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PubMed2000

Pretest assessment as a component of safer sex intervention: a pilot study of brief one-session interventions for women partners of male injection drug users in New York City.

This pilot study evaluated whether brief safer sex interventions for women partners of male injection drug users significantly influenced perceptions of partner risk, human immunodeficiency virus (HIV) knowledge, correct condom usage, and self-reported consistent safer sex (abstinence or 100% of vaginal-penile intercourse acts protected by male or female condoms). The study also examined the impact of pretest assessment on those variables since pretest assessment may challenge participants' current knowledge, safer sex practices, and partner communication techniques. The study randomly assigned participants to pretest or no pretest assessment. Each group was also assigned randomly to a presentation modality: (1) safer sex pamphlet review only, (2) pamphlet review with demonstration of several safer sex alternatives, or (3) pamphlet review with skills practice to mastery with one safer sex alternative of the woman's choice. For the last two conditions, a 35-minute interactive session covered prevention efficacy of safer sex methods for HIV, sexually transmitted infections, pregnancy, correct use, eroticization, local cost and availability, and partner objections. At 7 weeks postintervention, a higher proportion of women who took pretest assessment reported consistent safer sex (66.7%) compared to those without pretests (55.6%). Assignment to the interactive interventions (skills or demonstration) had little additional impact over pretest assessment for these women. Among women who did not take pretests, the interactive interventions had strong effects; 76.9% reported consistent safer sex versus 33.3% in the pamphlet review group. There were additional specific effects for pretest assessment on HIV knowledge and partner risk perception and for interactive intervention on correct condom usage. Brief interventions appear to have some positive short-term effects. Pretest assessment may be an important component of brief interventions.

Adult↗
PubMed1988

Increased readability improves the comprehension of written information for patients with skin disease.

Many standardized methods are available with which to evaluate the reading ease and comprehensibility of written material. Techniques depend on mechanical analysis of sentence length, multiple prepositional phrases, direct phraseology, and arrangement of printed materials on the page. Those techniques were used to analyze a pamphlet designed for patient education by the American Academy of Dermatology. The pamphlet scored a reading ease grade of 45, corresponding to what is considered difficult reading and at a level commonly found in academic journals. We rewrote the pamphlet and increased its reading ease score to 62.4, corresponding to material that appears in standard digest-type magazines. We gave both versions of the pamphlet to a group of first-year medical students and to a group of middle-class patients from a dermatology practice. In both groups the modified version led to greater understanding of the written material. We conclude that the usefulness of patient education materials now being distributed by dermatologists could be significantly improved by being rewritten according to well-recognized formulas.

Adult↗
PubMed1999

Twelve-step and mutual-help programs for addictive disorders.

Psychiatrists may wonder why both addiction treatment and the 12-step programs recommend abstinence. In his 50-year follow-up of two groups of alcoholics, Vaillant compared those who established secure abstinence with those who continued to drink. Secure abstinence was associated with: Living longer Better mental health Better marriages Being more responsible parents Being successful employees In considering the various routes to secure recovery, Vaillant recommended that clinicians: Offer the patient a nonchemical substitute for alcohol Remind the patient ritually that even one drink can lead to pain and relapse Repair the social and medical damage that the patient has experienced Restore the patient's self-esteem The preponderance of the research data now available indicates that the 12-step programs of AA, NA, Cocaine Anonymous, and Al-Anon are most helpful for alcohol-dependent and other drug-addicted patients as they seek to achieve secure, long-term abstinence. A growing number of clinicians is recommending that physicians become more knowledgeable and skilled in referring and supporting patients in working 12-step programs of recovery. Specific recommendations include: 1. Be familiar with 12-step activities and tools. These include meetings, home groups, sponsors, the Twelve Steps and Twelve Traditions, books, pamphlets, and slogans. To be able to discuss the meanings and applications of these tools for recovery is useful. Physicians can select those that are most suitable for the individual, recognizing that meeting attendance might not be the most important activity. 2. Support referral by facilitating a meeting between the patient and a temporary contact from the 12-step program. This means becoming familiar with local 12-step programs. Phoning the local AA or NA central office or hot line makes connecting patients to someone who will take them to a meeting that same day possible. AA and NA have committees whose members are interested in working with physicians to help get patients to meetings and to get information to physicians. These are the Cooperation with the Professional Community, Treatment Facilities, and Hospitals and Institutions committees. 3. Work with the resistance of patients. Many addicted patients are resistant to the idea of attending 12-step or mutual-help programs. Reminders of their painful personal database associated with the use of alcohol or other drugs can help break through denial. Involvement of family members and friends in the network therapy developed by Galanter can be effective in reducing resistance. Being patient and persistent in developing the therapeutic alliance helps to maintain contact during the first difficult year of recovery. Physicians should be prepared to work with patients as long as necessary to stabilize their sobriety. Zweben has suggested ways psychotherapy can help deepen work with the steps. 4. Help dual diagnosis patients understand AA's and NA's singleness of purpose. These programs work only with addiction; they do not try in any way to deal with other mental disorders. All patients have to say is, "I want to stop drinking or using drugs," and they will be welcomed and accepted at meetings (see Tradition 3). If they talk only about their psychiatric symptoms or medications, someone may suggest that they go elsewhere for help. Occasionally, well-intentioned AA or NA members tell patients to stop taking their medications. The authors always direct patients to the pamphlet The AA Member: Medications and Other Drugs. This pamphlet tells AA members not to play doctor and to take the medications their doctors prescribe. Copies of the pamphlet are widely available at many AA meetings, or they can be ordered by physicians from Alcoholics Anonymous World Services, General Service Office, Box 459, Grand Central Station, New York, NY 10163 (212-870-3400). 5. Get comfortable with the spiritual dimensions of healing. Zweber and Brown offer good suggestions for getting com

