Why won’t they participate? Barriers to participation in worksite health promotion programmes

Research suggests that worksite health promotion (WHP) programmes, and specifically health risk assessment (HRA) surveys and health education workshops, can be effective in enhancing employees’ health. However, 50–75% of employees choose not to participate when offered the opportunity to do so. The reasons for nonparticipation and the characteristics of nonparticipants have largely been overlooked. Building on premises of Conservation of Resources (COR) theory, we hypothesize that nonparticipation results from lack or loss of resources, or from the perceived low value of resources. These barriers to participation are expected to be related to employees’ characteristics and beliefs (termed implicit barriers) and reflected in employees’ self-reported reasons for nonparticipation (termed explicit barriers). We surveyed a large random sample of participants and nonparticipants in a WHP programme (n = 1926 employees), which included two steps: a HRA survey and a health education workshop. Participants completed an anonymous web-based questionnaire. Implicit and explicit barriers that reflect resource availability (e.g., age, health status) and valuation (e.g., low value of making a lifestyle change) were identified. The magnitude and nature of these barriers differed between the HRA survey and the workshop. We discuss how future research on WHP programmes can build on these findings and propose practical implications for reducing nonparticipation.     

The spiritual care of sick children: reflections from a pilot participation project

The authors are a multi-disciplinary team of chaplains, one with a counselling qualification, and an academic with a research background in spirituality and youth work. A pilot participation project undertaken at Birmingham Children’s Hospital (UK) focused on increasing the understanding of the spiritual needs of sick children and young people and involving children and young people in improving the service and provision of spiritual and religious care to them. Views from children, young people and parents were sought with the intention of developing resources and training that help facilitate the meeting of spiritual and religious needs of children and young people in hospital. Within the wider chaplaincy team are chaplains from the six major world faiths and this project considers spiritual needs of children and young people who perceive themselves as belonging to a faith group or not. Reflections from the pilot include identifying ten principles and practices to inform the spiritual care of sick children and proposing the concept of interpretive spiritual encounters as a tool for spiritual care. The pilot study indicated that being more proactive in offering spiritual care enhanced the quality of service offered by Chaplaincy.     

Posttraumatic Growth and Subjective Well-Being among Caregivers of Chronic Patients: A Preliminary Study

This preliminary study focused on positive phenomena among Israeli family caregivers (spouse, adult child, or parent) of patients with chronic illness hospitalized in a medical rehabilitation hospital. We investigated these caregivers’ posttraumatic growth (PTG) and subjective well-being (positive and negative emotions, life satisfaction), and their associations with the demographic and illness characteristics of the caregivers and patients, respectively. Participants included 74 adult primary caregivers: 28 were the patient’s spouse; 21 were the patient’s child; and 25 were the patient’s parent. Caregivers completed four self-report questionnaires. No significant association emerged between caregivers’ PTG and their negative affect or life satisfaction. Nevertheless, caregivers’ positive affect correlated with their PTG and also predicted it. Moreover, different patterns emerged for the caregiver subgroups (spouse, adult child, or parent): Patients’ children reported lower negative affect and greater life satisfaction than patients’ parents or spouses. Various explanations were discussed, alongside implications for giving recognition and assistance from the medical system to patients’ caregivers.     

Correlates of colorectal cancer screening compliance and stage of adoption among siblings of individuals with early onset colorectal cancer.

Concepts from the health belief, transtheoretical, and dual process models were used to examine how siblings of individuals diagnosed with colorectal cancer (CRC) before age 56 made decisions about CRC screening. Siblings (N = 504) were assessed for CRC screening practices and intentions, pros, cons, processes-of-change, perceived risk of CRC, perceived severity of CRC, preventability of CRC, cancer-related distress, and sibling relationship closeness. Physician and family recommendation and knowledge were also assessed. Fifty-seven percent of participants (n = 287) were compliant with CRC screening. Logistic regression indicated that perceived pros and cons, perceived risk, commitment to screening, health care avoidance, and sibling closeness were associated with screening compliance. Physician and family recommendation were also strong correlates. A similar set of factors was associated with stage of adoption of CRC screening.     

Lorenz Curves: A New Model for the Distribution of Psychiatric Services

The growth of child and adolescent psychiatric services based on the wraparound philosophy raises new questions for medical directors, investigators, and clinicians interested in improving quality of care and outcomes. Typically, quality improvement studies have focused on standardizing care and decreasing variation while community based services following a wraparound model are by definition individualized. To date, little information on how to evaluate such services in a managed care environment has been available. We present one option for evaluating the distribution of medical services and the extent to which providers individualize services for children with severe emotional disorders. Specifically, we (a) review the philosophy and goals of wraparound services, (b) introduce the Lorenz curve as a tool for determining the degree of inequality in service distribution at a given institution, and (c) present a case study on the use of Lorenz curves by a Medicaid Behavioral Health Organization in profiling behavioral providers.     

The role of perseveration in children's symbolic understanding and skill

In the first few years of life, children become increasingly sensitive to the significance of a variety of symbolic artifacts. An extensive body of research has explored very young children's ability to use symbol‐based information as a guide to current reality. In one common task, for example, children watch as a miniature toy is hidden in a scale model, and are then asked to retrieve a larger version of the toy from the corresponding place in the room itself. Two‐and‐a‐half‐year‐old children perform very poorly in most versions of this task. Their most common error is to perseverate; that is, they search again at the location where the toy was last hidden. Two studies examined the degree to which 2¹/₂‐year‐olds’ high rate of perseveration and poor performance stem from problems with inhibitory control. Results showed that problems with inhibitory control contribute very little to 2¹/₂‐year‐old children's difficulty with the task. Instead, the results confirm young children's great difficulty appreciating and exploiting symbol–referent relations.     

A Fine Risk To Be Run? The Ambiguity of Eros and Teacher Responsibility

Teachers are often placed in a space of tensionbetween responding to students as persons andresponding to students through theirinstitutionally-defined roles. Particularlywith respect to eros, which has becomeincreasingly the subject of strictinstitutional legislation and regulation,teachers have little recourse to a language ofresponsibility outside an institutional frame. By studying the significance of communicativeambiguity for responsibility, this paperexplores what is ethically at stake forteachers in erotic forms of communication. Specifically, it is Levinas's own ambiguousunderstanding of the ethical significance oferos, and what we have to learn from it, thatoffers a way of reading the place of eros inresponsibility. I conclude my discussion withsome thoughts on what a renewed understandingof responsibility might mean at the personaland institutional levels.     

Introduction: Levinas and Education: The Question of Implication

Studies in Philosophy and Education -     

The Use of Self-Pleasure: Masturbation and Body Image among African American and European American Women

The current investigation examined the relationship between masturbation and body image among 96 women seeking services at a local family planning clinic in a mid-southern U.S. city. Participants completed a questionnaire that assessed body image and masturbatory practices. Ethnic differences were found with European American women reporting greater masturbation frequencies and higher rates of body dissatisfaction than African American women. Among European American women, there was a positive relationship between women's sexual self-pleasuring and positive body image. For African American participants, body image was not related to masturbation practice or frequency.