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PubMed2004

A cost-effective approach to the development of printed materials: a randomized controlled trial of three strategies.

Printed materials have been a primary mode of communication in public health education. Three major approaches to the development of these materials--the application of characteristics identified in the literature, behavioral strategies and marketing strategies--have major implications for both the effectiveness and cost of materials. However, little attention has been directed towards the cost-effectiveness of such approaches. In the present study, three pamphlets were developed using successive addition of each approach: first literature characteristics only ('C' pamphlet), then behavioral strategies ('C + B' pamphlet) and then marketing strategies ('C + B + M' pamphlet). Each pamphlet encouraged women to join a Pap Test Reminder Service (PTRS). Each pamphlet was mailed to a randomly selected sample of 2700 women aged 50-69 years. Registrations with the PTRS were monitored and 420 women in each pamphlet group were surveyed by telephone. It was reported that the 'C + B' and 'C + B + M' pamphlets were significantly more effective than the 'C' pamphlet. The 'C + B' pamphlet was the most cost-effective of the three pamphlets. There were no significant differences between any of the pamphlet groups on acceptability, knowledge or attitudes. It was suggested that the inclusion of behavioral strategies is likely to be a cost-effective approach to the development of printed health education materials.

Aged↗
PubMed1995

Absence resulting from low back trouble can be reduced by psychosocial intervention at the work place.

STUDY DESIGN: A 1-year prospective study in industry, assessing effects of an educational pamphlet on various psychosocial parameters and absenteeism resulting from low back trouble. OBJECTIVES: To determine the value of distributing an educational psychosocial pamphlet to reduce absenteeism resulting from back trouble. The pamphlet was designed to alter avoidance behaviors by encouraging a positive, active approach. SUMMARY OF BACKGROUND DATA: Attempts to control back-pain disability have failed. Fear of pain and activity seemingly leads to avoidance behaviors than contribute to chronicity and work loss. Avoidance behaviors are mediated by attitudes and beliefs; such attitudes and beliefs are a reasonable target for educational interventions designed to change "inappropriate" behaviors (e.g., extended absenteeism). Health education pamphlets are advocated widely but tested rarely. METHODS: Three factories participated in the study. Psychosocial data were collected by questionnaires; absence data were extracted from company records. A psychosocial pamphlet was distributed in one factory; the control subjects received either a nonspecific pamphlet or no intervention. The pamphlet emphasized a positive approach to low back trouble (reduction of negative beliefs and attitudes). RESULTS: In the company whose employees received pamphlets, a significant reduction occurred for the number of spells with extended absence and the number of days of absence (70% and 60%, respectively) compared with extrapolated values. A concomitant positive shift in beliefs concerning the locus of pain control and the inevitable consequences of low back trouble was found. CONCLUSION: A simple industrial intervention using a psychosocial pamphlet, which was designed to reduce avoidance behaviors by fostering positive beliefs and attitudes, successfully reduced extended absence resulting from low back trouble.

Absenteeism↗
PubMed1987

The effect of message framing on breast self-examination attitudes, intentions, and behavior.

In this study we tested the framing hypothesis that a pamphlet stressing the negative consequences of not performing breast self-examination (BSE) would be more persuasive than a pamphlet emphasizing BSE's positive consequences. College-aged female subjects were exposed to a loss-frame pamphlet, a gain-frame pamphlet, or a no-arguments pamphlet, or they received no pamphlet describing the importance of and the techniques for performing BSE. Attitudes toward BSE and intentions to perform BSE were assessed immediately after this intervention and again 4 months later. The follow-up also assessed subjects' postexperimental BSE behavior. Consistent with predictions, subjects who read a pamphlet with arguments framed in loss language manifested more positive BSE attitudes, intentions, and behaviors than did subjects in the other three conditions. The greater impact of the loss pamphlet could not be attributed to greater fear arousal, better memory for pamphlet content, greater perceived susceptibility to breast cancer, or stronger beliefs in BSE's efficacy on the part of the loss subjects. Only measures of perceived self-efficacy in performing BSE were differentially affected by the framing manipulation, with loss subjects reporting the greatest levels of self-confidence. The results are discussed in terms of prospect theory's framing postulate and a simpler negativity-bias conceptualization, and underlying mechanisms such as differential salience and vividness are considered. Clinical implications of the findings are also explored.

Attitude to Health↗
PubMed2004

Randomized trial examining the effect of two prostate cancer screening educational interventions on patient knowledge, preferences, and behaviors.

