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PubMed1999

An evaluation of the impact of health worker and patient education on the care and compliance of patients with epilepsy in Zimbabwe.

PURPOSE: The use of primary health care personnel to identify cases of epilepsy and initiate simple treatment protocols has been advocated as a solution to the numeric inadequacy and uneven distribution of medical manpower available for the management of epilepsy in developing countries. This study sought to evaluate the effectiveness of primary health care nurses in the diagnosis and management of epilepsy, as well as the impact of patient-information pamphlets on drug compliance and clinic attendance of patients with epilepsy. METHODS: Primary health care workers from 24 clinics in the Zvimba district in Zimbabwe attended a workshop to improving their knowledge in the diagnosis and management of generalized tonic-clonic seizures. Half of these clinics (experimental group) subsequently received patient-information pamphlets for distribution to patients and relatives, whereas the other half (control group) did not. Frequency of clinic attendance, mean seizure frequencies, and mean serum levels of phenobarbitone were compared at baseline and at 6 months after intervention in patients within each group, and at 6 months after intervention between both groups. RESULTS: Community health worker education led to a 74% increase in patient recruitment as well as a marked improvement in patient drug compliance over the 6-month study period. The use of patient-information pamphlets led to a marked reduction in patient default from clinic follow-up, but did not appear to influence drug compliance or seizure frequency. CONCLUSIONS: The benefits of these simple and inexpensive interventions make a strong case for their widespread implementation for improved epilepsy care not only in Zimbabwe, but also in other developing countries.

Adult↗
PubMed1997

Do consumer infant feeding publications and products available in physicians' offices protect, promote, and support breastfeeding?

The purpose of this study was to determine if consumer infant feeding publications and products distributed by physicians' offices protect, promote, and support breastfeeding. A total of 127 physician office practices completed a mailed questionnaire that measured the types of print and nonprint materials available and policies and practices regarding these resources. Commercially produced pamphlets were available in 114 (90%) of the offices surveyed, and were twice as likely to be routinely distributed as pamphlets from nonprofit agencies and government. Many publications contained outdated recommendations about breastfeeding; the most accurate publications were available in only 29 (23%) of practices surveyed. Magazines contravening the WHO Code were widely available (91 offices; 72%) and routinely distributed (58 offices; 46%). One hundred one offices (80%) accepted free formula and 48 (38%) routinely distributed it. Few offices had a policy (n = 25; 20%) or criteria (n = 17; 13%) for selecting infant feeding resources. Those with policies were less likely to distribute commercial pamphlets. In the majority of offices surveyed, physicians' offices accepted and routinely distributed publications and products which do not "protect, promote, and support" breastfeeding. Offices are encouraged to have policies guiding the distribution of infant feeding materials.

Adult↗
PubMed2001

Effectiveness of a high school smoking cessation program.

OBJECTIVE: To evaluate the impact of a school-based smoking cessation program targeting adolescents interested in quitting. DESIGN: Randomized clinical trial over one school year. SETTING: Large public high school. PARTICIPANTS: Students interested in quitting smoking. INTERVENTION: Seventy-four students were randomized to receive either: 1) a 6-week, 8-session, classroom-based, smoking cessation curriculum designed for adolescents (n = 35) or 2) an informational pamphlet on how to quit smoking with promise of the classroom curriculum in 3 months (n = 39). OUTCOME MEASURES: Change in smoking behavior measured by: 1) self-reported smoking cessation and exhaled carbon monoxide <6 parts per million (smoke-free); 2) self-reported quit attempts; and 3) change in cigarettes per day (cpd) at the end of the 6-week curriculum and then 4, 10, and 20 weeks later. Saliva cotinine was also measured at these points to validate these outcome measures. Analysis. Intention-to-treat. RESULTS: Participants in the classroom group attended an average of 4.4 sessions. At the end of the curriculum, the classroom group was significantly more likely to be smoke-free (59% vs 17%), to have tried to quit smoking (82% vs 54%), and to reduce mean cpd (7.0 vs 1.0). Four weeks later, these differences persisted: smoke-free (52% vs 20%), quit attempt (85% vs 60%), and reduction in mean cpd (6.6 vs 1.6). Changes in saliva cotinine were consistent with reported outcome measures; those who were smoke-free had a significant reduction in saliva cotinine at the end of the intervention, and at 4 weeks. At 10 and 20 weeks after the curriculum, 41% and 31%, respectively, of the classroom group remained smoke-free. Once participants in the pamphlet group underwent the classroom intervention (average attendance of 2.2 sessions) their cessation rates were similar to the initial group: 31% at the end of the curriculum and 27% 10 weeks later. CONCLUSION: A school-based curriculum for adolescent smoking cessation is more effective than an informational pamphlet alone and reduces cigarette use by adolescents. More research is needed to test the reproducibility, sustainability, and generalizability of this curriculum to offer more smoking cessation options to teenagers.

