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AIDS prevention in primary care clinics: testing the market.

To assess attitudes toward educational programs about AIDS, 540 patients and 36 of their medical providers in primary care clinics were systematically sampled to ascertain what age groups should be exposed to a pamphlet entitled "Am I at Risk for AIDS?", as well as what was acceptable content for posters and pamphlets placed in clinic waiting rooms. Although fewer than 10% of patients and providers opposed asking both teenagers and adults to read a pamphlet listing risk groups and practices, 24% of patients and 51% of providers opposed exposing children to the pamphlets. Only 6% of patients and none of the providers opposed all posters about AIDS, but 30% of patients and 44% of providers opposed posters listing risk groups, and opposition was even greater to posters describing "safe sex." Regarding pamphlets acceptable for clinic waiting rooms, resistance among patients and providers was common (greater than 25%) only when sexual practices were specifically mentioned. Although 89% of patients stated they had never been asked about their sexual orientations by a doctor or nurse, 34% of providers stated that they "always" or "often" so inquire. In the primary care clinics surveyed, a wide variety of educational interventions about AIDS could be implemented with little opposition.

Acquired Immunodeficiency Syndrome↗

Using radon risk to motivate smoking reduction: evaluation of written materials and brief telephone counselling.

OBJECTIVE: Radon and cigarette smoking have synergistic effects on lung cancer, even when radon concentrations are relatively low. Working through an electric utility company, we sought to reach smoking households with low radon concentrations and motivate smoking cessation or prohibiting smoking in the home. DESIGN: Eligible homes (n = 714) were randomised to receive: (1) the Environmental Protection Agency's (EPA's) "A citizen's guide to radon"; (2) a specially developed pamphlet; or (3) that pamphlet plus brief telephone counselling. PROCEDURE: Utility company "bill stuffers" offered free radon test kits to smoking households. All households received radon test results with an explanatory cover letter. Both the specially developed pamphlet and the telephone counselling emphasised that smoking cessation or prohibiting smoking in the home were the optimal risk reduction strategies. Households were followed up at 3 and 12 months after receiving materials. RESULTS: The specially developed pamphlet and the EPA guide yielded similar outcomes. There was a non-significant trend for telephone counselling to produce greater sustained quitting than the specially developed pamphlet, and phone counselling led to significantly more new household smoking bans. CONCLUSIONS: Working through a public utility company is an efficient way to reach smoking households, and brief telephone counselling is a promising method for promoting household smoking bans and cessation in homes alerted to the risk posed by the combination of radon and smoking.

Counseling↗

[Nutritional assessment of recipes distributed to households].

This study examines the nutritional standards of recipes in six pamphlets distributed to all households in Denmark. The publications all purport to contain recipes for a healthy diet. The nutritional values given in the publications are compared to calculated values and found to be almost identical. The fat content of most of the recipes is too high: recipes in the first three pamphlets had a median fat energy content of 50%. The later publications are better: 40% in two pamphlet and 33% in the last pamphlet. It is likely that the high fat content of the household distributed pamphlets contributes to the continued high fat content in the Danish diet. We suggest that the fat energy percent should be less than 30 in half the recipes and be only 30-35 on average. The energy content should not be greater than 2.5-3.5 MJ per portion. Nutritional value estimates and the nutrition information should be standardized so as to make them more accessible for the consumer who wishes to make healthy diet choices, and more instructive generally concerning general principles of an appetizing and healthy diet.

Cooking↗

The role of relevancy in normative feedback for university students' drinking patterns.

OBJECTIVE: Intervention studies using normative feedback have reported changes in motivation for changes in alcohol use. The relevancy of the social comparison group of the feedback has not yet been examined. The purpose of this study was to examine whether varying the relevancy of the comparison group would result in greater motivation for changes in alcohol use. METHOD: Participants completed the AUDIT and then read one of three intervention pamphlets: (i) Canadian population drinking patterns; (ii) Canadian university students' drinking patterns; or (iii) American university students' drinking patterns. Afterwards, participants completed the recognition and ambivalence subscales of SOCRATES and rated their overall impressions of the pamphlet. RESULTS: Participants identified as problem drinkers who read the American university students pamphlet reported significantly higher recognition ratings, compared to problem drinkers who read one of the other two pamphlets. CONCLUSIONS: Explanations for the unanticipated findings are discussed. The authors speculate that participants may have relied on their knowledge of perceived drinking patterns as opposed to relevancy of the feedback in making their social comparison.

Adult↗

The effect of decision aids on the agreement between women's and physicians' decisional conflict about hormone replacement therapy.

