 2; (c) beginning at bottle handout number 5, a smaller % of children from the discussion than from the information condition picked up bottles. These results are discussed along with comparable results obtained from a previous experiment which used the same experimental conditions to influence 7th grade children to take three topical fluoride treatments over an 11 month period. Discussion focuses on the relevance of these data for understanding and predicting health behavior which must be carried out repetitively over long periods of time.

Current Status of Preventive Dental Health Behavior in the Population

Frequency of Dental L visits By Demographic Factors The most recent nationwide data indicate that about 46 percent of the United States population visit a dentist at least once a year.&dquo; The frequency of such visits has increased over the past 40 years; this increase has been at the rate of a little more than one half percent per year from a base of 20 percent in 1930. Annual visits to dentists and annual expenditures for dental services are distributed quite unequally among the U.S. population.&dquo;’ Few studies have attempted to obtain answers from the population about why they seek dental care as contrasted with what is provided them once in dental offices. Thus, it is difficult to provide other than socioeconomic data about characteristics of populations who visit dentists for preventive purposes. Available data indicates that about 25 to 30 percent of the United States’ population visit dentists on a routine periodic basis. This has increased slightly over the past 15 years from about 20 percent. Again, routine periodic visits are distributed unequally among the population.10 ’

Behavioral Science Data and Approaches Relevant to the Development of Education Programs in Cancer

This paper will attempt to provide a small, highly selected sample of notions, concepts, approaches and findings of behavioral scientists which have potential relevance for certain problems of cancer. Actual relevance of these notions can be determined only through empirical assessment. Among the myriad of problems in the life history of the cancer patient, stress here will be placed largely on program efforts for screening for pre-symptomatic cancer detection. Most of the data used will stem from activities directed toward increasing utilization of cervical cytology and breast cancer examination. In addition, however, three additional areas will be touched on which have not yet been sufficiently developed by health educators: self-care behavior, particularly cessation attempts for cigarette smoking; preparation of patients for cancer surgery; and rehabilitation of patients after cancer surgery .