Adolescent↗
PubMed1999

[Pills are my responsibility].

As major users of medications, senior citizens are often in the position of having to manage a large number of these products. Health professionals recognize the extent of this problem and are taking steps to promote the safe use of drugs. In spite of this, seniors are still playing a passive role that disregards the predictive factors for drug use. With seniors' co-operation, an innovative community project was developed to increase their knowledge and influence the predictive factors for drug use. A group of eight elderly women took part in four meetings to produce a preventive pamphlet for seniors. First, these women gained an awareness of the problem. Then, they decided what information should be included in the pamphlet. Finally, they served as agents for change by handing out pamphlets in their area. Qualitative results show that the project objectives were met; that seniors were actively involved in the entire process. The project raised awareness, forged social relationships, improved participants' sense of self-worth, and fostered a positive view of health. There is every indication that, in future, more seniors should be actively included in any community effort aimed at solving problems that directly concern them.

Aged↗
PubMed2005

The excoriation of Benjamin Bell: who was 'Jonathan Dawplucker'?

Because of a perceived lack of continuity of care of the surgical patients in Edinburgh Royal Infirmary, James Gregory, one of its managers, suggested that from 1800 a total of only six surgeons should be appointed full-time to that institution. As considerable animosity existed between Gregory and John Bell, a senior Edinburgh teacher and surgeon, a pamphlet that was extremely hostile to his activities was posted in prominent locations throughout Edinburgh. While the author was named 'Jonathan Dawplucker' it was speculated that Gregory, or one of his close associates, was its real author. The contents of a second Dawplucker pamphlet, in the same style, but probably written by John Bell, was subsequently published. This was extremely hostile to Benjamin Bell, one of Gregory's close surgical colleagues. While much distress was caused at the time, the real authors of these pamphlets are unlikely ever to be established.

Authorship↗
PubMed1987

Reaching low-literate adults with printed nutrition materials.

A receiver-assisted pamphlet featuring snack information written in the language of the target audience was developed using the language experience approach and compared to a standard sender-produced version written by nutrition professionals. Information garnered through free recall, main idea, content continuation, and signaled stopping statements suggests that the receiver-assisted pamphlet was more easily understood and the perception of personal relevance was improved, although content recognition and oral miscue analyses indicated that some of the wording in the receiver-assisted version tended to be more difficult. Subjects who read semantic differential passages gave the receiver-assisted pamphlet more favorable ratings on the neighborly, helpful, sensible, and informative scales. Semantic differential scores of white and nonwhite respondents favored the receiver-assisted version, indicating that the materials are appropriate for use with a racially mixed target audience.

Adult↗
PubMed1977

Child automobile restraints: evaluation of health education.

An experimental design was used to test the effectiveness of three modalities of instruction in pediatricians' offices. Parents in the experimental and control groups were asked if their children wore a car seat restraint on the way to the office. The parents in the experimental group were encouraged to have their children use restraints via one of the following methods: a pamphlet alone; a pamphlet and verbal instruction by the pediatrician; or a pamphlet, verbal instruction, and a brief slide-tape show. The parents were contacted by telephone, mail, or in person two weeks later and asked if their child used a restraint on their last car trip. There were no statistically significant changes in behavior in any of the gourps. Although the group that received all forms of instruction had the highest mean score, the greatest increase occurred with the control group.

Adolescent↗
PubMedDate not supplied

Sex roles in instructional materials: testing the stereotypes.

This special report discusses the significance and potential benefit of portraying men in nontraditional sex roles within pictorial instructional print materials on health and child care. It is based on the cognitive and behavioral findings of a comparative research study conducted in selected rural and periurban areas of Mexico on the use of two versions of an ORS pictorial pamphlet. Major findings of the study were: (1) portraying nontraditional sex roles for men in the ORS pamphlet did not reduce the credibility of technical information contained in the pamphlet; (2) a significantly greater number of subjects preferred the version that portrayed the father figure as co-caretaker of a sick child. These unexpected results have important implications for instructional and motivational communication and health education projects throughout the developing world.

Father-Child Relations↗
PubMed1995

Patient literacy and the readability of written cancer educational materials.

