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  • Title: A conceptual explanation of risk-reduction behavior and intervention development.
    Author: Cox CL, Sullivan JA, Roghmann KJ.
    Journal: Nurs Res; 1984; 33(3):168-73. PubMed ID: 6563535.
    Abstract:
    This study used a new conceptual model of health behavior to examine a specific risk-reduction response. Known to be at risk for fetal abnormalities because of maternal age, 203 women were examined for their acceptance or rejection of an amniocentesis test on the basis of individual characteristics and external significant factors. The multivariate approach to analysis offered a fuller explanation for nonuse of prenatal diagnosis than was previously available. In addition to specific client factors, environmental factors such as financial support for the procedure, multiple information sources, social support, and aspects of the client-provider interaction were determined to be important in explaining client acceptance or rejection of the test. More importantly, the study demonstrated the advantages of using a conceptual model to direct the development of interventions. A new conceptual model of health behavior was used to examine a specific risk-reduction response. The focus of the model is on the process by which the client's individual characteristics combine with physiological, psychological, sociodemographic, environmental, and provider intervention factors to produce a selected health behavior. Known to be at risk for fetal abnormalities because of maternal age, 203 women were examined for their acceptance or rejection of an amniocentesis test on the basis of individual characteristics and external significant factors. The Prenatal Diagnosis Survey's variables and the elements and factors that comprise the structure of the Interaction Model of Client Behavior (IMCHB) were compared. Relative to the discrete variables, 70.9% of the women were covered for the amniocentesis by insurance; 45% of the women were Catholic; 57% lived outside the service county area; 5% of the clients were black; 96% were married; and 86% had discussed amniocentesis with a physician. The dependent measure included 57.6% of the clients who did not elect genetic counseling or amneocentis, 4.9% who chose counseling only, and 37.4% who chose amniocentesis postcounseling. 12 of the 30 variables examined were significantly associated with having or not having amniocentesis. Age, in correlation with absolute risk, was unexpectedly not highly associated with amniocentesis requests. 6 variables -- insurance coverage, experience with birth defects, age, religious affiliation (Catholic), education, and the amount of power desired by the mother deciding on abortion -- emerged as casually independent of any antecedents. The variables insurance coverage and experience with birth defects had a strong direct impact on the client's decision to request amniocentesis. Physician support has a significant impact on peer support for the procedure and on the number of people with whom the client discussed amniocentesis. Both social support for and against amniocentesis exerted powerful direct effects on the client's final decision about use of prenatal diagnosis. The final variable to directly influence the decision on amniocentesis is the client's attitude toward the legality of abortion (legal). In sum, the relationships predicted in abstraction by the IMCHB were demonstrated to be accurate when applied to clients' decisions to request amniocentesis. 22 of the 35 hypothesized causal paths were statistically significant; 5 paths were marginally significant.
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