Kate Lorig - Academia.edu (original) (raw)
Papers by Kate Lorig
Health Education & Behavior, 1994
This article summarizes the outcome of health education efforts among populations that, due to th... more This article summarizes the outcome of health education efforts among populations that, due to their cultural heritage, have received limited services. The literature reviewed shows that programs found to be effective in one population cannot be assumed to be equally effective with a different population. An argument is made for the design of culturally appropriate and group-specific interventions which would properly serve the various underserved populations. Research needs to be conducted to identify appropriate approaches and intervention strategies, as well as the group-specific sociopsychological characteristics (attitudes, norms, values, expectancies) that are related to health-damaging and protective behaviors.
Medical Care, 1985
A workplace health education program aimed at reducing unnecessary outpatient visits was offered ... more A workplace health education program aimed at reducing unnecessary outpatient visits was offered through 22 California employers. A total of 5,200 employees attended a presentation, received self-help books, and completed self-administered questionnaires. All visits for their households were monitored for up to 15 months. The study utilized a quasi-experimental staggered intervention design involving eight different cohorts, before/after comparisons, with statistical adjustment for seasonality and other intervening variables. Visit rates for households insured only by Blue Cross of California were reduced by 17% (P = 0.001), or 2.0 visits per household per year. For all participants, the reduction was 7.2% (P = 0.06), or 0.8 visits. Reductions were seen for all age and educational strata. The program was most effective among households with first dollar fee-for-service insurance coverage. Households with insurance requiring co-payments had less reduction. No reduction was seen among health maintenance organization (HMO) members. The study concludes that a minimal cost, self-care workplace intervention can reduce outpatient visits by important magnitudes.
Journal of Community Health, 1991
Over 100 project staff, community coalition members, and other representatives from 10 comprehens... more Over 100 project staff, community coalition members, and other representatives from 10 comprehensive community health promotion projects in the western United States were surveyed two years into a three year funding cycle about: (1) the problems or obstacles they judged as preventing successful completion of their current goals and objectives, and (2) future goals and objectives they envisioned for their projects. The key issues confronting respondents were diverse, although issues around the process of implementing community health promotion programs were cited more frequently than issues related to the content of health promotion. When respondents were asked to prioritize Future Goals in the second survey, consensus across communities was obtained despite broad differences in the type of community surveyed and the health problem targeted. This study identifies the common organizational and community development problems faced by newly emerging community health promotion programs and has implications for other communities involved in designing, implementing, and evaluating community-wide health promotion programs.
Health Education & Behavior, 1998
This study examined factors that influence youth participation in heart disease prevention activi... more This study examined factors that influence youth participation in heart disease prevention activities among 2,609 ninth graders in six inner-city public high schools. Constructs derived from social cognitive, empowerment, and community development theories informed the conceptual framework employed. Study participants were diverse with respect to gender, ethnicity, parent education, acculturation, and academic achievement. Perceived incentive value, self-efficacy, outcome expectancies, sense of community, and perceived policy control were all significantly associated with participation in community activities promoting heart health. In multivariate analyses, perceived incentive value, defined as the extent to which participants valued a heart-healthy environment, was most strongly associated with community participation, accounting for 11.9% of the total variance. These findings have implications for designing school curricula and after-school and community programs targeting adolescents' involvement in health advocacy activities.
Arthritis and Rheumatism, 1988
An instrument was developeted to measure appraisal and coping in older people with osteoarthritis... more An instrument was developeted to measure appraisal and coping in older people with osteoarthritis (OA). Based on the Lazarus-Folkman model of stress and coping, our Arhtritis Appraisal and Ways of coping scale assessed the primary appraisal (perception of harm/loss) and coping thoughts and actions of OAs in response to specific incidents of pain. Factor analysis of the scores of 151 persons with osteoarthritis produced five coping subscales: dependency, adapting, distancing, anger-withdrawal, and expanding thoughts and actions. In a sample of 95 OAs, primary appraisal and coping were found to relate significantly to each other, to self-efficacy, and to health status (pain, depression, and activity level). Use of this instrument to understand better the change processes in sucessful patient education program is discussed.
Arthritis and Rheumatism, 2002
Health Education Research, 1994
In the September 1993 issue of this journal, one of the Executive Editors, one of the Associate E... more In the September 1993 issue of this journal, one of the Executive Editors, one of the Associate Editors and four members of the Editorial Board signed a lead Editorial that could discourage submissions by some of the journal's potential contributors. We offer this 'Point of view' ...
