The Dimensions of Health Education Literature An Evaluation of Published Health Education Research (2000–2005)

Examples of Information Sources Magazines Professional Journals Internet Based Information Newspapers

Types of Information Sources Primary Sources Written by people who actually conducted the data collection or had first hand experience Refereed journals publish information only after that information has been reviewed by peers Secondary Sources Written by someone who was not present at the data gathering or did not participate as part of the study team Value is that it provides a summary of many sources of information and provides a bibliography of original sources Can also be found in refereed journals Popular Press Publications Newspapers Magazines Tabloids

Identifying the Components of a Research Article Abstract Introduction Methodology Results Discussion

Critically Reading a Research Article Were the aims of the study defined in a clear manner? Were the research questions/hypotheses clearly stated? Was the description of the subjects clear? Did the article state how the subjects were recruited? Were the design and location of the study described clearly? Were the data collection instruments described? Did the results directly address the research questions/hypotheses? Were the conclusions logical in terms of the research design and data analyses performed? Were the study implications meaningful to the population you serve?

Evaluating the Accuracy of Non-Research-Based Sources What are the author’s qualifications? What is the style of presentation? Scientific writing? Generalities? Testimonials? Are references included? What is the purpose of the publication? Biases What is the reputation of the publication? Is the information new? Is the information reliable Is the information valid?

Professional Health Education Journals Journal/Availability at CSUN Print On-Line American Journal of Health Behavior Yes American Journal of Health Education American Journal of Health Promotion No American Journal of Health Studies Health Promotion Practice International Quarterly of Community Health Education Journal of School Health Health Education Research Health Promotion International Health Education & Behavior International Electronic Journal of Health Education Promotion and Education

Indexes Indexes are books that provide a link to articles of a category of interest from many refereed journals, books and research reports Example: Index Medicus lists articles relating to clinical and preventive medicine and does not include references to social science articles The list of journals that are included in the index are found in the front pages of each volume Many indexes are now on CD-ROM Users begin by looking up a topic of interest in the index (e.g., health behavior)

Example of Using Index Medicus Looking up “health behavior” Two sample citations come up The transitional model of change and HIV prevention: a review. Prochaska JO. Et al. Health Educ Q 1995 May; 22(2): 190-200 (48 ref) Self-esteem and the value of health as determinants of adolescent health behavior. Torres R. et al. J Adolesc Health 1995 Jan; 16(1): 60-83. (43 ref). The parts of these citations include The title of the article in the journal, The authors’ names The abbreviated title of the journal The year and month of publication The volume number The page numbers The number of references that can be foundin the bibliography of the article

Other Health Education Related Indices Cumulative Index to Nursing and Allied Health Literature Education Index Physical Education Index Current Index to Journals in Education

Abstracts Abstracts are book volumes that include short summaries of research studies that have appeared in other journals An abstract is usually more valuable than an index in that an abstract provides both a reference and a summary for each article included.

Using Abstracts Locate the index at the end of each volume You can such by both subject or author Find the subject or author you are interested in, and look at the titles of the articles listed under that subject/author heading At the end of each article reference there is a number G0 to the volume of the abstract that includes that number (the numbers included in each volume are listed on the outside binding of the volume Turn to the number of the article you are interested in and locate the desired article abstract

A Sample Abstract #34782 from Psychological Abstracts 34782. Fleury, Julie. (U of North Carolina, School of Nursing, Chapel Hill) The application of motivational theory to cardiovascular risk reduction. IMAGE: Journal of Nursing Scholarship, 1992(Fall), Vol 24(3), 229-239. The level of motivation sustained by an individual has been identified as a primary predictor of success in sustained cardiovascular risk factor modification efforts. This article reviews the primary motivational theories that have been used to explain and predict cardiovascular risk reduction. Specifically, the application of the Health Belief Model, Health Promotion Model, Theory of Reasoned Action, Theory of Planned Behavior and Self-efficacy Theory to the initiation and maintenance of cardiovascular health behavior is addressed. The implication of these theories for the development of nursing interventions as well as new directions for nursing research and practice in the study of individual motivation in health behavior change are discussed.

Abstracts Most Commonly Used by Health Educators Psychological Abstracts Sociological Abstracts Biological Abstracts Recourses in Education

Computerized Databases An alternative to searching indexes or abstracts manually Like an index or abstract, each database has a general subject area that it covers Education Medicine Psychology

The Power of Computerized Databases Provides access to the cumulative information found in several index or abstract sources Faster than manual searches User can link several concepts together to narrow the search A user can link two terms such as health behavior and cardiovascular disease by using the word “and” between the terms Eliminating any article that only address one or the other of these topics

ERIC

ERIC: Health Behavior 1,762 hits

ERIC: Health Behavior and Cardiovascular Disease 26 hits

Computerized Databases Educational Resources Information Center (ERIC) MEDLINE Cumulative Index to Nursing and Allied Health Literature (CINAHL) BIOETHICSLINE Psychological Abstracts (PsychLit) Health Services, Technology, Administration and Research (Health-STAR) Educational Resources Information Center (ERIC) Education and allied fields of study MEDLINE Medicine Nursing Dentistry Veterinary Medicine Preclinical Sciences Cumulative Index to Nursing and Allied Health Literature (CINAHL) Health Education Health Services Health Care Administration BIOETHICSLINE Ethics Law Public Policy Psychological Abstracts (PsychLit) Psychology Health Services, Technology, Administration and Research (Health-STAR) Clinical and Non-clinical aspects of health care

The Internet and the World Wide Web: Evaluating Information Content Authority Publisher-source References Documentation Facts Content Information has been verified Screened Referenced Indications of legitimacy: .edu, .gov, .org Authority Author has credentials Author’s email address or phone number is provided Publisher-source Information is unambiguous Clearly identified Sponsor should be clearly identified References Have other pages used this site as a link to their own page? Documentation Documentation is provided Sources are provided Facts Are the facts consistent with information obtained from other sources? Watch out for URLs ending in com – they are commercial in nature

Example of Internet Information

Another Example of Internet Information

The Kind of Articles You Will Find A total of 2610 articles were reviewed. 52% of these articles were research reports with an identifiable content focus, 28% dealt with the practice of health education (including planning and process evaluation research), 11% represented theoretical discussions and 9% were reviews of the literature.

