From the viewpoint of the public, academic work is relatively autonomous, stable, and stress-free as opposed to other professions. However, as the societal environment evolves, high satisfaction is no more an absolute consequence of academic work. Even in comparison to other professionals, the academics experienced longer working hours and heavier occupational stress; hence the events of ¡§Karoshi¡¨ among university academics happened from time to time. Actually, the reason resulting in ¡§Karoshi¡¨ has been proved related to health behavior, and the health behavior also has been proved associated with health belief. Following this concept, a study based upon ¡§health belief model¡¨ was carried out to investigate the health belief, health behavior, and health status of university academics, respectively, and the possible relationships among the aforementioned health related concepts. In total, 4,000 subjects were selected from among the 43,050 or so university academics nationwide based on stratified sampling approach. Data were collected through survey questionnaires which include personal demographics, health belief, health behavior, and health status information. From June through August 2004, 1,778 questionnaires returned with a response rate of 44.45%. SPSS was used for descriptive analysis and basic hypothesis test, and then the software package AMOS was used for structural equation modeling examination. Compared to the general population with the same age, the health status of university academics was worse in both physical and psychological function. Further, it was found that the factor work significantly contributed to each component of health belief (i.e. perceived susceptibility, perceived seriousness, perceived barriers, and perceived benefits). In terms of health behavior, although the academics had no unhealthy habits (i.e. smoking or excessive drinking), the average working hour after 10 pm was more than one hour and one in three teachers didn¡¦t take exercise regularly, which altogether are definitely harmful to health. The structural equation modeling showed that an academic¡¦s health belief would influence his/her health behavior and then influence the health status indirectly. In other words, positive health belief will lead to healthy status in the long run, and negative health belief will conduce to unhealthy status. To sum up, the issue on improving the health status of academics is on edge and the responsibility for taking this issue would be shouldered by teamwork¡X individuals, educational authorities, and public health agencies. An academic should try his/her best to improve the health; the educational authorities should assess the job loading on academic population from time to time and draw up a better educational system; and finally, the public health agency should play the role of information disseminator and catalyst for strengthening the health belief and then improving the health behavior and health status among the academics.

Women infected with the human immunodeficiency virus are at increased risk for developing cervical cancer. Current guidelines reflect that Pap smears should be performed twice during the first year after diagnosis with HIV and annually thereafter. However, women with HIV are not obtaining Pap smears per the current guidelines. The purpose of this study was to evaluate HIV-infected women's attitudes toward cervical cancer and cervical cancer screening. The research design is an exploratory, cross-sectional, quantitative design. The sample of convenience consisted of participants recruited from two ambulatory HIV clinics in Florida. Attitudes were assessed using Champion's Health Belief Model and Self-efficacy scales. Knowledge was evaluated with an updated HPV/Cervical Cancer Knowledge scale. Sociodemographic variables were assessed using a Demographic Data form. The results indicate that HIV-infected women in the study were not knowledgeable about HPV or cervical cancer. They did not perceive that cervical cancer was serious, nor did they feel that they were susceptible to cervical cancer. Overall, HIV-infected women were confident in their ability to request a Pap smear, and they perceived fewer barriers and more benefits to Pap smears. Despite, perceptions of fewer barriers and more benefits a chart review revealed that approximately 43% of the study participants received a Pap smear during the past year. Perceived barriers was a significant predictor of Pap smear adherence (OR = 0.93, CI: 0.90 to 0.96, p < .01). Findings from the exploratory study provide important information to clinicians and researchers that will assist in the development of effective interventions to increase Pap test adherence. Additional research is needed to further understand factors that influence cervical cancer screening in this at-risk population.

Premature death due to cardiovascular disease, including myocardial infarction, is higher in Hispanics (23.5%) than non-Hispanic White (16.5%) adults. Delaying treatment over 60 minutes increases the risk of sudden death by 50%. The purpose of this study was to describe the perceived benefits and barriers to seeking cardiac emergency care including emergency medical services (EMS) activation during an acute myocardial infarction (MI) in Mexican American adults. A qualitative descriptive design was used wherein semi-structured interviews and sociodemographic questionnaire were conducted with 12 Mexican Americans who had experienced an MI in the last two years. Qualitative conventional content analysis was used to uncover unique perceptions of Mexican Americans seeking emergency care. The overall theme that arose was degree of perceived threat leads to action. This theme was comprised five categories: perceived susceptibility, perceived severity, perceived barriers, perceived benefits, and learned behavior. Perceived severity was closely intertwined with perceived susceptibility. Recent appointments with HCPs facilitated low perceived susceptibility to an MI and acted as a barrier leading to ix decreased initiation of emergency services for MI. Participants attempted self-treatment and evaluation which was a barrier to immediate emergency care. Perceived benefits to initiation of emergency care were using EMS to achieve rapid treatment of MI symptoms. Though several participants initially stated they would activate EMS, further inquiry revealed calling EMS was considered a last resort if the participant were alone. The findings suggest education of lay people and HCPs needs to emphasize that MIs can present in a variety of ways from slow-onset to fast-onset. A goal for nursing practice is to include regular screening on cardiac risk factors along with interventions and evaluation among patients and family. Future research should aim at finding the most successful format to provide public education to Mexican Americans on MI symptom and rapid initiation of EMS. / text

