Emergence of consumer health self-care is a reflection of the increased commitment of health professionals to patient education, growing consumer awareness that they are capable of sophisticated self-help, and a variety of social, economic and technological currents. These currents are reviewed and a survey of existing medical self-care programs is summarized The attempts and potentials to evaluate these programs are critically examined
A number of important research and demonstration issues are raised including the determination of behavioral outcomes, technical limits, and manpower implications. A federal program of replicative studies on such issues would provide substantive knowledge in the self-care field, generalizable to the larger field of health education, but the hazards of undermining the voluntaristic and non-establish ment character of the programs must be considered in designing evaluative studies.
Brieland D.: Community advisory boards and maximum feasible participation. Am J Public Health61:292-296, 1971.
3.
Community Participation for Equity and Excellence in Health Care. Bull NY Acad Med46:(entire issue), December 1970.
4.
Dumont MP: Self-help treatment programs. Am J Psychiatry131:631-635, 1974.
5.
Kerri JN: Anthropological studies of voluntary associations and voluntary action: A review. J Voluntary Action Res3:10-25, 1974.
6.
Kurtz RA, Chalfant HP, Kaplan K.: Inner city residents and health decision-makers: Perceptions of health problems and solutions. Am J Public Health64:612-613, 1974.
7.
Levin LS: Building toward the future: Implications for health education. Am J Public Health59:1983-1991, 1968 .
8.
Moynihan DP: Maximum Feasible Misunderstanding: Community Action in the War on Poverty . New York, The Free Press, 1969.
9.
Navarro V.: The city and the region. Am Behav Sci14:865-892, 1971.
10.
Notkin H., Notkin MS: Community participation in health services. Med Care Rev27:1178-1201, 1970.
11.
Petersen HM , D'Elia G., Schussele MJ, et al: An approach to citizen involvement in education and health care delivery. J Med Educ49:189, 1974.
12.
Ruiz P., Behrens M.: Community control in mental health: How far can it go?Psychiatr Q47:317-324, 1973.
13.
Schwartz JL : Early histories of selected neighborhood health centers. Inquiry7:3-16, 1970.
14.
Silver AG: Community participation and health resource allocation. Int J Health Serv3:117-131, 1973.
15.
Sparer G., Dines. GB, Smith D.: Consumer participation in OEO-assisted neighborhood health centers. Am J Public Health60:1091-1102, 1970 .
Traunstein DM, Steinman R.: Voluntary self-help organizations: An exploratory study. J Voluntary Action Res2:230-239, 1973.
18.
Metsch JM, Veney JE: Measuring outcomes of consumer participation. J Health Soc Behav14:368-374, 1973.
19.
Partridge KB , White PE: Community and professional participation in decision making at a health center. A methodology for analysis. Health Serv Rep87:336-342, 1972.
20.
Partridge KB : Community and professional participation in decision making at a health center. Health Serv Rep88:527-534, 1973.
21.
Metsch JM, Berson A., Weitzner M.: The impact of training on consumer participation in the delivery of health services. Health Educ Monogr3:251-261, Fall 1975.
22.
Galassi JP, Galassi MD: Validity of a measure of assertiveness. J Couns Psychol21:248-250, 1974.
Green LW: Toward cost-benefit evaluations of health education: Some concepts, methods, and examples. Health Educ Monogr2 (Suppl):34-64, 1974.
25.
Hochbaum GM: Consumer participation in health planning: Toward conceptual clarification . Am J Public Health59:1698-1705, 1969 .
26.
Wang VL, Reiter H., Lentz GA, Whaples GC: An approach to consumer patient activation in health maintenance. Pub Health Rep90:449-454, 1975.
27.
Green LW: Constructive consumerism. Health Educ6:3-6, November-December, 1975.
28.
United States Senate, Committee on Labor and Public Welfare : S. 2642, Title II, Section 202 (3). The War on Poverty, The Economic Opportunity Act of 1964. A consideration of materials relevant to S. 2642, Select Subcommittee on Poverty. Washington, DC, US Government Printing Office, 1964.
29.
Grosser CG: New Directions in Community Organization: From Enabling to Advocacy. New York, Praeger Publishers, 1973 .
30.
Moffett T.: The Participation Put-On: Reflections of a Disenchanted Washington Youth Expert . New York, Dell Publishing Company , 1971.