Content Distribution 79% of the articles focused on outcome variables associated with the physical dimension of health (fitness, strength, body mass index, diet composition, blood pressure, activity level, cholesterol, etc.). Another 12% of research articles measured outcomes associated with social health (loneliness, parental interactions, social alienation, peer influences, etc.). Emotional health was addressed by 5% of research reports (stress, anxiety, resilience, self-esteem, hardiness, depression, etc.). Three percent of research papers measured variables associated with intellectual health (mental skills, learning styles, teaching techniques, etc.). The final 1% of research dealt with the spiritual dimension of health (purpose and meaning in life, connectedness with a higher power, spiritual well-being, etc.) (Figure 1).

The General Goal of Health Education To improve the health knowledge and attitudes of individuals and thereby promote personal behaviors that will lead to optimal health and wellness or high levels of functioning in all of the various dimensions of health* [*Butler J. Principles of Health Education and Health Promotion, 3rd ed. Belmont, CA: Wadsworth, 2001.]

Beliefs About the Nature of Health Health is typically defined in the literature as being multidimensional, This requires a balance among such elements as physical health, emotional health, intellectual health, social health and spiritual health* Further, these dimensions are considered to be dynamic in as much as the status of one dimension will often influence the condition of another** [*Cottrell RR, Girvan JT, McKenzie JF. Principles and Foundations of Health Promotion and Education, 2nd ed. San Francisco, CA: Benjamin Cummings, 2002.] [**Butler J. Principles of Health Education and Health Promotion, 3rd ed. Belmont, CA: Wadsworth, 2001.]

The Ultimate Function of Health It is argued that health is functional primarily for its usefulness in the pursuit of higher aims, rather than merely as an end in itself* [*Read DA. Health Education: A Cognitive-Behavioral Approach. Boston, MA: Jones and Bartlett, 1997.]

A Philosophical Inconsistency For the most part the health education literature ignores the multidisciplinary nature of health And, emphasizes physical health to the detriment of all other aspects of health This is in direct contradiction with health education’s definition of health The dynamic nature of health cannot be fully appreciated since there is no way to take into account the impact of each component of health on one another If the multidimensional nature of health is disregarded, then its dynamic nature cannot be fully appreciated. It is well documented, for example, that emotional well-being exerts a profound influence on cardiovascular health [5]. Similarly, social support is a significant factor in understanding a multitude of health outcomes, including various types of cancer, cardiovascular disease, immune function [6, 7], women’s health [8] and positive health practices [9]. And spiritual well-being influences such diverse outcomes as recovery from addiction [10], teen sexual activity [11], depression [12], eating disorders [13], breast cancer [14], long survival with acquired immune deficiency syndrome [15] and a number of health behaviors [16]. With few exceptions [17, 18], however, health education research seldom attempts to measure the dynamic nature of social support, emotional well-being or spirituality in health education contexts [19].

Inconsistencies in Theory and Practice The national health objectives for most developed nations (e.g. Healthy People 2010), continue to revolve almost exclusively around the prevention and treatment of physical illness. We now have firm evidence that the mind and body, far from being separate, are intimately interwoven. There truly are many dimensions of health that interact with each other. It is therefore less effective, if not negligent, to research and promote physical health without simultaneously addressing the ‘duality’ of other dimensions of health in a truly integrative fashion. [USDHHS. Healthy People 2010. Washington, DC: US Department of Health and Human Services, 2000]

Barriers to Promoting Multidimensional Wellness Physical health is tangible, understandable, measurable and objective—and it is therefore easy to target (blood pressure, blood lipid profiles, morbidity and mortality rates, energy expenditure, body mass index, etc.). A second barrier is the ambiguity of dealing with dimensions of health that have not achieved a consensus definition, are less tangible and seemingly immeasurable. Finally, there is a reluctance to step into politically charged arenas as the promotion of spirituality

Overcoming Barriers Pursue organized efforts to clearly define the various dimensions of health in a way that builds consensus. Place pressure on the crafters of national health objectives to develop objectives that represent a dynamic, multidimensional view of health. Increase local control over resource allocation that might include intervention and evaluation priorities that target nonphysical dimensions of health. A willingness to commit time and energy to designing, implementing and evaluating the impact of programs that target various nonphysical dimensions of health

What is a Professional Article Professional articles are written for a particular audience of professionals in a given field (or sub-field). These articles are usually technical in nature and follow a range of formats typical of publications in the field.

Assessing Health Literature In a nutshell, when assessing accuracy, consider the following: Is the information based on scientific evidence? Is the information supported by data? Is the original source referenced? Do other sources substantiate the information? Is the information current?

Red Flags to Watch Out For The information is anonymous There is a conflict of interest The information is one-sided or biased The information is outdated There is a claim of a miracle or secret cure No evidence is cited The grammar is poor and words are misspelled