Alcohol-Related Disorders↗
PubMed2001

Parental concerns for the child with febrile convulsion: long-term effects of educational interventions.

OBJECTIVE: To evaluate long-term effects of educational interventions on parental concerns for children with febrile convulsions (FC). SUBJECTS AND METHODS: 209 FC parents were recruited from southern Taiwan, and assigned into program or pamphlet groups by their choices. A questionnaire was used to examine the parental concerns at 4 time points: prior to the interventions, 3 months, 1 year, and 2 years after the interventions. RESULTS: The concern scores were high before the interventions. Parents concerned that their child is apt to get a fever, has further seizures in the night, that FC results in potential brain damage and is life threatening. After interventions the concern scores were significantly lower for the program group than for the pamphlet group. The educational program was the most significant factor that influenced the change in parental concerns. The recurrence of FC did not significantly influence the change in the concern trajectory in the program group but showed a significant difference in the pamphlet group. CONCLUSION: FC parental concerns decreased as time passed particularly in the program group. The educational program was the significant factor that influenced the change of concern trajectories, and the recurrent/non-recurrent factor influenced the change of concern only in pamphlet group. FC parental concerns should be assessed, and information given combined with emotional support.

Adult↗
PubMed2000

All here are agog with the chloroform.

Two letters written by James Y. Simpson are included among a bound collection of 25 of his pamphlets held in the Gordon Craig Collection of the Library of the Royal Australasian College of Surgeons. Both letters are written in pamphlets relating to Simpson's championing of chloroform. The first letter is written in a proof copy of a pamphlet titled Notice of a new anaesthetic agent as a substitute for Sulphuric ether in Surgery and Midwifery. This very rare pamphlet was posted to Dr Fleetwood Churchill, a Dublin obstetrician, on 13 November 1847, 9 days after the 'dining room experiment' in Simpson' s home, when the anaesthetic properties of chloroform were dramatically demonstrated. The second letter is written 10 months later and is also addressed to Dr Fleetwood Churchill. The content of both letters is discussed, as is also the rarity of the proof copies of the first printed document describing the use of chloroform.

Anesthesia, Inhalation↗
PubMedDate not supplied

Literacy in primary care populations: is it a problem?

BACKGROUND: Almost half of Canadians experience difficulty using print media, according to the 1994 International Adult Literacy Survey. Our objectives were to estimate the prevalence of low-literacy patients in our practice, to determine whether reading grade level is associated with self-perceived health status in primary care, and to evaluate the reading difficulty of commonly used patient education pamphlets. METHODS: We surveyed a random sample of 229 patients aged 18 to 85 years presenting for scheduled and walk-in care. Main outcome measures were reading ability as estimated by word decoding skill with the validated Rapid Estimate of Adult Literacy in Medicine (REALM) and self-perceived health status using COOP/WONCA functional health measures. We assessed the reading difficulty of 120 commonly used patient education pamphlets using the Simple Measure of Gobbledygook (SMOG) formula. RESULTS: The prevalence of low-literate patients was 9%. Poor reading ability in English was most likely among patients under 45 years of age not having completed high school, and among those whose maternal language was neither English nor French (immigrants). REALM scores and self-perceived health were weakly correlated but not significant statistically. The mean reading grade level of pamphlets was grade 11.5 (SD: 1.5). Seventy-eight percent of pamphlets required at least a high school reading level. CONCLUSION: Literacy levels were higher than expected in our patient population; this finding may be due to the rapid assessment tool used, which may have underestimated the difficulty of using print media. Clearly, the vast majority of commonly used patient education materials would not meet the needs of low-literate patients, who may be more likely to experience poorer health. Providers need to be sensitive to the reading limitations of patients and patient education materials should be written at a lower reading level.

