Objectives. A community trial was undertaken to evaluate the effectiveness of the North Carolina Breast Cancer Screening Program, a lay health advisor network intervention intended to increase screening among rural African American women 50 years and older.Methods. A stratified random sample of 801 African American women completed baseline (1993-1994) and follow-up (1996-1997) surveys.The primary outcome was self-reported mammography use in the previous 2 years.Results. The intervention was associated with an overall 6 percentage point increase (95% confidence interval [CI] = −1, 14) in communitywide mammography use. Low-income women in intervention counties showed an 11 percentage point increase (95% CI = 2, 21) in use above that exhibited by lowincome women in comparison counties. Adjustment for potentially confounding characteristics did not change the results.Conclusions. A lay health advisor intervention appears to be an effective public health approach to increasing use of screening mammography among low-income, rural populations.
Purpose -The aim is to explore users' reactions to health information web sites from the perspective of trust, retrieval of relevant information and ease-of-use, and to establish the link between perceived quality, trust, and usability. Design/methodology/approach -An analysis of three Australian health web sites was undertaken. A usability test was conducted on those three web sites resulting in 207 completed user evaluations. The evaluations included both quantitative and qualitative data. Findings -The three investigated health information web sites do not meet the needs of health consumers. More details such as how information is selected to engender greater trust need to be provided. The retrieval of relevant information could be improved through the implementation of functionality such as spell checking and information differentiation. Finally, ensuring web sites are easy to use contributes to the level of trust users have in a web site. Research limitations/implications -This was a relatively small study investigating only three generic Australian health web sites, the results however suggest that a larger study looking at other health web sites is needed. Practical implications -For government agencies developing health information web sites more attention needs to be paid to the design of these web sites if users are to be encouraged to use the web site and return. The research suggests that effective health information web sites must be perceived to be of reliable quality, be trustworthy, have some level of intelligence to assist in the retrieval of relevant information, and be easy to use. Originality/value -Although there is much research relating to the relationship between web site design and trust for e-commerce transactional web sites this work has not been undertaken for web sites designed for information retrieval, in particular little work has been done of health information web sites. This paper fills in some of the gaps.
D uring the past several years, programs have proliferated throughout the United States that train indigenous community members to serve as links between their communities and the professional health care system (Eng & Young, 233 Health Programs that train natural helpers, or members of the community to whom others naturally turn for help, to be lay health advisors (LHAs) have proliferated throughout the United States; evaluations of these programs, however, are uncommon. The goal of this exploratory study was to understand how the natural helper LHA approach, as operationalized by the North Carolina Breast Cancer Screening Program (NC-BCSP), was translated
from idea into practice. Data from document review and in-depth interviews with 24LHAs and four of their coordinators were used to compare theory-based program plans with actual practice. Results suggest that although in large part the natural helper model was followed, program implementation departed from program plans in several unanticipated ways in the areas of (a) recruitment, (b) program direction, and (c) LHA activities. Differences illustrate the tensions between theory and practice and between community and program planners that may be inherent in a natural helper program, and highlight the need to include community members and program participants in all aspects of planning.
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