31.
Moynihan DP (ed): On Understanding Poverty: Perspectives from the Social Sciences. New York , Basic Books Inc, 1969.
32.
Brown BB: New Mind, New Body; Biofeedback: New Directions for the Mind. New York, Harper and Row, 1974.
33.
Mahoney MJ, Thoresen CE: Self Control: Power to the Person. Monterey, California , Brooks-Cole, 1974.
34.
Watson DL, Tharp RG: Self-Directed Behavior: Self-Modification for Personal Adjustment. Monterey, California, Brooks-Cole, 1972.
35.
Kazdin AE: Behavior Modification in Applied Settings. Homewood, Illinois , The Dorsey Press, 1975.
36.
Kanfer FH, Marston AR: Conditioning of self-reinforcing responses: An analogue to self-confidence training. Psychol Rep13:63-70, 1963.
37.
Kanfer FH, Marston AR: Determinants of self-reinforcement in human learning. J Exp Psychol66:245-254, 1963.
38.
Kanfer FH, Phillips JS: Behavior therapy: A panacea for all ills or a passing fancy?Arch Gen Psychol15:114-128, 1966.
39.
Kanfer FH, Phillips JS: Learning Foundations of Behavior Therapy. New York, John Wiley, 1970.
40.
Stuart RB: Behavioral control of overeating. Behav Res Ther5:357-365, 1967.
41.
Stuart RB: Situational versus self control of problematic behaviors. In Rubin RD (ed): Advances in Behavior Therapy, 1970. New York, Academic Press, 1971.
42.
Harris MB: A self-directed program for weight control: A pilot study. J Abnorm Psychol74:263-270, 1969.
43.
Hall SM, Hall RG: Outcome and methodological considerations in behavioral treatment of obesity . Behav Ther5:352-364, 1974.
44.
Tooley JT, Pratt S.: An experimental procedure for the extinction of smoking behavior. Psychol Rec17:209-218, 1967.
45.
Nolan JD: Self-control procedures in the modification of smoking behavior. J Consult Clin Psychol32:92-93, 1968.
46.
Hall VR, et al: Use of self-imposed contingencies to reduce the frequency of smoking behavior. Association for the Advancement ofBehavior Therapy, Washington, D.C., September 5-6, 1971.
47.
Green LW, Green PF: Intervening in social systems to make smoking education more effective. Paper presented at the Third World Conference on Smoking and Health , New York City, June 1975.
48.
Nursing Development Conference Group: Concept Formalization in Nursing: Process and Product. Boston, Little, Brown and Company, 1973.
49.
Nightingale F. : Sick nursing and health nursing. In Hampton I, et al: (eds): Nursing of the Sick, 1893. New York, Mcgraw-Hill Book Co, Inc, 1949.
50.
Shaw Csw: A Textbook of Nursing. New York, D. Appleton and Co, 1885 and 1902 (3rd) editions.
51.
Harmer B.: Text-Book of the Principles and Practice of Nursing. New York, Macmillan Co, 1922.
52.
Frederick HK, Northam E.: A Textbook ofNursing Practice (2d Ed.). New York, Macmillan Co, 1938.
53.
Henderson V.: ICN Basic Principles of Nursing Care. London: International Council of Nurses House, 1960.
54.
Orem DE: Nursing: Concepts of Practice. New York, McGraw-Hill Book Co, 1971.
55.
Stunkard AJ : The success of TOPS: A self-help group. Postgrad Med51:143-147, 1972.
56.
Mann M.: New Primer on Alcoholism. New York, Holt, Rinehart and Winston, 1958.
57.
Cornacchia A.: A layman's view of group therapy in weight control. Can J Public Health58:505-507, 1967.
58.
Ingraham NR, et al: A Little Group Can Do It: The Philadelphia Research-Demonstration in Accident Control Through Small Group Discussion. Philadelphia , Department of Public Health, 1964 .
59.
Ivanova IN: Method of Collective Prophylatic Consultation for Hypertensive Patients. Moscow, Institute forHealth Education, 1955.
60.
Rybakova LA : Combatting rheumatic fever in children. Int J Health Educ1:140-143, 1958.
61.
Zabolotskaia LP: Experience of an educational program with patients sick with ulcer of the stomach or the pancreas. Rev Sovietskai Med, No 6, 1973.