Adult↗
PubMed1992

Prenatal literature testing: a pilot project.

A pilot study was conducted in 1987-1988 to evaluate current health literature utilized for prenatal health education of the high risk population in County Health Departments in Arizona. Towards that end, sixty-five distinct pamphlets were obtained from Arizona's County Health Departments and assessed for reading level using the SMOG Readability Formula. The majority of the prenatal literature were found to be 10th to 12th grade reading level, higher than the typical reading level of the high risk prenatal population. A modified literature testing instrument was further utilized to test eight general prenatal pamphlets to assess the printed literature for accuracy, usability, believability, appeal, and cultural relevance. Four pamphlets of those tested, two English and two Spanish, were identified as being the most appropriate for the high risk prenatal population.

Arizona↗
PubMedDate not supplied

The effect of a self-care minimal intervention for colds and flu on the use of medical services.

OBJECTIVE: To determine the impact of mailed distribution of a brief self-care pamphlet on upper respiratory infection (URI)-related-medical care utilization. DESIGN: Randomized controlled clinical trial with randomization by physician panel. SETTING: Health maintenance organization. PATIENTS: 20,127 patients assigned to the panels of 22 primary care physicians randomly divided into an experimental group (n = 12,353) and a control group (n = 7,774), each consisting of 11 physician panels. INTERVENTION: A mailed four-page self-care pamphlet for URI care. MEASUREMENTS AND MAIN RESULTS: The medical records and survey data of a random sample of 790 persons were studied during a baseline period and an intervention period. URI visit rates decreased 14% more in the experimental group versus the control group (p = 0.878). Appropriateness of URI visits during the intervention period in the experimental group (80%) was comparable to that in the control group (76%). URI drug prescriptions during the intervention period for all 20,127 patients showed no significant difference. CONCLUSIONS: A simple mailed self-care pamphlet has little effect on medical care utilization for URI care.

Adult↗
PubMed1990

Improving follow-up after an abnormal Pap smear: a randomized controlled trial.

Less than 60% of women diagnosed with cervical abnormalities on Pap smears return for proper surveillance and timely treatment. Previous tactics used to motivate these women to return have mainly relied on costly intensive recall efforts. Using a framework based on psychological value expectancy theory, a pamphlet was designed to motivate women with abnormal Pap smears to return for a repeat Pap smear. The effect of this pamphlet was tested in a randomized controlled trial. A total of 161 women with abnormal Pap smears were randomized and received either the pamphlet plus a notification letter or the letter only. The compliance rate was 64.2% in the intervention group and 51.3% in the comparison group (P = 0.10; two-tailed). In addition, subgroups of women who do not practice health-related behaviors were identified as groups where more intensive interventions may be needed. These results have implications for future strategies used to recall women with abnormal Pap smears.

Adult↗
PubMed2006

Dietary supplement information and intention to continue and recommend supplements.

This posttest only two-group design study with 113 adults tested how reading a pamphlet based on the United States' Federal Drug Administration (FDA) Tips for the Savvy Supplement User affects intention to use and recommend supplements. A total of 23.7% fewer people with health problems who prior to reading the pamphlet believed that supplements were safer than medications planned to recommend their dietary supplement to family and friends after reading the pamphlet than in the comparison group. A lower probability of recommending dietary supplements is a helpful starting point for safer dietary supplement use by consumers.

Adult↗
PubMedDate not supplied

A comparison of two methods of delivering presurgical instructions.

A 2 x 2 factorial design was employed to test the effects on various indicators of postoperative recovery of surgical patients who had received preoperative instructions. A pamphlet and/or a nurse visit were used as delivery methods. The study population consisted of 50 patients who were scheduled for cholecystectomies. Patients were given information on the expected sequence of events on the day of surgery and instructions in postoperative self-care activities. Findings indicate that a differential effect of providing information was dependent on the patient's level of preoperative fear, with high-fear patients benefiting most from information. Patients in the high preoperative-fear group who received either the pamphlet or the pamphlet and a nurse visit had shorter postoperative hospitalizations, switched from injected to oral medication sooner, scored higher on an index of energy and movement, and rated their appetites as better when compared with patients in either the nurse-visit or control groups. However, among those who scored low in preoperative fear, patients in the control group had better recoveries from surgery than patients who received preoperative information. The study points out the need to perform an educational assessment of patients before information is provided.

