Objective: To determine the impact of a structured program on health-related and coping behaviors in persons with multiple sclerosis (MS). Design: Persons who are newly diagnosed wtih MS may experience anxiety, depression, and a sense of control on learning of their diagnosis.  These stressors may aggrevate or interfere with a person's implementation of positive health-related behaviors.  Educational interventions are widely used in other chronic disease models (diabetes, hypertension, epilepsy) to promote positive health behaviors.  Setting: University based MS center treating outpatients.  Participants: 76 subjects were self-referred or referred by a health care professional.  Criteria included diagnosis of MS <5 years and minimal symptoms of disability.  Most participants were employed at least part time.  Intervention:  Participants met weekly for 3 hours a session over 12 weeks.  Intervention consisted of didactic presentations, which included symptom management, strategies, nutrition, preventive health practices, fitness activities, and emotional and spiritual wellness exercises.  Main Outcome Measures: Measures administered to participants at the beginning and end of the program included the Profile of Mood States, Modified Fatigue Impact Scale, Stress Profile Inventory, 3-item spirituality index, Marlow Crowne Social Desirabilty Index, and Taylor Manifest Anxiety scale.  a 5-item post-them measure of current health and functioning was specifically developed to evaluate overall program outcomes and effect sizes were determined for practical significance.  Results: At the end of the program, participants reported statstically significant improvement (P < .01) in all areas assessed including fatigue, mood, stress, sleep patterns, health related behaviors (e.g. those relating to nutrition and exercise), spirituality and coping strategies after controlling for age, sex and education. Conclusion: Effect sizes inidcated the biggest impact of the program in self-reported overall health, knowledge about MS, reduced stress, and enhanced feelings of empowerment and meaningfulness in life (spirituality index).

The major goal of 360-degree feedback interventions is to facilitate purposeful individual or team behavior change. Successful behavior change at the individual or team level requires three necessary conditions:

1. Awareness/Insight;
2. Motivation/Self-Efficacy; and
3. Ability.

When properly designed and implemented, multi-rater or 360-degree feedback interventions provide specific feedback to enhance self-insight and self-awareness necessary for any potential behavior change. However, without sufficient motivation and self-efficacy, most behavior change efforts are largely unsuccessful. Effective 360-degree feedback interventions enhance the motivation levels of individuals and teams to make constructive behavior changes to meet the needs of both internal and external stakeholders (e.g., customers, direct reports, team members, etc.).

Multi-rater or 360-degree feedback interventions involve the systematic collection of specific information from multiple sources to enhance awareness of individuals and teams. Most commonly, data and information are collected from multiple sources that have a relevant, and hopefully accurate, perspective to share using focus group, interview, or paper-and-pencil instruments. The data collected are commonly summarized quantitatively and/or qualitatively and shared with one or more members of the organization in an oral and/or written manner. The most common form of multi-rater or 360-degree feedback interventions today typically utilizes an off-the-shelf or in-house designed instrument measuring critical competencies required for competitive performance. Most feedback from these interventions is collected from multiple perspectives (e.g., one's supervisor, direct reports, peers, team members) and is summarized in the form of a written and/or computerized feedback report (often including graphic comparisons of self-other perceptions, written comments, and narrative information). The most common uses of multi-rater or 360-degree feedback interventions include: Executive/management coaching, training and development, career counseling, succession planning and development, training needs assessment, training evaluation, and performance appraisal and evaluation.

Despite the growing popularity of multi-rater of 360-degree feedback, a number of issues emerge in the use and implementation of such organizational interventions. These include such things as:

What competencies should be assessed and measured?
How many individuals ensure a reliable and valid set of observations about another individual?
Who should provide feedback?
How should raters be selected?
Should 360-degree feedback be used for development or appraisal purposes?
Should individuals providing feedback be identified?
The chapter includes a real-world case study and answers to the current issues and questions regarding best practices in the use of 360-degree feedback interventions. References are also provided for additional readings in the multi-rater or 360-degree feedback literature.
 

A sizeable literature exists documenting a relationship between perceived levels of stress, social support, and immune function. Little research has examined whether changes in perceived levels of stress and social support are associated with corresponding changes in immune function. In this study , four groups of subjects between the ages of 60 and 70 (group 1, n=31, group 2, n=24, group 3, n=25, group 4, n=30) were pretested and retested 3 months after participating in an 11 day intensive health promotion program for the elderly at a large health resort in Arizona. This 11-day in-house program emphasized lifestyle change behaviors, health education, physical exercise, stress management and relaxation skill building.

As part of a battery of both psychological and biological variables, measures of perceived stress and social support (Nowack, 1990) and percent lymphocytes and monocytes (from CYR blood counts) were obtained, and changes in these variables over the three months were correlated.

For the total sample (n=110), subjects who reported experiencing a decrease in perceived stress over time showed a significant increase in lymphocytes over time (r= -.231, p < .01). This pattern was observed in each of the four groups analyzed separately (r's = -.20, -.39, -.33, -.33).

Subjects who reported an increase in perceived social support over time showed increased monocytes over time (r = .27, p < .01). Again, this pattern was observed in each of the four groups analyzed separately (r's = .19, .30, .26, .33).
 

It is becoming increasingly clear that the effects of work and life stress are costly both to the individual and to the organization. Everyone experiences work and life stress, yet many people are more stress resistant (hardy) than others. Several factors appear to be quite predictive of the stress resistant employee. These include the perception of stress; the practice of good daily health habits; the expressing of less Type A behavior; satisfaction with social support networks; and an involved, committed, and empowered outlook. Hardy Type A persons can be distinguished from less hardy Type A's by their internal, rather than external, commitment to aspects of work and life. Previous research suggests that for working women, even if it is possible to "have it all," something may have to go and that may be the women's health. In a study of 350 employees, professional working women reported significantly lower overall health habits than their working male counterparts. Professional working women reported significantly more work and life stress and a less optimistic outlook on life than did men. Health promotion programs with targeted and specific outcomes may produce better success than those trying to be everything for everybody. Companies committed to employee health promotion may wish to succinctly define what organizational and individual outcomes they are targeting and structure their programs and interventions accordingly. Paper presented at the 68th Annual Meeting of the Western Psychological Association, Burlingame, CA, April 28-May 1, 1988.

Conducting a competency based training needs assessment can be challenging in most organizations. In this ASTD Trainer's Toolkit, an actual sample of a competency based training need assessment survey is provided for use with all levels within any organization. The training needs evaluation survey can be easily customized to meet the needs of any organization. A brief, psychometrically tested, organizational climate survey is also provided for organizations also looking to include some type of employee attitude survey. This 1990 ASTD Trainer's Toolkit: Needs Assessment is available for purchase by contacting American Society for Training and Development (ASTD) at 703.683.8100 or at their website: www.astd.org