62.
Elliott FC: Classes for people with heart disease. Nurs Outlook9:177-178, 1961.
63.
Wishick SM: Parents' group discussion in a child health conference. Am J Public Health43:888-895, 1953.
64.
Goodman JJ, Schartz ED, Frankel L.: Group therapy of obese diabetic patients. Diabetes2:280-283, 1953.
65.
Linde TF, Patterson CH: Influence of orthopedic disability on conformity behavior. J Abnorm Soc Psychol68:115-118, 1964.
66.
Lewin K.: Group decision and social change. In Readings in Social Psychology . New York, Henry Holt and Co, 1947, pp 330-334.
67.
Bond BW: Group Discussion-Decision: An Appraisal of Its Use in Health Education. Minneapolis, Minnesota Department of Health, 1956.
68.
Thornhill MA , Thornhill AJ, Youngman MB: A computerized and categorized bibliography on locus of control. Psychol Rep36:505-506, 1975.
69.
Throop WF, MacDonald AP, Jr: Internal-external locus of control: A bibliography. Psychol Rep28 (Monogr Suppl 1 V 28):175-190, 1971.
70.
Joe VC: Review of the internal-external control construct as a personality variable . Psychol Rep28 (Monogr Suppl 3 V 28):619-640, 1971.
71.
MacDonald AP : Internal-external locus of control techniques . Rehab Lit33:44-47, 1972.
72.
Wallstan BS, Wallston KA: Health Care Education Programs: Training Patient Internality. Paper presented at the American Public Health Association, San Francisco, November 1973.
73.
Battle ES, Rotter JB: Children's feelings of personal control as related to social class and ethnic group. J Pers31:482-490, 1963.
Divesta FJ, Merwin JC: The effects of need-oriented communications on attitude change. J Abnorm Soc Psyrhol60:80-85, 1960.
76.
Fitch G.: Effects of self-esteem, perceived performance and choice on causal attributions . J Pers Soc Psychol16:311-315, 1970.
77.
Gurin P., Gurin G., Lao RC, et al: Internal-external control in the motivational dynamics of Negro youth. J Soc Issues25:29-53, 1969.
78.
James WH: Internal vs. External Control of Reinforcements as a Basic Variable in Learning Theory. Columbus, Unpublished doctoral dissertation, Ohio State University, 1957.
79.
Jessor R., Graves TD, Hanson RC, et al: Society, Personality, and Deviant Behavior: A Study of a Tri-Ethnic Community. New York, Holt, Rinehart and Winston, 1968.
80.
Liverant S. , Scodel A.: Internal and external control as determinants of decision-making under conditions of riskPsychol Rep7:59-67, 1960.
81.
Miller JO: The children's locus of evaluation and control scale. In Haywood HC, Woodcock RW (eds): Abstracts of Peabody Studies in Mental Retardation, Vol 3. Nashville, George Peabody College, 1965.
82.
Rotter JB: Generalized expectancies for internal versus external control of reinforcement . Psychol Monogr80:(1, entire no. 609), 1966.
83.
Schwartz SH : Words, deeds, and the perception of responsibility in action situations. J Pers Soc Psychol10:232-242, 1968.
84.
Shaw ME, Sulzer JC: An empirical test of Heider's levels of attribution of responsibility. J Abnorm Soc Psychol69:39-46, 1964.
85.
Seeman J.: Personality integration in college women. J Pers Soc Psychol4:91-93, 1966.
86.
Strodtbeck FL : Family interaction, values and achievement . In McClelland DC et al (eds): Talent and Society. Princeton,Van Nostrand, 1958.
87.
Schneider JM : Skill versus chance activity preference and locus of control. J Consult Clin Psychol32:333-337, 1968.
88.
Washburn WC : Patterns of self-conceptualization in high school and college students. J Educ Psychol52:123-131, 1961.
89.
Nowicki S., Jr, Duke MP: A locus of control scale for non-college as well as college adults. J Pers Assess38:136-137, 1974.
90.
Chun K., Cobb S., French Jrp: Measures for Psychological Assessment. Ann Arbor, Survey Research Center, University of Michigan, 1975.
91.
Wallston BS, Wallston KA, Kaplan GD et al: Development and validation of the health locus of control (HLC) scale. Unpublished manuscript, Vanderbilt University, 1975.
