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PubMed1997

Evaluation of a video-supplement to informed consent: injection drug users and preventive HIV vaccine efficacy trials.

We evaluate the impact of a videotape specially produced to supplement written information about preventive HIV vaccine trials. One hundred eighty-six injection drug users were randomly assigned to an education session in which either: (a) a pamphlet was reviewed before a brief discussion period or (b) the videotape was watched prior to reviewing the pamphlet and participating in the discussion. The relationship among retention of information, trust in government, and willingness to participate in a vaccine trial was tested before the presentation of information, immediately after, and 1 month later. Results indicate that both methods produced significant increases in knowledge immediately after information presentation, but only the video-supplemented group retained the information 1 month later. Subjects receiving the video supplement also showed a significant increase in trust at the first posttest period, but this increase was not maintained 1 month later. Regardless of group assignment or evaluation point, willingness to participate was not associated with knowledge but was associated with trust in government.

AIDS Vaccines↗
PubMed1998

Cancer screening guideline preference surveys: physicians' perceptions of the American Cancer Society.

OBJECTIVE: The primary objective of this study was to assess cancer screening guideline preference by Tennessee internists and family physicians. DESIGN: A one-page, 14-item survey was mailed to 580 internists and family physicians followed by a reminder postcard and a second survey within six weeks of the original mailing. The survey addressed physician practice characteristics, specific preferred cancer screening guidelines used, and self-evaluation of cancer screening and detection practices compared with the practice of coronary artery disease risk and prevention, depression, and obesity/adult-onset diabetes mellitus. SETTING: Internal medicine and family physicians in Tennessee. RESULTS: The overall survey response rate was 57% (N = 300). Of respondents, 83.4% were male and 16.6% were female. Eighty-three percent were board-certified, 30% had subspecialty training, and 62% practiced in a solo practice or a single-specialty group. There were few differences in guideline preference between generalists and subspecialists. Approximately 52% of respondents cited American Cancer Society (ACS) guidelines, 1.7% used US Preventive Services Task Force (USPSTF) guidelines, 34% cited a compilation of various guidelines, and 10% used no guidelines. More physicians rated their treatment of depression (22.9%) or obesity/diabetes mellitus (22.0%) as poor or needing improvement than rated their screening of cancer (16.3%) and coronary artery disease (12.5%) as poor or needing improvement. Survey respondents suggested that the ACS could be most effective in lobbying against tobacco and in providing patient education pamphlets. CONCLUSIONS: Most physicians report using ACS screening guidelines, rate their cancer screening practices as good or very good, and recommend that the ACS lobby against tobacco and provide patient pamphlets. This study reflects physician preference of various cancer screening guidelines. Further research is needed to determine factors influencing physician preferred guideline use as well as actual practices.

American Cancer Society↗
PubMed1998

Fluorine-18-fluoro-L-DOPA dosimetry with carbidopa pretreatment.

UNLABELLED: This article presents dosimetry based on the measurement of fluoro-DOPA activity in major tissues and in the bladder contents in humans after oral pretreatment with 100 mg carbidopa. METHODS: Bladder activity was measured continuously by external probe and calibrated using complete urine collections. Quantitative dynamic PET scans provided time-activity curves for the major organs. Bladder wall dosimetry was calculated using the methods of MIRD Pamphlet No. 14. Effective dose was calculated as described in ICRP Publication 60. RESULTS: Mean absorbed dose to the bladder wall surface per unit administered activity was 0.150 mGy/MBq (0.556 rad/mCi) with the realistic void schedule used in our studies. The dose was 0.027 mGy/MBq (0.101 rad/mCi) to the kidneys, 0.0197 mGy/MBq (0.0728 rad/mCi) to the pancreas, and 0.0186 mGy/MBq (0.0688 rad/mCi) to the uterus. Absorbed doses to other organs were an order of magnitude or more lower than the bladder, 0.009-0.015 mGy/MBq. The effective dose per unit administered activity was 0.0199 mSv/MBq (0.0735 rem/mCi.) CONCLUSION: Urinary excretion of fluoro-DOPA was altered significantly by pretreatment with carbidopa. In general, any manipulation of tracer metabolism in the body should be expected to produce changes in biodistribution and dosimetry. The largest radiation dose was to the bladder wall, for which our estimate was one-fifth of that from the original report. The methods used reflect realistic urinary physiology and typical use of this tracer. The principles of MIRD Pamphlet No. 14 should be used in planning studies using tracers excreted in the urine to minimize the absorbed dose.