OBJECTIVE: To assess the effect of video and pamphlet interventions on patient prostate cancer (CaP) screening knowledge, decision-making participation, preferences, and behaviors. DESIGN: Randomized, controlled trial. SETTING: Four midwestern Veterans Affairs medical facilities. PATIENTS/PARTICIPANTS: One thousand, one hundred fifty-two male veterans age 50 and older with primary care appointments at participating facilities were randomized and 893 completed follow-up. INTERVENTIONS: Patients were randomized to mailed pamphlet, mailed video, or usual care/control. MEASUREMENTS AND MAIN RESULTS: Outcomes assessed by phone survey 2 weeks postintervention included a 10-item knowledge index; correct responses to questions on CaP natural history, treatment efficacy, the prostate-specific antigen (PSA)'s predictive value, and expert disagreement about the PSA; whether screening was discussed with provider; screening preferences; and PSA testing rates. Mean knowledge index scores were higher for video (7.44; P = .001) and pamphlet (7.26; P = .03) subjects versus controls (6.90). Video and pamphlet subjects reported significantly higher percentages of correct responses relative to controls to questions on CaP natural history (63%, 63%, and 54%, respectively); treatment efficacy (19%, 20%, and 5%), and expert disagreement (28%, 19%, and 8%), but not PSA accuracy (28%, 22%, and 22%). Pamphlet subjects were more likely than controls to discuss screening with their provider (41% vs 32%; P = .03) but video subjects were not (35%; P = .33). Video and pamphlet subjects were less likely to intend to have a PSA, relative to controls (63%, 65%, and 74%, respectively). PSA testing rates did not differ significantly across groups. CONCLUSIONS: Mailed interventions enhance patient knowledge and self-reported participation in decision making, and alter screening preferences. The pamphlet and video interventions evaluated are comparable in effectiveness. The lower-cost pamphlet approach is an attractive option for clinics with limited resources.

Aged↗
PubMed1997

Written patient information about triple-marker screening: a randomized, controlled trial.

OBJECTIVE: To investigate to what extent a newly revised educational pamphlet on triple-marker screening improves patient knowledge and to identify subgroups of women who may not benefit from these materials. METHODS: Women in six geographically and demographically diverse Ontario sites were allocated randomly to receive the pamphlet on triple-marker screening or a similar-appearing educational pamphlet on daily activities during pregnancy. The primary outcome measure was the Maternal Serum Screening Knowledge Questionnaire, a previously validated 14-item scale. RESULTS: Baseline demographic, obstetric, and medical factors were comparable in the intervention and control groups, as were measures of previous exposure to triple-marker screening. Knowledge scores were significantly higher among the 133 women receiving the intervention pamphlet than among 64 women who received the control pamphlet (0.89 versus 0.52 on a scale from -2 to +2, P < .001). Subgroups not benefiting from the pamphlet on triple-marker screening were women age 25 and younger and those not speaking English at home. Those who had completed university or postgraduate education had high levels of knowledge with and without the pamphlet. CONCLUSION: Written patient information can contribute in an important way to patient knowledge about triple-marker screening. Providers of antenatal care should be made aware of the value of written patient information as well as the limitations for some subgroups of women. These subgroups are likely to require additional educational materials and resources. It would be appropriate to make these materials available to the general public and pregnant women in their physicians' offices.

Adult↗
PubMed2004

Information empowers but who is empowered?

This article presents part of the findings of a study that examined an information pamphlet written by nurses and given to relatives of patients in a Critical Care Unit (CCU) in an Australian acute care hospital. The pamphlet, Information for Relatives, was analyzed using Systemic Functional Linguistics (SFL) and examines how a relatives' information pamphlet written by nurses constructs the reader-relatives' view of a Critical Care Unit. The results revealed how the language chosen by the nurse-writers of this pamphlet acts to restrict and constrain the reader-relatives while constructing the staff as ethical experts. Furthermore, it questions the notion that all information empowers healthcare clients and demonstrates how this information pamphlet is not value free but has embedded in it social values of the culture from which it emanates. The pamphlet empowers the writers and staff, not the relatives.

Australia↗
PubMed1995

The comprehensibility of Australian educational literature for patients with asthma.