92.
Green LW, Levine DM, Deeds SG: Clinical trials of health education for hypertensive outpatients: Design and baseline data. Prev Med4:417-425, 1975.
93.
Green LW, Levine DM, Wolle JM, Deeds SG: Two Years of Randomized Patient Education Experiments with Urban Poor Hypertensives . Presented at the First International Congress on Patient Counseling, Amsterdam, Netherlands, April 21, 1976.
94.
Strickland B. : Locus of control: Where have we been and where are we going? Presented at theAmerican Psychological Association , Montreal, 1973.
95.
Marston MV: Compliance with medical regimens: A review of the literature. Nurs Res19:312-323, 1970.
96.
O'Bryan GG: The relationship between an individual's I-E orientation and information-seeking, learning, and use of weight control relevant information. Dissert Abstr Int33 (1-B): 447, 1972.
97.
Rotter JB: Some problems and misconceptions related to the construct of internal versus external control of reinforcementJ Consult Clin Psychol43:56-67, 1975.
98.
Rokeach M.: The Nature of Human Values. New York, The Free Press, 1973.
99.
Kaplan GD: Externally and internally obese: The application of locus of control to the treatment of obesity. Unpublished manuscript, Vanderbilt University, 1974.
100.
Maides SA: Factors Influencing Health-Related Information Seeking. Unpublished manuscript , Vanderbilt University, May 1974.
101.
Ware JE, Wright WR, Snyder MK et al: Consumer Perceptions of Health Care Services: Implications for the Academic Medical Community. New York, American Heart Association, 1975.
102.
Hulka BS, Zyzanski SJ, Cassel JC, et al: Scale for measurement of attitudes toward physicians and primary health care. Med Care8:429-436, 1970.
103.
Zyzanski SJ, Hulka BS, Cassel JC: Scale for the measurement of "satisfaction" with medical care: Modifications in content, format and scoring. Med Care12:611-620, 1974.
104.
Franklin BJ, McLemore SD: A scale for measuring attitudes toward student health services. J Psychol66:143-147, 1967.
105.
Andersen R.: A Behavioral Model of Families' Use of Health Services. Chicago, University of ChicagoCenter for Health Administration Studies, Research Series No 25, 1968.
106.
Suchman EA : Sociomedical variations among ethnic groups . Am J Sociol70:319-331, 1964.
107.
Reeder LG, Berkanovic E.: Sociological concomitants of health orientations: A partial replication of Suchman. J Health Soc Behav14:134-143, 1973.
108.
Geertsen R. , Klauber MR, Rindflesh M., et al: A reexamination of Suchman's views on social factors in health care utilization. J Health Soc Behav16:226-237, 1975.
109.
Ware JE, Snyder MK: Dimensions of patient attitudes regarding doctors and medical care services . Med Care13:669-682, 1975.
110.
Lebor JL: Consumer assessments of the quality of medical care. Med Care12:328-337, 1974.
111.
Hollingshead AB, Redlich FC: Social Class and Mental Illness: A Community Study. New York, John Wiley, 1958.
112.
Koos EL: The Health of Regionville. New York, ColumbiaUniversity Press, 1954.
113.
Reader GC, Pratt L., Mudd MC: What do patients expect from their doctors? Mod Hosp89:88-94, 1957.
114.
Davis MS: Variations in patients' compliance with doctors' advice: Empirical analysis of patterns of communication. Am J Public Health58:274-288, 1968.
115.
Davis MS, Von Der Lippe R: Discharge against medical advice: A study of reciprocity in the doctor-patient relationship. Soc Sci Med1:336-344, 1968.
116.
Korsch BM, Gozzi EK, Francis V.: Gaps in doctor-patient communication 1: Doctor-patient interaction and patient satisfaction. Pediatrics42:855-871, 1968.
117.
Francis V. , Korsch BM, Morris MJ: Gaps in doctor-patient communication: Patients' response to medical advice. New Engl J Med280:535-540, 1969.
118.
Lipton HL, Svarstad BL: Parental expectations of a multi-disciplinary clinic for children with developmental disabilities. J Health Soc Behav15:157-166, 1974.
119.
Jackson JO , Greenlick MR: The worried-well revisited. Med Care12:659-667,1974.