The aim of this secondary analysis was to compare the effects of a tailored decision aid (DA) with those of a pamphlet on the agreement between women's and physicians' decisional conflict about hormone replacement therapy (HRT). A total of 40 physicians and 184 women provided data. The agreement between women's and physicians' decisional conflict scores was measured using the intraclass correlation coefficient (ICC). The ICC was higher for dyads in the DA group (ICC=0.44; 95% confidence interval (CI)=0.25-0.59) compared to the pamphlet group (ICC=0.28; 95% CI=0.06-0.47). When the average score of decisional conflict of women nested within a physician and of each physician were used, the ICC for the DA group and the pamphlet group was 0.41 (95% CI=-0.04 to 0.72) and 0.06 (95% CI=-0.41 to 0.49), respectively. Compared to pamphlets, DAs appear to improve the agreement between women's and physicians' decisional conflict about HRT.

Adult↗

Print material content and design: is it relevant to effectiveness?

Printed materials are widely used in cancer education. There are a considerable number of guidelines in the literature on the content and design characteristics of print materials. However, there is little outcome-based evidence about whether materials containing these characteristics are more effective under real-world conditions. Six pamphlets were designed such that two had most of these characteristics, one had content characteristics only, one had design characteristics only and two had few of the characteristics. The pamphlets encouraged women aged 50-69 years to join a Pap Test Reminder Service (PTRS). The pamphlets were mailed to a randomly selected sample of 7668 women. Registrations with the PTRS were monitored. Receipt, readership, acceptability, knowledge and attitudes were assessed by telephone interview. There were no significant differences between the pamphlet groups in registrations with the PTRS, receipt, readership, acceptability, knowledge or attitudes. It was concluded that the inclusion of content and design characteristics does not result in more effective print materials.

Aged↗

Teaching mothers about childhood immunizations.

This article describes an educational intervention designed to increase maternal knowledge and understanding of the need for, and timing of, childhood immunizations and to clarify misconceptions about vaccine efficacy and safety. A pamphlet was used as a method of imparting pertinent information about childhood immunization to mothers in the early postpartum period. Strategies known to be effective for women with low literacy levels were used in the pamphlet's design. It was piloted as an adjunct discharge teaching tool with 10 mothers in a large Southern teaching hospital in the United States. The pamphlet's use was openly received, considered effective, and endorsed by the mothers and nursing staff. The pamphlet is easy to use and duplicate, and can serve as a future resource to mothers after discharge. Because the problem of childhood underimmunization continues to be a serious concern for specific populations, it is essential that mothers have access to information that is concise, user friendly, and written at their level of understanding.

Adolescent↗

Effect of two educational interventions on knowledge and attitudes towards electroconvulsive therapy.

The aims of this study were to assess students' knowledge and attitudes toward ECT and to assess the effect of an educational video and pamphlet on knowledge and attitudes toward ECT. Additionally, this study aimed to assess which form of information delivery was most efficacious in improving knowledge and changing attitudes toward ECT. Seventy-seven students were allocated to an educational video, pamphlet, or control group. Participants completed questionnaires assessing knowledge and attitudes pre and post the aforementioned educational interventions, to assess the relative efficacy of both forms of information delivery. The majority of participants had reasonable knowledge of ECT indications, effects and side effects. However, participants still maintained a number of common misconceptions and possessed an overall neutral to negative attitude toward ECT. After education (video or pamphlet), participants' overall knowledge significantly increased and attitudes became significantly more favorable, relative to the control group. However, neither form of education was superior. Providing education about ECT, whether in the form of a video or information pamphlet, has the ability to increase knowledge and improve attitudes toward this treatment. The above results may have particular applicability when designing and tailoring educational efforts to the needs of an individual who may be considering ECT as a treatment option.

Adult↗

Preparation for caesarean childbirth: derivation of a nursing intervention from the Roy Adaptation Model.

The paper describes a programme of research directed toward developing and testing a nursing intervention derived from the Roy Adaptation Model of Nursing and designed to prepare expectant parents for unplanned Caesarean birth. The first study was a retrospective survey of Caesarean-birth parents that revealed the need for detailed information about the events surrounding Caesarean birth. The second study was a clinical field test of the nursing intervention, which consisted of a pamphlet containing information about all aspects of Caesarean birth with follow-up discussion of pamphlet content. Data analysis indicated that Caesarean-birth parents found the pamphlet content informative and reassuring and found the follow-up beneficial. The third study was a clinical field test of a modified version of the intervention consisting of the pamphlet and focused discussion about Caesarean birth. Data analysis revealed that the nursing intervention provided the information expectant parents needed to prepare for the possibility of Caesarean childbirth. The fourth study is an ongoing experiment designed to test the effects of the nursing intervention on responses to unplanned Caesarean birth. Emphasis throughout the paper is placed on the links between the Roy Adaptation Model and the methodology and findings of each study.