PURPOSE/OBJECTIVES: The purpose of this study was to determine whether the reading level of educational materials for patients with cancer corresponds to the reading abilities of a sample of patients. A secondary aim was to describe what type of educational materials patients with cancer report as most helpful. DESIGN: Descriptive, cross-sectional. SETTING: Outpatient oncology clinics at an urban Veterans Affairs Medical Center. SAMPLE: A convenience sample of 63 outpatients with cancer. METHODS: Investigators used the Word Recognition Achievement Test-Revised Level (WRAT-R2) to measure patients' reading levels. They used the Flesch Index to analyze the reading levels of the booklets that the patients used (14 booklets developed by the American Cancer Society and 16 developed by the National Cancer Institute). Data were analyzed through descriptive statistics and a Wilcoxon signed rank test. MAIN RESEARCH VARIABLES: Patient and booklet reading levels. FINDINGS: The reading level of 27% of the sample was less than that of all 30 pamphlets (less than a sixth-grade reading level). Seventeen percent of the patients had a reading level between sixth and eighth grades (representing 47% of the pamphlets). Twenty-nine percent of the sample had WRAT scores between 9th and 12th grades (representing 80% of the pamphlets). Only 27% had WRAT scores of the 13th grade and above. Twenty-six percent of the patients preferred written educational materials alone, while 57% of patients desired more than one method of instruction. CONCLUSION: Written materials for the education of patients with cancer must be carefully matched to patient reading levels. Written materials may not be the only desirable mode of instruction. IMPLICATIONS FOR NURSING PRACTICE: Given the increasing complexity of cancer care, shorter hospital stays, and a shift toward busy ambulatory care centers, nurses need to develop creative, innovative, and comprehensive patient education programs that are understandable to patients and that use multiple types of instruction.

Adult↗
PubMedDate not supplied

A patient-education tool for patient-controlled analgesia.

PURPOSE/OBJECTIVES: To develop a pamphlet for educating patients about patient-controlled analgesia (PCA). DATA SOURCES: Journal articles and pump manufacturers' materials. DATA SYNTHESIS: This pamphlet defines PCA and describes PCA pump operation, pain assessment, medication side effects, and safety considerations. A numerical pain-assessment tool also is included. CONCLUSIONS: This pamphlet has been helpful in assisting patients to use PCA pumps effectively. IMPLICATIONS FOR NURSING PRACTICE: Nurses can use this tool to educate patients requiring PCA therapy for pain management.

Analgesia, Patient-Controlled↗
PubMed1984

Effects of public education about breast cancer and breast self-examination.

In a field experiment severity of and susceptibility to breast cancer were varied in four different persuasive messages about breast cancer and breast self-examination (BSE). The purpose of this study was to find out whether such health messages in a real-life setting had an effect on knowledge about symptoms, attitudes and behavior relating to BSE. The second goal of this study was to investigate whether fear, aroused by these persuasive communications, had a significant role in influencing the recommended behavior (BSE). In spite of a successful manipulation of seriousness and susceptibility no differences for the dependent variables could be established between the experimental groups after one month. However, differences were found by comparing the experimental groups with the no health message group. After reading the pamphlet (no matter which of the four) women showed greater intention to perform BSE regularly. This could be attributed to a higher estimation of the chance of recovery through early detection of lumps (efficacy) after reading the pamphlet. The health messages also appeared to have a positive influence on compliance with recommended behavior: women examined their breasts more in the prescribed way. An inhibiting effect of fear on behavior (which is sometimes theoretically suggested) was not found. The effects of the pamphlet that were established are formed in a more informational, cognitive way.

Attitude to Health↗
PubMed2002

Development of cervical cancer control interventions for Chinese immigrants.

The objective of the study was to develop a culturally relevant video and a pamphlet for use as a cervical cancer screening educational intervention among North-American Chinese women. The project conducted 87 qualitative interviews and nine focus groups to develop a culturally tailored intervention to improve Pap testing rates. The intervention consisted of an educational/motivational video, a pamphlet, and home visits. Less acculturated Chinese women draw on a rich tradition of herbal knowledge and folk practices historically based on Chinese medical theory, now mixed with new information from the media and popular culture. The video, the pamphlet, and the outreach workers knowledge base were designed using these results and combined with biomedical information to address potential obstacles to Pap testing. Culturally relevant information for reproductive health promotion was easily retrieved through qualitative interviews and used to create educational materials modeling the integration of Pap testing into Chinese women's health practices.

Journal Article↗
PubMed1995

Readability of pediatric patient education materials. Current perspectives on an old problem.

