Sharon M. Desmond

Urban black women's perceptions of breast cancer and mammography

The purpose of this study was to examine differences in perceptions of breast cancer and mammography between black women who wanted a mammogram and those who did not. The subjects were 186 low socioeconomic black women who attended an inner city community health clinic (83% response rate). There were no significant differences on the demographic and background variables between women who did (N=139) and did not (N=47) want a mammogram. The knowledge level of both groups regarding breast cancer was poor. Those who desired a mammogram perceived themselves as more susceptible to breast cancer, and considered breast cancer more severe than those who did not want a mammogram. Neither group identified many barriers to obtaining a mammogram. The majority (at least 88 percent of those who wanted a mammogram and at least 55 percent of those who did not) agreed with each of the five benefit items. Eighty-five percent of both groups agreed they would receive a mammogram if their physician told them to do so. The two Health Belief Model components which accounted for the largest percentage of the variance between women who wanted a mammogram and those who did not were perceived benefits (13 percent) and perceived susceptibility (3 percent).

Exploring Implementation and Fidelity of Evidence-Based Behavioral Interventions for HIV Prevention: Lessons Learned From the Focus on Kids Diffusion Case Study

Evidence-based interventions (EBIs) are used in public health to prevent HIV infection among youth and other groups. EBIs include core elements, features that are thought to be responsible for the efficacy of interventions. The authors evaluate experiences of organizations that adopted an HIV-prevention EBI, Focus on Kids (FOK), and their fidelity to the interventions eight core elements. A cross-sectional telephone survey was administered to 34 staff members from organizations that had previously implemented FOK. Questions assessed how the organization adhered to, adapted, dropped, or altered the intervention. None of the organizations implemented all eight core elements. This study underscores the importance for HIV intervention researchers to clearly identify and describe core elements. More effort is needed to reflect the constraints practitioners face in nonresearch settings. To ensure intervention effectiveness, additional research and technical assistance are needed to help organizations implement HIV prevention EBIs with fidelity.

Rural eHealth Nutrition Education for Limited-Income Families: An Iterative and User-Centered Design Approach

Background Adult women living in rural areas have high rates of obesity. Although rural populations have been deemed hard to reach, Internet-based programming is becoming a viable strategy as rural Internet access increases. However, when people are able to get online, they may not find information designed for them and their needs, especially harder to reach populations. This results in a “content gap” for many users. Objective User-centered design is a methodology that can be used to create appropriate online materials. This research was conducted to apply a user-centered approach to the design and development of a health promotion website for low-income mothers living in rural Maryland. Methods Three iterative rounds of concept testing were conducted to (1) identify the name and content needs of the site and assess concerns about registering on a health-related website; (2) determine the tone and look of the website and confirm content and functionality; and (3) determine usability and acceptability. The first two rounds involved focus group and small group discussions, and the third round involved usability testing with individual women as they used the prototype system. Results The formative research revealed that women with limited incomes were enthusiastic about a website providing nutrition and physical activity information targeted to their incomes and tailored to their personal goals and needs. Other priority content areas identified were budgeting, local resources and information, and content that could be used with their children. Women were able to use the prototype system effectively. Conclusions This research demonstrated that user-centered design strategies can help close the “content gap” for at-risk audiences.

A community-campus partnership for health: the Seat Pleasant-University of Maryland health partnership.

A partnership formed between the University of Maryland and the city of Seat Pleasant, Maryland, designed to enhance the health of the citys residents and the education of the universitys students—graduate and undergraduate—in the Department of Public and Community Health is described. The health partnership is based on service-learning theory, and a presentation of research findings related to service learning is offered. The history of the health partnership, its developmental stages, its operational procedures, and its evaluation are discussed. In addition, projects resulting from health partnership activities and projects and goals projected for the future are presented. Throughout the article, lessons learned are discussed, and the discussion and conclusions detail the benefits to inform other programs interested in forming a community-campus partnership for health.

Implementation Issues for Consumer-Directed Programs: Comparing Views of Policy Experts, Consumers, and Representatives

Summary An increasing number of aging community providers and consumers support consumer-direction (CD) in long-term care services. In regard to devolution, consumer-direction goes beyond the usual approach of shifting responsibilities from the federal government to state governments to bring programs “closer to the people.” Consumer-direction goes even further by placing resources directly in the hands of consumers. Yet, many questions remain unanswered regarding how to implement CD personal assistance services in general, and especially for older persons. This article describes the importance of examining views from multiple key stakeholders involved in implementing CD programs. We report on three background studies that have informed the Cash and Counseling Demonstration and Evaluation (CCDE) design and implementation-policy expert interviews as well as surveys and focus groups with consumers and representatives. As a fourth data source, we drew upon experiences in designing the CCDE and initial results from the first year of implementation. Each of the three studies on its own provided essential information for planning the CCDE. However, when we examined the studies together, and added CCDE design and implementation experiences, views expressed by the different stakeholders formed a type of multi-perspective “dialogue” that expanded our knowledge about implementing CD services. We hope this increased knowledge will help expand the availability of such services for consumers of any age who want to direct their own care.

Consumer Preferences for a Cash Option Versus Traditional Services Telephone Survey Results From New Jersey Elders and Adults

The Cash and Counseling Demonstration and Evaluation (CCDE) is a policy-driven evaluation of the basic belief that most people, including the elderly, want a say in matters that affect their daily lives. The evaluation is comparing cost, quality, and satisfaction of consumers receiving traditional personal care services with those receiving a consumer-directed cash benefit and information services. This article presents results from a telephone survey conducted as background research to assess the preferences of elders and adults with disabilities for a cash option versus traditional services in New Jersey, one CCDE demonstration state. This preference study provides information about consumer perceptions and attitudes, need for help or training with service management tasks, and outreach messages to emphasize when promoting a consumer-directed cash option.

Consumer and Surrogate Preferences for a Cash Option Versus Traditional Services: Florida Adults With Developmental Disabilities

As long-term service expenditures have risen, policymakers have sought ways to control costs while maintaining consumer satisfaction. Concurrently, there is increasing interest in the disability community in consumer direction. 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. Because the disability community is composed of diverse subgroups, needs of these consumer communities must be assessed individually. Results from a telephone survey conducted to assess the interest in a cash option for Florida adults with developmental disabilities is presented, the three-state CCDE described, how survey findings can inform consumer information efforts discussed, and policy issues highlighted.

Preferences for a Cash Option Versus Traditional Services for Florida Children and Adolescents with Developmental Disabilities

Traditional personal assistance programs often lack a significant consumer-direction focus that allows or encourages consumers to be in charge of their services. Independent evaluations of the Cash and Counseling Demonstration and Evaluation (CCDE) project are comparing costs of, quality of, and satisfaction with traditional personal care services versus consumer-directed cash benefit and information services. Because the disability community is composed of diverse subgroups, each group having with its own needs and concerns, the interests of each of these various populations should be assessed. This article presents the results of a telephone survey conducted in Florida as background research for the CCDE project to assess the interest in a cash option among families of children and adolescents with developmental disabilities. The findings indicate overall high levels of interest in the cash option, especially among individuals who were willing to pay a worker directly, persons who desired more involvement with services, and consumers dissatisfied with the current services. The authors of this article also include suggestions regarding how to communicate with families when informing them of such an option.

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

Borrowing From the East to Strengthen the West: Merging Public Health Case Studies of Community-Based Service-Learning Practices From India and the United States

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 childrens 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%).