Despite multiple campaigns by the American Cancer Society, reports indicate that Latinas living in the United States who contract breast cancer are more likely than Anglos to die. These findings correlate with low participation in breast cancer screenings among Latinas. The objective of this study was to identify key obstacles that influence Latinas' low participation in breast cancer screenings, based on their health beliefs, knowledge of screenings, acculturation, and socio-economic factors.The study was a face-to-face informal interview, combined with a survey questionnaire conducted at churches, social clubs and/or at the participants' homes in a southwest Florida urban community. The sample consisted of a total of 50 women: all of the participants were Latinas 40 years of age and over; they had to be fluent in Spanish or English or both. A Spanish-English bilingual individual conducted a personal interview in the preferred language of each participant. The first part of the interview was to identify barriers that affect screenings. The second part used a survey to weigh the identified factors in order to determine their importance to the participants' health decisions. This study used a health belief model scale to evaluate women's beliefs about breast cancer, and the benefits of screenings.The research results revealed that Latinas who participated in this study were acculturated to the United States culture; the largest group of participants reported being from Colombia, followed by Cuba and Puerto Rico; only two of the participants were Mexican. Seventy-eight percent of the participants self- reported having yearly mammograms, and 74% performed monthly breast self examination BSE; 60% were bilingual; 68% had some kind of health insurance. These results differ from earlier studies from the western United States where the majority of Latinas were of Mexican or Central American origin. This suggested that Latinas from Southwest Florida are different from Latinas in other areas of the United States. A weak but significant correlation was found between acculturation and perceived barriers to breast cancer screenings, (r = 0.45, p = .01); Latinas who are more acculturated perceived more barriers than those who are less acculturated. There was not significant difference between participants who had health insurance and those who did not (t = 0.96, p = .35). The results of this study are significant for nurses and especially for advanced practice nurses, who can assess patients' knowledge about cancer in general, and breast cancer in particular when caring for Latinas; of particular concern should be the evaluation of patients' levels of acculturation, health beliefs, and understanding of the English language. Still the fundamental barrier to Latinas not bilingual in Spanish and English may be the lack of resources and information in Spanish.

Colorectal cancer (CRC) is the third most common cancer in the United States (U.S.) and is the second leading cause of cancer deaths. Although the incidence of CRC has been decreasing with CRC screenings, disparities of CRC and screening prevalence exist for racial and ethnic groups. The CRC incidence rates have dramatically increased in Korean Americans, however, there is little known about their CRC screening behaviors and the factors that may predict screening behaviors have not been fully investigated. The purposes of this study were to describe CRC screening behaviors and identify the predictors and barriers influencing CRC screening behaviors among Korean Americans. A sample of 254 Korean Americans participated in this study. Correlation, Multiple logistic regression, and Chi-square were used to analyze data. In this study, Korean American had lower rates of CRC screenings compared to the general U.S. population. Only 20% of the sample had ever had a fecal occult blood Test (FOBT), 49% had ever had a colonoscopy, and 19% responded they had ever had a sigmoidoscopy in their lifetime. Korean Americans had low rates of perception of cancer screening (annual physical exam and periodic cancer screening), moderate CRC knowledge, low cancer fatalism, limited CRC literacy, lack of health care access, and a low rate of receiving the physician's recommendation of CRC screenings. The greatest predictors influencing CRC screening were perception of cancer screening for a FOBT, and the physician's recommendation for a colonoscopy and a sigmoidoscopy. There were no significant differences by gender in CRC screening behaviors. However, significant differences were found between the two groups divided by length of U.S. residence. Compared to those who have lived in the U.S.>10 years, new immigrants had lower rates of all three CRC screening, lower perception of cancer screening, higher uninsured, less receiving physician's recommendation, and higher perceived barriers to CRC screening. The findings of this study suggest that improved efforts are needed to increase CRC screenings among Korean Americans. Further research is needed to increase a physician's recommendation for CRC screenings and awareness for the importance of annual checkups and periodic cancer screening among Korean Americans.