Schizophrenia Research, 2010
Arthritis and Rheumatism, 2001
British Medical Journal, 2011
Health Promotion Practice, 2011
Type 2 diabetes disproportionately affects American Indians and Alaska Natives (AI/ANs). In the l... more Type 2 diabetes disproportionately affects American Indians and Alaska Natives (AI/ANs). In the larger population, patient self-management has become an increasing focus of the health care system to help reduce the impact of diabetes. However, little is known about patient self-management programs designed for AI/ANs. This study reports on the feasibility of implementing the Stanford Internet Diabetes Self-Management Workshop within the AI/AN population using a participatory research approach. This is a continuation of self-management studies to assist in meeting the needs of both patients and the health care system for health services that are effective (evidence based), efficient, and culturally appropriate. To our knowledge, this is the first study examining the effectiveness of an Internet-based diabetes patient self-management program among AI/ANs. This article reports on a pilot for a larger randomized study that is ongoing.
Lifestyle interventions can prevent diabetes through weight loss, but they are rarely translated ... more Lifestyle interventions can prevent diabetes through weight loss, but they are rarely translated for use in underserved communities. The aim of this study was to describe how a community–academic partnership formed and developed a program to address local health disparities by developing a low-cost, culturally and economically appropriate, peer-led community-based diabetes prevention program. Using a participatory approach, the partnership chose to focus on diabetes prevention, and co-developed all intervention, recruitment, research, and evaluation strategies. The partnership's philosophy to maintain high clinical and scientific standards paired with their ability to represent and engage the community facilitated the development of a randomized controlled trial that achieved statistically significant and sustained weight loss, and the recruitment of a largely Spanish-speaking, low income, uninsured population. The success of this intervention lies in the partnership's commitment to the community, co-ownership of research, and a careful balance between academic rigor and community engagement and relevance.
Health Education & Behavior, 1992
Although the integration of health education theory with practice has always been taught, this li... more Although the integration of health education theory with practice has always been taught, this linkage has not always occurred as a systematic part of program or theory development. This paper reflects the 12-year experience of one health education program which started from a base not soundly grounded in theory and moved to one tightly linked with theory. Throughout this process, outcome data were collected allowing for evaluations of both practice and theory.
Patient Education and Counseling, 1987
Patient Education and Counseling, 2005
While evidence exists regarding the effectiveness of many health education interventions, few of ... more While evidence exists regarding the effectiveness of many health education interventions, few of these evidence-based programs have been systematically or widely disseminated. This paper reports on the dissemination of one such intervention, the 6-week peer-led Chronic Disease Self-Management Program, throughout a large health-care system, Kaiser Permanente. We describe the dissemination process and, using qualitative analysis of interviews and surveys, discuss the factors that aided and hindered this process and make recommendations for similar dissemination projects. Six years after the beginning of the dissemination process, the program is integrated in most of the Kaiser Permanente regions and is being offered to several thousand people a year.
Annals of Behavioral Medicine, 2003
Self-management has become a popular term for behavioral interventions as well as for healthful b... more Self-management has become a popular term for behavioral interventions as well as for healthful behaviors. This is especially true for the management of chronic conditions. This article offers a short history of self-management. It presents three self-management tasks—medical management, role management, and emotional management—and six self-management skills—problem solving, decision making, resource utilization, the formation of a patient-provider partnership, action planning, and self-tailoring. In addition, the article presents evidence of the effectiveness of self-management interventions and posits a possible mechanism, self-efficacy, through which these interventions work. In conclusion the article discusses problems and solutions for integrating self-management education into the mainstream health care systems.
Journal of Clinical Epidemiology, 2001
Arthritis and Rheumatism, 1996
To compare the effects of education interventions and nonsteroidal antiinflammatory drug (NSAID) ... more To compare the effects of education interventions and nonsteroidal antiinflammatory drug (NSAID) treatment on pain and functional disability in patients with osteoarthritis (OA), and on pain, functional disability, and tender joint counts in patients with rheumatoid arthritis (RA). Two meta-analyses were performed: one of controlled trials of patient education interventions and one of placebo-controlled trials of NSAID treatments. Nineteen patient education trials comprised of 32 treatment arms and 28 NSAID trials comprised of 46 treatment arms were included. The weighted average effect size for pain was 0.17 in the education trials and 0.66 in the NSAID trials. The average effect size for functional disability was 0.03 in the education trials and 0.34 in the NSAID trials; effects of education were much larger in RA studies than in OA studies. In RA studies, the average effect size for the tender joint count was 0.34 in the education trials and 0.43 in the NSAID trials. Because most patients in the education trials were being treated with medications, the effect sizes of these trials represent the additional, or marginal, effects of patient education interventions beyond those achieved by medication. Based on this meta-analysis, patient education interventions provide additional benefits that are 20-30% as great as the effects of NSAID treatment for pain relief in OA and RA, 40% as great as NSAID treatment for improvement in functional ability in RA, and 60-80% as great as NSAID treatment in reduction in tender joint counts in RA.