BACKGROUND: Education of patients with asthma is aimed at improving their knowledge, skills and attitudes, and thus compliance and control. Patient information pamphlets play a role in education, medication information and informed consent processes, and must be understood. We assessed the comprehensibility of Australian pamphlets on asthma. METHOD: 50 Australian pamphlets on asthma (written in English for adults) were selected from the Asthma Foundation, a teaching hospital in South Australia, the pharmaceutical industry, the National Asthma Campaign and specialist books and journal articles. The Australian Rix readability formula was used to estimate the grade of reading difficulty, and thus comprehensibility, of these patient information pamphlets (grade 1 = most comprehensible; grade 12 = most difficult). RESULTS: The mean grade of reading difficulty of the 50 patient information pamphlets was 8 (SD, 1.4; range, 6-11). One-third were written at or above grade 9 and two-thirds were at or above grade 8. CONCLUSION: As recent educational attainment data suggest that up to 52% of 15-69-year-olds in Australia comprehend text at or below grade 7, a substantial number of pamphlets on asthma are beyond the reading and comprehension abilities of many of their target population.

Adolescent↗
PubMed1997

Educational material about genetic tests: does it provide key information for patients and practitioners?

Genetic testing for common conditions will be used increasingly in primary care, but resources for patient counseling are decreasing. It is also necessary that primary care practitioners be better equipped to do basic genetic counseling. Therefore, the quality of informational materials for practitioners and patients is important. It was unknown how often key elements recommended by policy groups were actually included in such material. It was our aim to determine the content of printed informational material for practitioners and patients on genetic testing. We performed (1) a telephone survey of organizations in the United States that developed genetic tests or services and (2) a content analysis of pamphlets obtained from these organizations to determine the presence of 10 critical elements necessary to evaluate the appropriateness and performance of the tests. Almost 95% (169/178) of organizations responded to our survey; 131/169 (78%) reported using informational materials. We analyzed 115 pamphlets collected from 125/131 (95%) organizations. Elements least frequently included in the pamphlets were risks and benefits, patient rights, and intended use or purpose of the test. Most frequently included were descriptions of the conditions detected by the test, and the appropriate patients for testing. Nearly one half of the pamphlets included some statement about the accuracy of the test, but most of these did not specify whether their statements referred to sensitivity, specificity, or predictive value. Overall, pamphlets tended to contain information that would aid in determining a patient's eligibility for a genetic test, but did not contain sufficient information about the tests themselves. Our results suggest that several critical elements need to be added to enhance informed choices by patients and physicians.

Benchmarking↗
PubMed2006

Comparison of three interventions to increase mammography screening in low income African American women.

BACKGROUND: Low-income African American women are more likely to die of breast cancer than their Caucasian counterparts, and at least part of the difference in mortality results from differential screening adherence. The purpose of this study was to identify more efficacious methods of promoting routine mammography screening in underserved populations. METHODS: A prospective randomized intervention study of 344 low income African American women compared the impact of three interventions on mammography adherence and stage of readiness: (1) pamphlet only; (2) culturally appropriate video; and (3) interactive computer-assisted instruction program. RESULTS: The interactive computer intervention program produced the greatest level of adherence to mammography (40.0%) compared to the video group (24.6%) and the pamphlet group (32.1%). When subjects in the pamphlet and video groups were combined to form a non-interactive group, this group had a significantly lower adherence than the group who received the interactive computer intervention (27.0% versus 40.0%). There was also significantly more forward movement in mammography stage of readiness among participants in the computer group (52.0%) compared to those in the pamphlet group (46.4%) or the video group (31.3%). When combining the non-interactive technology (pamphlet and video) there was also more forward movement in mammography stage of readiness for those in the interactive intervention group (52.0% moved 1 or 2 stages) compared to those in the non-interactive group (36.2%). CONCLUSIONS: These data indicate that tailored approaches are more effective than targeted messages either in print or video format. Another finding of this study is that interactive interventions are more effective than non-interactive interventions in increasing adherence and moving African American women forward in their mammogram stage of readiness.

Adult↗
PubMed2005

Patient education materials for mental health problems in family practice: does location matter?

INTRODUCTION: This study examines how frequently family physicians display printed educational materials about mental health problems in their practices and where these materials should be located for optimal effect. METHODS: A cross-sectional observational study of pamphlet display practices in 13 family physicians' offices in Hamilton, Ontario, Canada was followed by an intervention which placed selected mental health educational materials in waiting rooms and examining rooms, and monitored the pick up rate from each location by patients. MAIN RESULTS: The study found that few mental health pamphlets were displayed by the participating physicians, that when a range of these pamphlets was made available, pamphlets on mood disorders were the most popular, and that significantly more pamphlets were picked up from examining rooms than from waiting rooms. CONCLUSIONS: We conclude that patients are interested in having access to printed materials about mental health problems, and that the optimal location is in display racks in examining rooms.

Bias↗
PubMed2006

Who uses decision aids? Subgroup analyses from a randomized controlled effectiveness trial of two prostate cancer screening decision support interventions.