Purpose: The purpose of this study is to evaluate and compare the extent and potential correlates of sexual risk taking behaviors related to condom use and number of sexual partners among Haitians aged 15 to 49 years old living in the urban and rural areas. Methods: Data were obtained from the 2005-2006 cross-sectional survey conducted by the Demographic Health survey. Our study population (15143) was analyzed based on the Health Belief Model (HBM) theory using a bivariate and multiple logistic regression analysis with SPSS for windows. Results: In both rural and urban areas dwellers had an accurate knowledge of the disease. However, a small proportion in both areas used condoms during their last sexual intercourse. Perceiving the disease's severity was more likely associated with condom use in the urban (OR 1.36, p ≤ .01) and in the rural areas (OR 1.45, p ≤.05). Strong associations have been found between some variables of the HBM and condom use but none have been found associated with zero or one sex partner. Findings were similar in both areas Conclusion: Holistic approach should be considered in the prevention strategy conducted in Haiti to tackle other factors that may contribute in delaying responsible sexual behavior in that country.

The purpose of this capstone is to develop a program to address health literacy among African American adults. The social cognitive theory and the health belief model was used to create a model of an age appropriate, culturally sensitive program with a pre and post test to improve the health literacy in this population. The Community Health Literacy Improvement Program (CHIP) is a pilot program that will consist of a four week didactic intervention focused on combating prose, document, and quantitative health illiteracy. This program will be implemented through a community based nonprofit organization. Participants who complete the CHIP program will be able to identify risk factors for chronic diseases, assess their ability to avoid chronic diseases, and be able to locate community health resources. This proposed intervention will show that community based nonprofit organizations have an important role to play in building community buy in and establishing the agency necessary for community based, culturally sensitive programs such as CHIP to succeed.

This study examines the use of songs, poems and drama to raise awareness of, and respond to the HIV/AIDS epidemic in Nakuru, Kenya. The primary focus is that of youth-oriented interventions, but additional examples are also examined and analyzed. A qualitative approach is used and the study is based on semi-structured interviews with teachers, performers, students, NGO-representatives and former students conducted during four weeks in November and December 2012. Additionally, songs, poems and dramas have been collected and observed and finally analyzed using a theoretical framework that combines the Health Belief Model, the Social Cognitive Theory as well as principles of the research discipline of Medical Ethnomusicology. The study shows that songs, poems and drama are important methods to communicate messages and play an important role in shaping the local HIV/AIDS discourse. Due to its effectiveness, it is vital that the messages promoted are culturally appropriate as well as correct since the study shows that false information through these methods can hamper a desired behavior change.

Influenza is a major concern across healthcare environments. Annual vaccination of healthcare workers (HCWs) remains essential for maintaining the health and availability of HCWs, as well as influenza prevention in healthcare environments. Yet, annual vaccination coverage among HCWs continues to be below recommended standards during pandemic (pH1N1) and non-pandemic (sINFLU) influenza seasons. The primary aim of this research is to inform the design and implementation of effective HCW targeted influenza vaccination campaigns via a 1) systematic review of the existing literature on HCW pH1N1 vaccination, 2) qualitative content analysis of motivators and barriers to HCW pH1N1 and sINFLU vaccination, as well as 3) quantitative regression analysis of modifiable factors predicting pH1N1 and sINFLU vaccination. The qualitative and quantitative analysis processes were applied to data collected from a large-scale multi-professional sample of HCWs. Findings from all analysis sections were found to be consistent. Most attitudes, beliefs, motivators, and barriers influencing HCW influenza vaccination were similar for pH1N1 and sINFLU vaccinations. Yet, a number of notable differences were also identified. HCWs were likely to accept vaccination if they perceived, 1) vaccination to be safe, 2) vaccination to be protective against influenza for self, loved ones, patients or communities, and 3) influenza to be a serious and severe infection to self and others. Additionally, encouragement from supervisors and colleagues, physicians, and loves ones also enhanced vaccine uptake. Most HCWs avoided vaccination because of 1) limited knowledge or misinformation about vaccination, 2) concern for vaccine induced side-effects and 3) assuming vaccination was not a requirement for healthy adults. With respect to pH1N1 vaccination, mass media communications, perceptions of novel vaccinations, and rapid vaccine development processes especially deterred HCW pH1N1 vaccination. Future vaccination programs targeting HCWs should look towards influencing HCWs’ vaccination attitudes and promoting pro-vaccination cultures in healthcare workplaces.