Adult↗
PubMed1997

Evaluation and impact of promotion of a cancer helpline to cancer patients through their specialists.

Four hundred and sixty four cancer patients attending their first outpatient consultation (96% of those eligible) were given a pamphlet promoting a cancer helpline by their participating specialist. Calls to the helpline during and six weeks following the study period were made relating to 4% (95% CI: 2.1%-5.6%) of patients or family members receiving the pamphlet. Whilst this response is small, the willingness of cancer specialists to distribute the pamphlet identifies them as a valuable channel for linking patients with complementary services.

Advertising↗
PubMed2001

Evaluation of the quality of patient information to support informed shared decision-making.

OBJECTIVES: (a) To find out how much patient information material on display in family physicians' offices refers to management choices, and hence may be useful to support informed and shared decision-making (ISDM) by patients and (b) to evaluate the quality of print information materials exchanged during the consultation, i.e. brought in by patients or given out by family physicians. DESIGN: All print information available for patients and exchanged between physicians and patients was collected in a single complete day of the office practices of 21 family physicians. A published and validated instrument (DISCERN) was used to assess quality. SETTING AND PARTICIPANTS: Community office practices in the greater Vancouver area, British Columbia, Canada. The physicians were purposefully recruited by their association with the medical school Department of Family Practice, their interest in providing patients with print information and their representation of a range of practice types and location. MAIN VARIABLES STUDIED: The source of the pamphlets and these categories: available in the physicians' offices; exchanged between physician and patient; and produced with the explicit or apparent intent to support evidence-based patient choice. MAIN OUTCOME MEASURES: The quality of the print information to support ISDM, as measured by DISCERN and the ease of use and reliability of the DISCERN tool. RESULTS AND CONCLUSIONS: Fewer than 50% of pamphlets available in these offices fulfilled our minimum criteria for ISDM (mentioned more than one management option). Offices varied widely in the proportion of pamphlets on display that supported ISDM and how particular the physician was in selecting materials. The DISCERN tool is quick, valid and reliable for the evaluation of patient information. The quality of patient information materials used in the consultation and available in these offices was below midpoint on the DISCERN score. Major deficiencies were with respect to the mention of choices, risks, effect of no treatment or uncertainty and reliability (source, evidence-base). Good quality information can be produced; some is available locally.

British Columbia↗
PubMed2002

Effects of educational intervention on changing parental practices for recurrent febrile convulsions in Taiwan.

PURPOSE: To evaluate the effects of educational interventions on parental practices for recurrent febrile convulsions (FC). METHODS: A 2-year follow-up, nonequivalent comparison group design was used to evaluate the intervention effects. Two educational interventions were provided for FC parents in southern Taiwan. The 326 parents voluntarily chose either to receive a mailed pamphlet (n=196) or to attend a 2-h educational program (n=130). Five telephone interviews focused on investigating FC episodes and parental practices for seizures were conducted at months 3, 6, 12, 18, and 24 after the interventions. RESULTS: Of the 326 FC children, 78 (23.9%) had recurrent FCs within the 2-year follow-up. Parents who only received pamphlets did not show significant improvements. Parents who attended the educational program demonstrated significant improvements in the recommended practices, particularly in protecting the convulsing child (8.3 vs. 36.1%; p=0.02 by McNemar) and placing the child on his or her side (19.4 vs. 47.2%; p=0.01). Nonrecommended practices including rushing the convulsing child to the hospital (88.9 vs. 30.6%; p < 0.01) and putting protective devices in the child's mouth (38.9 vs. 8.3%; p < 0.01) significantly decreased. By generalized estimating equation analyses, the types of interventions are the single significant factor influencing parental practice changes from initial to recurrent FCs. CONCLUSIONS: Most parents used inappropriate practices for their child's initial FC. Compared with the mailed pamphlet, the educational program had significant improvements in recommended and nonrecommended practices from initial to recurrent FCs.

Adult↗
PubMedDate not supplied

Effects of 2 educational methods on the knowledge, attitude, and practice of women high school teachers in prevention of cervical cancer.

