Community Health Equity Research & Policy

Culturally appropriate educational intervention was developed and directed toward agricultural families to improve knowledge and practice of agricultural families in order to protect their children from exposure to pesticides. Parents (n = 297) were randomly assigned into either lecture or video training group. Ability to recall information or improve practices among parents was evaluated in three consecutive sessions (2 weeks and 1 month apart). All participating families were using pesticides inside homes and in the fields. All families were using flying insect killers inside homes (main ingredients include tetramethrin, sumithrin, pyrethrin, piperonyl butoxide) in different forms. Pesticides applied in the fields are organophosphates (57.9%), carbamates (41.4%), and pyrethroids (28.5%). In both lecture and video training groups, knowledge scores of participants improved significantly in the second and third sessions, as compared to the first session. Although practice scores of both groups improved in subsequent sessions, the changes were not significant. Using non-traditional appropriately designed educational interventions that depend more on visual memory is more likely to ensure sustainability of the gained knowledge as well as practice.

Health educators working in developing nations commonly encounter administrative constraints and methodological problems which prevent rigorous program evaluation. Using a time-series design, this study followed approximately 600 families in two Guatemalan villages during a four-year period to measure the impact of community health education on seven indicators of change in environmental sanitation. Adoption of new behavior was accompanied by widespread change in village attitudes and perceptions of health benefits. At the level of the family, change in perception was not predictive of change in behavior. A strong relationship between participation in planned educational events and the adoption of sanitation changes suggests that the formative educational strategy was responsible for stimulating change for five of seven indicators. Suggestions are made about the usefulness of the methodology, ways that private behavioral changes may be measured are discussed, and the advantages of the time-series design for health education evaluation and monitoring are noted.

Among those concerned with fighting AIDS worldwide, it is agreed that the best weapon to change people's behavior is education. In this educational effort, all available channels have to be explored. In Ghana, the Health Education Division (HED) of the Ministry of Health set up three drama troupes to carry out AIDS education on a pilot basis. This study evaluates the impact of one of the troupes on AIDS knowledge, attitude and behavior using the focus group research approach. The findings confirm that drama about a well thought out AIDS-related theme does increase knowledge about AIDS and promotes commendable attitudes toward AIDS. It could also lead to changes in sexual behavior. The study also revealed that songs with AIDS-related themes could serve as important cues to “healthful” action in the environment by reminding listeners to adopt safer sexual behaviors.

Various reforms have been undertaken to improve the functioning of health systems in developing countries, but there is limited comparative analysis of reform initiatives. This article discusses health sector reform experiences of four developing countries and identifies the lessons learned. The article is based on the review of background papers on Bangladesh, Pakistan, Indonesia, and Tanzania prepared as part of a multi-country study on health sector reform. Findings suggest that decentralization works effectively while implementing primary and secondary health programs. Decentralization of power and authority to local authorities requires strengthening and supporting these units. Along with the public sector, the private sector plays an effective role in institutional and human resources development as well as in improving service delivery. Community participation facilitates recruitment and development of field workers, facility improvement, and service delivery. For providing financial protection to the poor, there is a need to review user fees and develop affordable health insurance with an exemption mechanism. There is no uniform health sector reform approach; therefore, the experiences of other countries will help countries undertake appropriate reforms. Here, it is important to examine the context and determine the reform measures that constitute the best means in terms of equity, efficiency, and sustainability.

The objective of this review is to draw attention to smoking cessation in view of the Transtheoretical Model (TTM). A large body of literature published in the last 15 years was screened by searching the keywords of “Smoking” and “Transtheoretical Model.” The Transtheoretical model consists of stages of change and is used to explain addictive behaviors such as smoking. It addresses behavioral change by taking into consideration factors such as planning and decision-making. This article examines this theory and sets forth the processes of change, according to the positive and negative evaluations and strength of the smoking habit. Although the stages of change and the transitions between these stages have not been clearly defined, it still helps in understanding the nature of some addictive behaviors, particularly smoking.