120.
Kalmer H.: Member-Professional Agreement Related to Use of a Prepaid Ambulatory Care Setting: An Analysis of Some Related Factors. Paper presented at the American Public Health Association, Chicago, November 19, 1975.
121.
Etzwiler DD , Robb JR: Evaluation of programmed education among juvenile diabetics and their families. J Am Diabetes Assoc21:967-971, 1972.
122.
Katz HP, Clancy RR: Accuracy of home throat culture program: A study of parent participation in health care. Pediatrics53:687-691, May 1974 .
123.
Avery CH, Green LW, Krieder S.: Reducing emergency visits of asthmatics: An experiment in patient education . Presented as testimony at hearings of the President's Committee on Health Education, Pittsburgh, 1972.
124.
Miller LV, Goldstein J.: More efficient care of diabetic patients in a county-hospital setting. New Engl J Med286:1388-1391, 1972.
125.
Rosenberg SG: Patient education leads to better care for heart patients. HSMHAHealth Rep86:793-802, 1971.
126.
American Hospital Association: Readings in Health Education. Chicago, American Hospital Association, 1969.
127.
Aday LA, Eichorn R.: The Utilization of Health Services — Indices and Correlates: A Research Bibliography. National Center for Health Services Research and Development, DHEW Pub No (HSM) 73-3, 003, 1972.
128.
Antonovsky A. , Hartman H.: Delay in the detection of cancer: A review of the literature. Health Educ Monogr2:98-128, 1974.
129.
Green LW, Roberts BJ: The research literature on why women delay in seeking medical care for breast symptoms. Health Educ Monogr2:129-177, 1974.
130.
Glogow E.: Effects of health education methods on appointment breaking. Pub Health Rep85:441-450, 1970.
131.
Greenlick MR, Freeborn DK, Colombo TJ, et al: Comparing the use of medical care services by a medically indigent and a general membership population in a comprehensive prepaid group practice program. Med Care10:187-200, 1972.
132.
Hurtado AV , Greenlick MR, Colombo TJ: Determinants of medical care utilization: Failure to keep appointments. Med Care11: 189-198, 1973.
133.
Stine OC, Chuaqui C., Jimenez C., et al: Broken appointments at a comprehensive clinic for children. Med Care6:332-339, July 1968.
134.
Sussman MB, Caplan EK, Huag MR, et al: The Walking Patient: A Study in Outpatient Care. Cleveland, The Press of Case Western Reserve University , 1967.
135.
Caldwell JF , Cobb S., Dowling MD, et al: The dropout problem in antihypertensive treatment. J Chronic Dis22:579-592, 1970.
136.
Finnerty FA , Jr, Mattie EC, Finnerty FA, III: Hypertension in the inner city. I. Analysis of clinic dropouts. Circulation47:73-75, 1973.
137.
Williams AF , Wechsler H.: Interrelationships of preventive actions in health and other areas. Health Serv Rep87:969-976, 1972.
138.
Green LW: Status Identity and Preventive Health Behavior. Berkeley , University of California, Pacific Health Education Reports No 1, 1970.
139.
Steele J., McBroom WH: Conceptual and empirical dimensions of health behavior. J Health Soc Behav13:382-392, 1972.
140.
Rosenstock IM: The health belief model and preventive health behavior. Health Educ Monogr2:354-386, 1974.
141.
Becker MH: The health belief model and sick role behavior. Health Educ Monogr2:409-419, 1974.
142.
Kasl SV: The health belief model and behavior related to chronic illness. Health Educ Monogr2:433-454, 1974.
143.
Mitchell JH : Compliance with medical regimens: An annotated bibliography. Health Educ Monogr2:75-87, 1974.
144.
Green LW: Site- and symptom-related factors in secondary prevention of cancer. In Cullen JW, Fox BH, Isom RN (eds): Cancer: The Behavioral Dimensions. National Cancer Institute Monographs. New York, Raven Press, 1976, pp 45-61.
145.
Enelow A, Henderson JB (eds): Applying Behavioral Sciences to Cardiovascular Risk. New York, American Heart Association , 1975.
146.
Chen JL, Moore N., Norman PS, et al: Di-sodium cromoglycate: A new compound for the prevention of exacerbations of asthma. J Allergy43:89-100, 1969.