Because of the increased emphasis on prevention and early detection of cervical cancer, we studied the effects of 2 educational methods on the knowledge, attitude, and practice, as regards prevention of cervical cancer, of women high school teachers in Tabriz. This study was a semiexperimental research. Samples were 129 female teachers divided in 3 groups: experimental 1 (educated by pamphlets), experimental 2 (educated by a lecture and flash cards), and control group (not manipulated). After doing pretest in the 3 groups, investigators used 2 educational methods for experimental groups. Data regarding the knowledge and attitude of 3 groups were gathered after 14 days and data regarding practice were gathered after 2 months. Chi-square and 1-way ANOVA were used for data analysis. Before education, knowledge, attitude, and practice of the 3 groups were the same, but after education there were significant differences in mean scores of knowledge and attitude of 2 experimental groups as compared with the control group and also between the 2 experimental groups (P < .001). Education by lecture and flash cards was more effective than by pamphlets. In regard to Pap smear practice, there was a significant difference between the 2 experimental groups as compared with the control group (P = .001), but there was no significant difference between the 2 experimental groups. Therefore, educational methods were effective on knowledge, attitude, and practice of teachers regarding prevention of cervical cancer and education by lecture and flash cards was more effective than by pamphlets in increasing knowledge and inducing a positive attitude but the 2 educational methods had the same effect on practice of teachers.

Adult↗
PubMedDate not supplied

Readability: an important issue impacting healthcare for women with postpartum depression.

PURPOSE: To evaluate the reading level of depression-screening instruments commonly used in postpartum depression (PPD) and evaluate the reading level of prevalent consumer pamphlets and books on PPD. DESIGN AND METHODS: Descriptive study evaluating the reading level of four PPD instruments (the Edinburgh Postnatal Depression Scale, The Center for Epidemiologic Symptoms of Depression, the Postpartum Depression Screening Scale, and the Beck Depression Inventory-II), five pamphlets from grassroots organizations, and seven consumer books using the Fry Readability Graph. RESULTS: The readability of the postpartum screening instruments varied, but all were at or below the recommended 6th grade reading level. CES-D had the lowest reading level (grade 2). The readability of the consumer publications also varied, but all had a higher reading level than the recommended 6th grade level, some at the college reading level. CLINICAL IMPLICATIONS: Readability is an important consideration in the choice of depression-screening instruments and written materials for consumers. Nurses using any of the four postpartum screening instruments studied can feel confident that women who can read will be able to read them. The readability of a book, pamphlet, or instrument should be of concern to nurses who work with women during the postpartum period.

Attitude to Health↗
PubMed1996

Mothers' knowledge of the risk factors and anxiety about SIDS.

OBJECTIVE: To assess the impact on mothers' knowledge and anxiety of the 1991-92 health promotion campaign on Sudden Infant Death Syndrome (SIDS) risk factors. METHODOLOGY: A telephone survey of a population based sample of 339 mothers in Victoria, Australia, conducted 1992-94. RESULTS: Recall by mothers of the risk factors for SIDS was as follows: not breast-feeding, 15%; smoking, 46%; overheating, 48%; and prone sleeping, 84%. Recall rate increased as the campaign progressed. Receiving the campaign pamphlet was associated with an increased recall of all risk factors. Discussion of the pamphlet with a health professional was rare (9%). One-third of all mothers reported being very worried about cot death when caring for their babies. Self-reported worry was significantly more common among mothers whose babies were born at the time of the campaign introduction. CONCLUSIONS: The campaign pamphlets were effective in increasing knowledge of the risk factors. The limited discussion with health professionals suggests that future campaigns need increased professional involvement to address problems, including anxiety among new mothers.

Anxiety↗
PubMedDate not supplied

Assisting women to learn myocardial infarction symptoms.

OBJECTIVE: The purpose of this study was to test how teaching format (factual versus storytelling) and restructuring the social norm of caring for others to caring for self affects how women learn to identify and respond to myocardial infarction (MI) symptoms. DESIGN: The study was a randomized pretest posttest full factorial experiment. SAMPLE: One hundred and thirteen women participated. MEASURES: Before and after reading the intervention pamphlet, the women wrote all the MI symptoms that they knew and rated their intention to call 911 if symptoms occurred. INTERVENTION: The women read one of the four MI pamphlets corresponding to the four conditions. RESULTS: No significant effects for learning MI symptoms resulted from teaching format or social norms. Women learned three additional MI symptoms. All responded with high intention to call 911 if MI symptoms occurred. CONCLUSIONS: Women can learn additional MI symptoms from reading a brief pamphlet about MI symptoms. Use of a storytelling format and the social norm of caring for self might not impact how many MI symptoms women learn. Studies using audiovisuals and larger samples are needed to clarify whether storytelling format and the social norm of caring for self-impact learning MI symptoms.

Adult↗