Health Education & Behavior, 1994
This article summarizes the outcome of health education efforts among populations that, due to th... more This article summarizes the outcome of health education efforts among populations that, due to their cultural heritage, have received limited services. The literature reviewed shows that programs found to be effective in one population cannot be assumed to be equally effective with a different population. An argument is made for the design of culturally appropriate and group-specific interventions which would properly serve the various underserved populations. Research needs to be conducted to identify appropriate approaches and intervention strategies, as well as the group-specific sociopsychological characteristics (attitudes, norms, values, expectancies) that are related to health-damaging and protective behaviors.
Medical Care, 1985
A workplace health education program aimed at reducing unnecessary outpatient visits was offered ... more A workplace health education program aimed at reducing unnecessary outpatient visits was offered through 22 California employers. A total of 5,200 employees attended a presentation, received self-help books, and completed self-administered questionnaires. All visits for their households were monitored for up to 15 months. The study utilized a quasi-experimental staggered intervention design involving eight different cohorts, before/after comparisons, with statistical adjustment for seasonality and other intervening variables. Visit rates for households insured only by Blue Cross of California were reduced by 17% (P = 0.001), or 2.0 visits per household per year. For all participants, the reduction was 7.2% (P = 0.06), or 0.8 visits. Reductions were seen for all age and educational strata. The program was most effective among households with first dollar fee-for-service insurance coverage. Households with insurance requiring co-payments had less reduction. No reduction was seen among health maintenance organization (HMO) members. The study concludes that a minimal cost, self-care workplace intervention can reduce outpatient visits by important magnitudes.
Journal of Community Health, 1991
Over 100 project staff, community coalition members, and other representatives from 10 comprehens... more Over 100 project staff, community coalition members, and other representatives from 10 comprehensive community health promotion projects in the western United States were surveyed two years into a three year funding cycle about: (1) the problems or obstacles they judged as preventing successful completion of their current goals and objectives, and (2) future goals and objectives they envisioned for their projects. The key issues confronting respondents were diverse, although issues around the process of implementing community health promotion programs were cited more frequently than issues related to the content of health promotion. When respondents were asked to prioritize Future Goals in the second survey, consensus across communities was obtained despite broad differences in the type of community surveyed and the health problem targeted. This study identifies the common organizational and community development problems faced by newly emerging community health promotion programs and has implications for other communities involved in designing, implementing, and evaluating community-wide health promotion programs.
Health Education & Behavior, 1998
This study examined factors that influence youth participation in heart disease prevention activi... more This study examined factors that influence youth participation in heart disease prevention activities among 2,609 ninth graders in six inner-city public high schools. Constructs derived from social cognitive, empowerment, and community development theories informed the conceptual framework employed. Study participants were diverse with respect to gender, ethnicity, parent education, acculturation, and academic achievement. Perceived incentive value, self-efficacy, outcome expectancies, sense of community, and perceived policy control were all significantly associated with participation in community activities promoting heart health. In multivariate analyses, perceived incentive value, defined as the extent to which participants valued a heart-healthy environment, was most strongly associated with community participation, accounting for 11.9% of the total variance. These findings have implications for designing school curricula and after-school and community programs targeting adolescents' involvement in health advocacy activities.
Arthritis and Rheumatism, 1988
An instrument was developeted to measure appraisal and coping in older people with osteoarthritis... more An instrument was developeted to measure appraisal and coping in older people with osteoarthritis (OA). Based on the Lazarus-Folkman model of stress and coping, our Arhtritis Appraisal and Ways of coping scale assessed the primary appraisal (perception of harm/loss) and coping thoughts and actions of OAs in response to specific incidents of pain. Factor analysis of the scores of 151 persons with osteoarthritis produced five coping subscales: dependency, adapting, distancing, anger-withdrawal, and expanding thoughts and actions. In a sample of 95 OAs, primary appraisal and coping were found to relate significantly to each other, to self-efficacy, and to health status (pain, depression, and activity level). Use of this instrument to understand better the change processes in sucessful patient education program is discussed.
Arthritis and Rheumatism, 2002
Health Education Research, 1994
In the September 1993 issue of this journal, one of the Executive Editors, one of the Associate E... more In the September 1993 issue of this journal, one of the Executive Editors, one of the Associate Editors and four members of the Editorial Board signed a lead Editorial that could discourage submissions by some of the journal's potential contributors. We offer this 'Point of view' ...