Written patient education materials are an important part of ambulatory pediatric practices. We evaluated the readability of 33 representative pediatric education materials using three common formulas: Fog, Fry, and SMOG. The majority of pamphlets had readabilities of grade nine or above. The need to use multiple readability formulas was also demonstrated. Although the three readability formulas were highly correlated, they were significantly different from each other when using a repeated measures analysis of variance (ANOVA) design. In almost half, the readability estimates differed by at least two grade levels. In addition, a large intrapamphlet variability for some pamphlets suggests a need to focus more attention on the readability of multiple sections within a pamphlet, not only on the overall or average readability. We conclude that the readability levels of patient education materials continue to be too high.

Adolescent↗
PubMed1994

Attitudes of healthcare professionals toward patient counseling on drug-nutrient interactions.

OBJECTIVE: To evaluate the attitudes of healthcare providers on drug-nutrient interaction (DNI) counseling. DESIGN: A mail survey. SETTING: Random sample of healthcare providers with interest in nutrition, practicing in Iowa or Nebraska. METHODS: A 48-item questionnaire was constructed on the basis of a review of DNI literature. The survey was sent to 100 pharmacists, 50 registered dietitians, 25 registered nurses, and 25 physicians identified from culled mailing lists of the American Society of Parenteral and Enteral Nutrition and the Iowa Nebraska Society of Parenteral and Enteral Nutrition. Assessed variables included the amount of DNI counseling provided, who is in the best position to provide DNI counseling, and what information should be included in instructional materials on DNIs for patients. Data were entered into a relational database for evaluation and comparison. RESULTS: The usable response rate was 49.5 percent (n = 99): 49 pharmacists, 29 dietitians, 18 nurses, and 3 physicians. Only 12 respondents provided DNI counseling in > 50 percent of patient interactions. Seventy-one respondents (72 percent) felt pharmacists were in the best position to discuss DNIs with patients. More than half of the respondents felt a new DNI pamphlet should be developed to replace an existing Food and Drug Administration-sponsored pamphlet. Although 70 percent felt the new pamphlet should be organized according to specific drugs, many felt the format should also include specific populations and disease states. Eighty-six percent indicated that a chart on DNIs geared toward healthcare professionals would be useful. CONCLUSIONS: Patient-oriented resources should be developed to enhance DNI counseling. Pharmacists are in a uniquely advantageous position to provide DNI counseling.

Attitude of Health Personnel↗
PubMed1999

Parent-daughter discussions to discourage tobacco use: feasibility and content.

Parents engaged their 6th- and 8th-grade daughters in a conversation about tobacco. The parents were guided by a pamphlet designed to encourage effective family communication about tobacco. Conversations were audiotaped for later coding. Evidence is presented that such parent-daughter conversations about tobacco use can be successfully carried out in a nonaversive manner. Overall, the conversations were perceived to have gone well, with very little conflict reported. Further, the daughters reported that the parental advice was helpful and they did not resist receiving such advice. Among the topics suggested by the pamphlet, the following were most frequently discussed: consequences of smoking as experienced by friends and relatives, difficulty of quitting, promotional tactics of tobacco companies, making rules about tobacco use, and deciding on the consequences of rules adherence or violation. Other frequently discussed topics, which were not covered in the pamphlet, may also be appropriate for parent-daughter conversations: diminished physical attractiveness and body-image issues, how to resist peer pressure, and health risks.

Adolescent↗
PubMed1995

Varying nicotine patch dose and type of smoking cessation counseling.