OBJECTIVE: To examine who reported using unsolicited prostate cancer screening decision aids distributed as part of a randomized controlled trial, whether reported use varied by type of aid (video or pamphlet), and what affect reported use had on study outcomes. METHODS: A total of 1,152 men aged 50 and older from four medical facilities in the United States were randomly assigned to pamphlet, video or usual care (control). Materials were mailed 2 weeks prior to clinic appointments in general internal medicine. Outcomes were assessed by phone survey 1 week after appointments. Analyses examined the reported use of materials by study group, the association between patient characteristics and reported use, and the impact of reported use (adjusting for patient characteristics) on a 10-item knowledge index. RESULTS: Fifty-six percent of those randomized to receive the video and 50% of those randomized to receive the pamphlet reported using the materials. Reported use of the video was higher for patients who had greater than a high school education (OR 1.73), were married (OR 2.20), and reported no prior abnormal prostate cancer screening test results (OR 3.39). Reported use of the pamphlet did not vary by patient characteristics. In intent-to-treat analyses (ignoring reported use), individuals randomized to the video and pamphlet groups had significantly higher knowledge scores relative to the control group (7.44, 7.26 and 6.90 respectively). Adjusting for reported use modestly increased the estimated differences across treatment groups but did not substantially change conclusions about the relative effects of these aids on knowledge. CONCLUSIONS: Only half of men receiving unsolicited prostate cancer screening decision aids before a visit reported using the aids, and who reported using them varied by type of aid. Efforts to broadly implement decision aids may need to offer a variety of approaches, and incorporate creative strategies to enhance reaching all population subgroups.

Aged↗
PubMed2005

The development and process evaluation of an information-based intervention for pregnant women aimed at addressing rates of caesarean section.

OBJECTIVE: Few strategies aimed at addressing rising rates of caesarean section have explicitly involved information-based approaches for pregnant women. This study describes the development and evaluation of such an intervention for pregnant women, encompassing pamphlets and a peer support network (PSN). DESIGN: Process evaluation. SETTING: The study was undertaken at a metropolitan teaching hospital in Adelaide, South Australia. POPULATION: A consecutive sample of pregnant women attending the ultrasound clinic over a two-month period, recruited at 18 weeks of gestation. METHODS: Participants received two pamphlets at 18 weeks of gestation and information on a PSN at around 28 weeks of gestation. A questionnaire was sent to women at seven weeks postnatal, asking them to evaluate the intervention. MAIN OUTCOME MEASURES: The extent to which the intervention resources were used and participants were satisfied with the resources they received. RESULTS: Ninety-two women returned questionnaires (response rate of 62%). Women generally resisted engaging with the informational resources, citing irrelevance to their situation, for example, 53% (49/92) read all of the pamphlets. None of the women used the PSN. Women who had experienced childbirth previously and those of higher education were significantly more likely to read the pamphlets. While generally satisfied with pamphlet content, one in five women reported feeling distressed by some of the information. CONCLUSIONS: This exploratory study casts doubt on the notion of information provision for pregnant women as a panacea for addressing rising rates of caesarean section.

Adult↗
PubMedDate not supplied

Readability levels of selected hypercholesterolemia patient education literature.

OBJECTIVES: To assess the readability of selected hypercholesterolemia print materials, summarize the limitations of readability formulas, describe how expert judgement can be used to enhance readability determinations of printed materials, and discuss indirect and direct methods for assessing patient literacy levels. DESIGN: Descriptive, retrospective, convenience sample OUTCOME MEASURES: Readability of four AHA/NLHBI hypercholesterolemia patient education pamphlets by use of three readability formulas and the Reading Materials Checklist. RESULTS: The FOG, Fry, and SMOG formulas were used to calculate reading levels by two raters who independently applied the formulas to the same word passages chosen from the beginning, middle, and end of the pamphlets. The mean reading grade levels were 14.4, 15.8, 14, and 14.4, demonstrating that all four pamphlets were written for people with college level reading skills. The limitations of readability formulas such as variations in reading estimates were demonstrated. When expert judgement was applied with the Reading Materials Checklist, all pamphlets were found lacking in the areas of legibility, usability, and motivational appeal. CONCLUSIONS: The results indicate that the pamphlets may not be appropriate for use with most of the adults in the United States who may be candidates for hypercholesterolemia patient education. Because reading formulas are limited in the information they provide, expert judgement regarding readability of print materials should also be applied. Additionally, indirect and direct techniques need to be used to assess the literacy level of the patient population who will be using the printed materials.

American Heart Association↗