Schizophrenia Research, 2010
Arthritis and Rheumatism, 2001
British Medical Journal, 2011
Health Promotion Practice, 2011
Type 2 diabetes disproportionately affects American Indians and Alaska Natives (AI/ANs). In the l... more Type 2 diabetes disproportionately affects American Indians and Alaska Natives (AI/ANs). In the larger population, patient self-management has become an increasing focus of the health care system to help reduce the impact of diabetes. However, little is known about patient self-management programs designed for AI/ANs. This study reports on the feasibility of implementing the Stanford Internet Diabetes Self-Management Workshop within the AI/AN population using a participatory research approach. This is a continuation of self-management studies to assist in meeting the needs of both patients and the health care system for health services that are effective (evidence based), efficient, and culturally appropriate. To our knowledge, this is the first study examining the effectiveness of an Internet-based diabetes patient self-management program among AI/ANs. This article reports on a pilot for a larger randomized study that is ongoing.
Lifestyle interventions can prevent diabetes through weight loss, but they are rarely translated ... more Lifestyle interventions can prevent diabetes through weight loss, but they are rarely translated for use in underserved communities. The aim of this study was to describe how a community–academic partnership formed and developed a program to address local health disparities by developing a low-cost, culturally and economically appropriate, peer-led community-based diabetes prevention program. Using a participatory approach, the partnership chose to focus on diabetes prevention, and co-developed all intervention, recruitment, research, and evaluation strategies. The partnership's philosophy to maintain high clinical and scientific standards paired with their ability to represent and engage the community facilitated the development of a randomized controlled trial that achieved statistically significant and sustained weight loss, and the recruitment of a largely Spanish-speaking, low income, uninsured population. The success of this intervention lies in the partnership's commitment to the community, co-ownership of research, and a careful balance between academic rigor and community engagement and relevance.
Health Education & Behavior, 1992
Although the integration of health education theory with practice has always been taught, this li... more Although the integration of health education theory with practice has always been taught, this linkage has not always occurred as a systematic part of program or theory development. This paper reflects the 12-year experience of one health education program which started from a base not soundly grounded in theory and moved to one tightly linked with theory. Throughout this process, outcome data were collected allowing for evaluations of both practice and theory.
Patient Education and Counseling, 1987
Patient Education and Counseling, 2005
While evidence exists regarding the effectiveness of many health education interventions, few of ... more While evidence exists regarding the effectiveness of many health education interventions, few of these evidence-based programs have been systematically or widely disseminated. This paper reports on the dissemination of one such intervention, the 6-week peer-led Chronic Disease Self-Management Program, throughout a large health-care system, Kaiser Permanente. We describe the dissemination process and, using qualitative analysis of interviews and surveys, discuss the factors that aided and hindered this process and make recommendations for similar dissemination projects. Six years after the beginning of the dissemination process, the program is integrated in most of the Kaiser Permanente regions and is being offered to several thousand people a year.
Annals of Behavioral Medicine, 2003
Self-management has become a popular term for behavioral interventions as well as for healthful b... more Self-management has become a popular term for behavioral interventions as well as for healthful behaviors. This is especially true for the management of chronic conditions. This article offers a short history of self-management. It presents three self-management tasks—medical management, role management, and emotional management—and six self-management skills—problem solving, decision making, resource utilization, the formation of a patient-provider partnership, action planning, and self-tailoring. In addition, the article presents evidence of the effectiveness of self-management interventions and posits a possible mechanism, self-efficacy, through which these interventions work. In conclusion the article discusses problems and solutions for integrating self-management education into the mainstream health care systems.
Journal of Clinical Epidemiology, 2001
Arthritis and Rheumatism, 1996
To compare the effects of education interventions and nonsteroidal antiinflammatory drug (NSAID) ... more To compare the effects of education interventions and nonsteroidal antiinflammatory drug (NSAID) treatment on pain and functional disability in patients with osteoarthritis (OA), and on pain, functional disability, and tender joint counts in patients with rheumatoid arthritis (RA). Two meta-analyses were performed: one of controlled trials of patient education interventions and one of placebo-controlled trials of NSAID treatments. Nineteen patient education trials comprised of 32 treatment arms and 28 NSAID trials comprised of 46 treatment arms were included. The weighted average effect size for pain was 0.17 in the education trials and 0.66 in the NSAID trials. The average effect size for functional disability was 0.03 in the education trials and 0.34 in the NSAID trials; effects of education were much larger in RA studies than in OA studies. In RA studies, the average effect size for the tender joint count was 0.34 in the education trials and 0.43 in the NSAID trials. Because most patients in the education trials were being treated with medications, the effect sizes of these trials represent the additional, or marginal, effects of patient education interventions beyond those achieved by medication. Based on this meta-analysis, patient education interventions provide additional benefits that are 20-30% as great as the effects of NSAID treatment for pain relief in OA and RA, 40% as great as NSAID treatment for improvement in functional ability in RA, and 60-80% as great as NSAID treatment in reduction in tender joint counts in RA.