OBJECTIVE: To compare the efficacy and safety of 22-mg and 44-mg doses of transdermal nicotine therapy when it is paired with minimal, individual, or group counseling to improve smoking cessation rates. DESIGN: An 8-week clinical trial (4 weeks double-blind followed by 4 weeks open label) using random assignment of participants to both dose (22 or 44 mg) and counseling (minimal, individual, or group) conditions. PARTICIPANTS: Daily cigarette smokers (> or = 15 cigarettes per day for at least 1 year) who volunteered to participate in a study of smoking cessation treatment. A total of 504 participants were enrolled at two sites. INTERVENTION: Four weeks of 22- or 44-mg transdermal nicotine therapy followed by 4 weeks of dosage reduction (2 weeks of 22 mg followed by 2 weeks of 11 mg). Counseling consisted of a self-help pamphlet (minimal); a self-help pamphlet, a brief physician motivational message, and three brief (< 15 minutes) follow-up visits with a nurse (individual); or the pamphlet, the motivational message, and eight weekly 1-hour group smoking cessation counseling visits (group). All participants returned weekly to turn in questionnaires and for assessment of their smoking status. MAIN OUTCOME MEASURES: Abstinence from smoking was based on self-report, confirmed by an expired carbon monoxide concentration lower than 10 ppm. Withdrawal severity was assessed by means of an eight-item self-report questionnaire completed daily. RESULTS: Smoking cessation rates for the two nicotine patch doses and three levels of counseling did not differ significantly at either 8 weeks or 26 weeks following the quit date. Among those receiving minimal contact, the 44-mg dose produced greater abstinence at 4 weeks than did the 22-mg dose (68% vs 45%; P < .01). Participants receiving minimal-contact adjuvant treatment were less likely to be abstinent at the end of 4 weeks than those receiving individual or group counseling (56% vs 67%; P < .05). The 44-mg dose decreased desire to smoke more than the 22-mg dose, but this effect was not related to success in quitting smoking. Transdermal nicotine therapy at doses of 44 mg produced a significantly greater frequency of nausea (28%), vomiting (10%), and erythema with edema at the patch site (30%) than did a 22-mg dose (10%, 2%, and 13%, respectively; P < .01 for each adverse effect). Three serious adverse events occurred during use of the 44-mg patch dose. CONCLUSIONS: There does not appear to be any general, sustained benefit of initiating transdermal nicotine therapy with a 44-mg patch dose or of providing intense adjuvant smoking cessation treatment. The two doses and all adjuvant treatments produced equivalent effects at the 26-week follow-up, and the higher patch dose produced more adverse effects. Higher-dose (44-mg) nicotine replacement does not appear to be indicated for general clinical populations, although it may provide short-term benefit to some smokers attempting to quit with minimal adjuvant treatment.

Administration, Cutaneous↗
PubMed1994

Readability of the childhood immunization information forms.

OBJECTIVE: To compare the reading level required to understand childhood immunization information forms with the reading grade level of an inner-city parent/caretaker population. DESIGN: Descriptive study (parents/caretakers). SETTING: Inner-city pediatric clinic. PARTICIPANTS: One hundred fifty English-speaking, low-income parent/caretakers. INTERVENTIONS: None. MEASUREMENTS/MAIN RESULTS: The reading level of our parent population ranged from grades 2.9 to 13.3, with a median grade level of 6.90. The reading levels required for the three vaccine information pamphlets issued in 1992 by the Centers for Disease Control and Prevention (Atlanta, Ga) averaged 11.1 (approximately at the level of a high school junior). Eighty-six percent of our parents/caretakers did not have a reading level sufficient to cope with the easiest of the forms. CONCLUSIONS: The vaccine information pamphlets require a reading level beyond the capability of the vast majority of our parent population. Therefore, the goal of informed consent clearly is not being met.

Adolescent↗
PubMed1998

Evaluation of a patient file folder to improve the dissemination of written information materials for cancer patients.

BACKGROUND: Many cancer centers make available to patients written information material to supplement verbal information provided by clinicians. Randomized trials have demonstrated that providing such information can increase patient knowledge and satisfaction. However, little data are available regarding effective means of dissemination of such materials. The purpose of this study was to determine whether providing patients with a personal file folder after their first clinic appointment would improve the dissemination of written information materials and increase patient satisfaction. METHODS: A before/after study was performed. Consecutive patients with newly diagnosed cancer attending the Hamilton Regional Cancer Centre were selected randomly and interviewed by telephone within 1-2 weeks of the first clinic appointment regarding the number of information pamphlets received, patient satisfaction, and general preference for written information materials. The preintervention evaluation (T1) occurred over a 4-month period followed by the introduction of the personal file folder into the clinical practice. Six weeks after its introduction, the postintervention (T2) evaluation took place over the ensuing 4 months. RESULTS: A total of 300 patients completed the evaluation (150 each in T1 and T2). Responding patients in the two time periods were comparable with respect to background demographic variables. The mean number of information pamphlets received by patients increased with the introduction of the personal file folder from 2.4+/-2.0 standard deviations (SD) in T1 to 3.6+/-2.5 SD in T2 (P=0.0001). The percentage of patients planned for treatment who received treatment-related information increased from 36% (42 of 116 patients) in T1 to 65% (68 of 105 patients) in T2 (P=0.002). Mean patient satisfaction increased from 3.3+/-1.1 SD to 3.8+/-1.0 SD over the 2 time periods (P=0.0001). The majority of patients (87%) believed it was important to receive written information materials. CONCLUSIONS: The patient file folder increased the dissemination of written information materials and currently is being incorporated into routine practice.

Attitude↗