Adaptation, Psychological↗

Readability of health care literature.

A sample of health care literature produced for parents was analysed, using the Flesch method, for readability and human interest. As a comparison, the readability and human interest scores were also calculated for Sydney daily newspapers. It was found that the pamphlets produced by government agencies were more readable than those produced by non-government agencies. Those pamphlets written with input from parents were the most readable of all. Similar results were found for the human interest level of the pamphlets. The readability and the human interest scores of the government-produced pamphlets were similar to those of the larger circulation daily newspapers. Health care literature for parents needs to be good quality and easily understood. The involvement of parents in their production may improve the effectiveness of these leaflets.

Persons with Disabilities↗

Listeria awareness among new mothers in Western Australia.

OBJECTIVE: To assess awareness, knowledge and behaviour relating to Listeria among recent mothers (12 weeks post-partum) in Western Australia and determine the usefulness of a Listeria information pamphlet. METHOD: A postal survey of a random 10% sample of Western Australian mothers whose babies were born between 1 January and 13 April 1997. RESULTS: Of the 680 women surveyed, 509 (75%) responded and 451 (89%) respondents had heard of Listeria. The 11% who had not heard of Listeria had higher odds of living in a rural area, speaking a foreign language at home, having less formal education, being younger, having had an unplanned pregnancy, and having not taken folic acid supplements. Respondents who had seen the Listeria pamphlet had greater odds of correctly identifying foods at risk of Listeria. Of the women who had heard of Listeria, 90% had avoided certain foods during their pregnancy. Risk factors for not changing eating behaviour were similar to those for not having heard of Listeria. CONCLUSIONS: Factors associated with not having heard of Listeria, not having seen the pamphlet and not having changed behaviour were similar, suggesting that there may be a group of women who are less likely to be aware of Listeria or other health issues and/or may be resistant to health-related behaviour changes. IMPLICATIONS: The Listeria pamphlet is an effective medium for educating pregnant women about Listeria. Rural, young, single and non-English speaking background women may require a different or supplementary approach.

Adult↗

The readability of health-care literature.

The readability of health-related pamphlets intended for the British public was compared with that of English national newspapers. Many of the pamphlets were found to be less readable than desirable. Pamphlets issued by government departments (principally the Department of Health and Social Security) were assessed as particularly difficult to read, but some specialist and commercially produced pamphlets also gave cause for concern. A small number of specially produced 'baby books' were found to have more suitable levels of prose difficulty. It is suggested that readability formulae can be a useful tool in the initial assessment of health education literature.

Child↗

Randomized trial of a portable, self-administered decision aid for postmenopausal women considering long-term preventive hormone therapy.

Although practice guidelines suggest that postmenopausal women learn about the benefits and risks and consider their values when deciding about hormone therapy, the optimal decision-support method has not been established. In a randomized controlled trial, the authors compared the efficacy of a general educational pamphlet with that of a tailored decision aid. The pamphlet briefly summarized benefits, risks, and likely beneficiaries in general terms. The decision aid, delivered via booklet and audiotape, provided: detailed benefits and risks using functional terms and probabilities tailored to clinical risk; and steps for considering the issue in a woman's own situation, including a value-clarification exercise. Compared with the pamphlet group, the decision-aid group had statistically significant (p < 0.05) improvements in terms of realistic personal expectations of the benefits and risks, decisional conflict, and perceived acceptability of the intervention. Levels of general knowledge about the main benefits and risks were comparable for the two interventions. It is concluded that tailored decision aids prepare women for decision making better than do general pamphlets.

Aged↗

Positron emission tomography: a study of PET test-related anxiety.

The objective of this study was to determine whether sending an information pamphlet to patients scheduled for a PET test two weeks prior to the appointment date significantly reduced patient anxiety and increased patient knowledge about the test. This study was conducted as a randomized controlled trial in which patients were randomly allocated to receive a mailed information pamphlet (intervention) or no mailed pamphlet two weeks prior to the appointment (usual care). The results of this study suggested that sending information pamphlets to patients scheduled for PET scans did not decrease pre-test levels of patient anxiety or result in increased patient knowledge about test preparation and procedures.

Aged↗

Liquid-crystal thermometer use in pediatric office counseling about tap water burn prevention.

