A spoonful of sugar helps the medicine go down

Perception of HIV/AIDS risk among urban, low-income senior-housing residents

Despite the rising number of cases of HIV in adults over age 50, older persons rarely are considered to be at risk for HIV/AIDS, and even though they may be involved in risky behavior, such as unprotected penetrative sex, they may not consider themselves vulnerable to becoming infected. Informed awareness of risk is essential to making positive decisions about adopting preventive measures. We examined demographic, sociobehavioral, and contextual factors that predict urban, low-income older adults' perception of HIV/AIDS risk. Logistic regression results from 398 residents aged 50-93 living in six buildings in two American cities found that males, younger participants (aged 50-61), those living in higher risk buildings, and those who worried more about contracting HIV/AIDS were more likely to perceive themselves to be at HIV/AIDS risk. Findings accounted for 32% of the variance and the prediction success rate was 72%. Results point to the importance of considering sociodemographic characteristics and environmental (contextual) factors as they influence heuristic decision making in understanding HIV/AIDS risk perception among low-income urban older adults and when designing HIV/AIDS education and intervention strategies targeting this population.

Applications of cost-effectiveness methodologies in behavioral medicine

In 1996, the Panel on Cost-Effectiveness in Health and Medicine developed standards for cost-effectiveness analysis. The standards include the use of a societal perspective, that treatments be evaluated in comparison with the best available alternative (rather than with no care at all), and that health benefits be expressed in standardized units. Guidelines for cost accounting were also offered. Among 24,562 references on cost-effectiveness in Medline between 1995 and 2000, only a handful were relevant to behavioral medicine. Only 19 studies published between 1983 and 2000 met criteria for further evaluation. Among analyses that were reported, only 2 studies were found consistent with the Panel's criteria for high-quality analyses, although more recent studies were more likely to meet methodological standards. There are substantial opportunities to advance behavioral medicine by performing standardized cost-effectiveness analyses.

Medical compliance as an ideology

Medical compliance researchers have produced more than 4000 scientific papers in the past two decades, but their research into the determinants of non-compliance has been inconclusive. This paper argues that the popularity of compliance and the uncertainty over its determinants can be understood if compliance is analyzed as an ideology that assumes and justifies physician authority. I explore compliance as a problematic concept, looking at its assumptions and its influences on clinical practice. The concept of patient compliance has a social history linked to the struggle to create and maintain physician control over infant feeding technology earlier in this century. But while physicians were successful in that struggle, they have never exercised complete control over health care products. Compliance must be reconceptualized and its research reoriented if it is accurately to portray medication usage and related health behaviors outside the clinic.

Visiting the dentist: a behavioral community analysis of participation in a dental health screening and referral program

One-hundred and twenty-five families in the Medicaid Early Periodic Screening, Diagnosis and Treatment Program were assigned to one of five treatments to encourage parents to obtain health care service following the dental screening of their children: (a) a control procedure, in which parents were given a dentist's name; (b) a multiple contact procedure, in which parents received a postcard and two telephone call reminders; (c) a problem-solve procedure, in which a social worker aide conducted a brief session with the parent; (d) an incentive procedure, in which parents selected among four gifts that were contingent on seeking care; (e) an incentive + problem-solve procedure, in which the latter two treatments were combined. The multiple contact, incentive, and incentive + problem-solve techniques were significantly more effective in initiating dental visits than the control procedures. Families assigned to the intensive strategies were most likely to complete treatment. A cost-efficiency analysis showed the multiple contact technique to be a low-cost and highly effective procedure.

A mass immunization campaign in rural Ghana. Factors affecting participation

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