Obstructive Sleep Apnoea (OSA) is a common sleep disorder for which Continuous Positive Airway Pressure Therapy (CPAP) is the standard treatment. Despite the effectiveness of this treatment, CPAP acceptance and adherence rates are generally suboptimal. The aim of this dissertation was to validate a new, inclusive Health Belief Model (HBM) for the prediction of CPAP acceptance and adherence. It was argued that the HBM could predict future adherence even before patients have experienced the treatment, thus providing valid intervention targets to improve CPAP acceptance as well as adherence. Modifiable constructs that are proximal to the decision making process for OSA patients, were identified from the literature (Chapter 1). Along with the generic HBM constructs of perceived benefits, barriers, severity, risk, self-efficacy and cues to action, additional predictors were incorporated in the OSA specific model. These included biomedical indices of objective disease severity and measures of psychological distress. Study One assessed 77 newly diagnosed, CPAP naïve OSA patients on a questionnaire battery at baseline (prior to CPAP treatment). The questionnaire included HBM measures which were available in the literature; benefits perception, self-efficacy, functional severity, and perceived risk of negative health outcomes. CPAP adherence was assessed at four month follow-up. This initial investigation found that health beliefs alone explained 21.8% of the variance in CPAP adherence, whilst health beliefs and biomedical indices together explained 31.8% of the variance in CPAP adherence. The greatest proportion of CPAP adherence was explained by higher benefits perception, greater severity and lower risk perception. Study Two reported on the development and validation of a measure of the barriers construct (as no measure of this existed). A sample of 113 newly diagnosed, CPAP naïve OSA patients completed a questionnaire containing potential items of the Barriers to CPAP Use questionnaire (BACQ) at baseline. Exploratory Factor Analysis (EFA) showed a two factor structure of the eight-item BACQ, with ‘Barriers’ and ‘Cost of Treatment’ subscales identified. The BACQ had an internal consistency of 0.82 and readability at a fifth grade reading level. The aim of Study Three was to develop a valid and reliable measure of the cues to action construct. A sample of 63 OSA patients (from the total 113 patients assessed in Study Two) completed a questionnaire containing potential items of the Cues to CPAP Use questionnaire (CCUQ) one month after being prescribed CPAP. EFA showed a three factor structure of the nine-item CCUQ, with ‘Health Cues’, ‘Partner Cues’ and ‘Health Professional Cues’ subscales identified. The CCUQ demonstrated modest internal consistency and split-half reliability, and readability at a seventh grade level. Study Four incorporated three sub-studies which assessed the accuracy of the fully articulated HBM (including the BACQ and CCUQ measures) in predicting CPAP adherence at two months. Study Four A reported on the same sample of 113 CPAP naïve patients (from Study Two). Structural Equation Modelling demonstrated the complex relationship between health beliefs, psychological variables, and biomedical indices in CPAP adherence. The full HBM predicted 24% of the variance in CPAP adherence at two months. Adherence was directly predicted by lower perception of treatment cost as a barrier to CPAP use, higher self-efficacy, and higher BMI. Study Four B reported on 63 patients who completed HBM questionnaires at one month. The model predicted 42% of the variance in CPAP adherence at two months. Adherence was directly predicted by greater benefits perception, greater psychological distress, and lower perception of the Health Professional as the important cue to action. Study Four C investigated changes in health beliefs between baseline and one month. By one month patients generally reported more positive attitudes to CPAP, and better overall functioning. These changes did not correlate with CPAP adherence. Those who used CPAP more than four hours per night demonstrated greater improvement in functional severity and in anxiety score. Study Five used the findings of the HBM studies in developing a theory-driven Motivational Intervention (MI) to target specific beliefs associated with poor adherence. 101 newly diagnosed, CPAP naïve OSA patients were randomly assigned to nurse-led MI + Standard Care (50 participants), or to Standard Care only (51 participants). MI patients received two sessions before starting CPAP, and one session one month after CPAP prescription. By three months, the MI group used CPAP 50% more of the time, and were six times less likely to reject CPAP. The MI group demonstrated greater self-efficacy and a lower perception of barriers to CPAP use. The findings were largely supportive of the HBM theory of CPAP adherence. The substantive findings of this dissertation were that patients do need relevant, timely and targeted support in order for them to effectively commence on CPAP and then continue to adequately adhere. At a minimum, psychological intervention, such as a Motivational Intervention, is likely to be needed for the subset of patients who report beliefs associated with poor adherence at pre-treatment.