Tap water scald burns are an important topic of injury prevention in pediatricians' offices. Consecutive pediatric clinic clients, randomized to two groups, received an informational pamphlet, a one-minute discussion about tap water safety, and a baseline questionnaire. The first group also received a liquid-crystal thermometer for testing maximum hot tap water temperature. One month later in a follow-up telephone interview (n = 503), the impact of the added thermometer on knowledge regarding scalding, temperature testing, and thermostat lowering was assessed. Approximately 80% of each group read the pamphlet. Reading the pamphlet was associated with greater temperature testing in the thermometer (T) group but not in the pamphlet only (P) group. Temperatures were checked by 46.4% of the T group but by only 23.0% of the P group (P less than .001). In the households in which the reported water temperature exceeded 54.4 degrees C (130 degrees F) and the water heater was accessible, 77.3% reported lowering the setting, independent of receiving the thermometer. The reliability of self-reported water temperature was assessed after 1 year by home visits. The use of relevant facilitating devices, such as a liquid-crystal thermometer, in-office anticipatory guidance efforts may increase behavioral compliance.

Accidents, Home↗

Cardiovascular risk reduction: a randomized trial of two health promotion strategies for lowering risk in a community with low socioeconomic status.

AIM: To compare the effects of information pamphlets with those of group counselling on cardiovascular risk among individuals from a community with low socioeconomic status. METHODS: Risk factors for coronary heart disease were assessed in 1131 men and women from a community with low socioeconomic status in suburban Melbourne. Individuals deemed to be at moderate risk, on the basis of an integrated risk score greater than 65, were asked to participate in a randomized trial comparing two simple interventions designed to reduce cardiovascular risk. One hundred and sixty-four individuals were randomly assigned to group A (n = 85) and participated in a single group counselling session lasting between 1.5 and 2.0 h. Group B (n = 79) received a specially prepared pamphlet that provided brief written information concerning risk-factor modification. Both groups were asked to attend a follow-up assessment of risk factors 3 and 6 months after entry. RESULTS: There were no significant difference in the change in risk-factor levels between those receiving information pamphlets and those attending the group counselling session after 3 or 6 months of follow-up. Small but significant decreases (P<0.05) were seen in systolic and diastolic blood pressures (-5/4 mmHg for group A, -5/3 mmHg for group B), total plasma cholesterol level (-0.30 mmol/l for groups A and B) and overall coronary risk score (-14.4 and -13.9 for groups A and B, respectively). Body weight remained unchanged during the study period in both groups. CONCLUSION: Screening together with 1.5-2h group counselling had no more influence on cardiovascular risk factors than screening together with provision of information pamphlets in a population with low socioeconomic status.

Adolescent↗

[Can physicians efficaciously promote the purchase of bicycle helmets?].

OBJECTIVE: To evaluate the effectiveness of physician intervention in the purchase of bicycle helmets. DESIGN: Randomized single-blind controlled trial; randomization by clusters. SETTING: July 11, 1992, cycling path in Beauport, Quebec. PARTICIPANTS: Non-helmeted cyclists riding alone and groups of two to six cyclists in which at least one member was not wearing a helmet were invited to participate in the study; 274 individuals or groups of cyclists (total n = 485 cyclists) were randomized for the study. INTERVENTION: For the study group a physician handed out and explained the Canadian Medical Association's (CMA) pamphlet on bicycle helmets. This pamphlet includes a discount coupon for the purchase of a helmet. All of the participants in both the study group and the control group completed a questionnaire, including queries about sociodemographic characteristics, name, and telephone number. MAIN OUTCOME MEASURE: Proportion of previously non-helmeted cyclists purchasing a helmet within 2 to 3 weeks of the intervention. RESULTS: Telephone contact was made with 340 of the 416 non-helmeted cyclists (from 224 groups of cyclists). Of the 174 cyclists who had received a CMA pamphlet, 13.8% (n = 24) had purchased a helmet, compared to 3.0% (n = 5) of the 166 control group cyclists (RR = 4.6, 95% CL = 1.8-11.7). Similar results were achieved by cluster analysis of cyclists. CONCLUSION: Physician intervention using the CMA pamphlet could be effective in promoting the purchase of bicycle helmets.

Adolescent↗

Evaluation of HIV/AIDS education initiatives among women in northeastern Thai villages.

A longitudinal, naturalistic experimental design was used in an evaluation of the effects of an HIV/AIDS educational pamphlet controlling for secular trends (most specifically media coverage of HIV/AIDS) in Northeastern Thailand. Nine hundred and fifty-four women from 18 villages completed KAP interviews either in the autumn of 1991 or 1992 with HIV/AIDS education pamphlets distributed to every household in 12 of these villages in the spring of 1992. Pamphlets influenced women's perceptions of personal risk from casual sources and the degree to which they volunteered that condoms were a means of prevention of HIV transmission. Both results were related to the content and style of presentation of information about sources of risk and about condoms in the pamphlets. Secular trends and an increase in communication between villagers had a significant influence on knowledge, perceived efficacy of self protection, readiness to use condoms, and perception of levels and sources of personal risk.

Adolescent↗