Aromatic Amino Acid Decarboxylase Inhibitors↗
PubMed1999

The MIRD perspective 1999. Medical Internal Radiation Dose Committee.

The MIRD schema is a general approach for medical internal radiation dosimetry. Although the schema has traditionally been used for organ dosimetry, it is also applicable to dosimetry at the suborgan, voxel, multicellular and cellular levels. The MIRD pamphlets that follow in this issue and in coming issues, as well as the recent monograph on cellular dosimetry, demonstrate the flexibility of this approach. Furthermore, these pamphlets provide new tools for radionuclide dosimetry applications, including the dynamic bladder model, S values for small structures within the brain (i.e., suborgan dosimetry), voxel S values for constructing three-dimensional dose distributions and dose-volume histograms and techniques for acquiring quantitative distribution and pharmacokinetic data.

Humans↗
PubMed2004

[Information materials on mammography screening in Austria--do they help women with informed decision?].

OBJECTIVES: Autonomy of patients is receiving greater acceptance in health care and prevention. Therefore, patients' and consumers' information attains greater significance. METHODS: The following study analyses the information in pamphlets on mammography aimed at consumers in Austria, in total five leaflets and two brochures. RESULTS: The results show that the information given does not support patients' informed decisions. CONCLUSIONS: The discussion lists reasons and shows ways to meet the challenges.

Adult↗
PubMed1995

Why people don't learn from diabetes literature: influence of text and reader characteristics.

The study was designed to identify text and reader characteristics that impede learning. Twenty-six adults with diabetes mellitus took a 15-item test for prior knowledge of diabetes, a 20-item vocabulary test, and a Need for Cognition questionnaire. Immediately after reading an excerpt from a commonly used diabetes pamphlet, they could recall an average of only eight of the 108 ideas in it. Readers seldom monitored their comprehension. Also, the topics that they thought were important differed from the topics that a physician thought were important. Many readers lacked reading skills, but those with high need for cognition and higher vocabulary scores recalled more topics. Even with an appropriate reading level, text characteristics that could hinder comprehension included lack of organization and clarity.

Adult↗
PubMed1996

Readability of printed sources of diet and health information.

This study surveyed nutrition education materials which are low in cost, brief and the type most used in patient education to determine which might be useful with low literacy clients. Readability of 209 pamphlets from professional health organizations, commercial organizations, government agencies, and educational institutions was assessed using three different tests. Using the Flesch and Raygor tests, materials from educational institutions had significantly lower reading levels than materials from professional organizations and government agencies. No significant differences were seen among the sources using the Fry test. Sixty-eight percent (142) of the publications were written at ninth grade level or higher. Eleven percent (24) scored at sixth grade or below on either the Fry or Raygor scale. Only two publications were written at the third grade level. Many of the publications reviewed can be read and understood by many Americans, but there were few for the millions that have limited literacy skills.

Educational Status↗
PubMed2004

Suitability of prostate cancer education materials: applying a standardized assessment tool to currently available materials.

Written educational materials serve as important teaching instruments for prostate cancer patients and their families. However, they must be understandable for their intended audiences. We examined prostate cancer brochures and pamphlets using the Suitability Assessment of Materials (SAM) instrument for the materials' overall suitability, readability, and cultural appropriateness. These factors are crucial to ensure that patients are able to understand and relate to the information. Our evaluation of 29 materials demonstrated that the majority, 22 (75.8%), scored "adequate" for their overall suitability. However, 26 materials (90%) scored "not suitable" for their reading grade level, while 55% of the materials could not be rated on cultural appropriateness because of lack of cues about the intended audience. Also, many of the materials scored poorly on content, graphics, self-efficacy, and learning motivation and stimulation. Most of the materials did well with typography and layout. Overall, the findings point to the need to carefully assess written materials used for multicultural audiences with low reading ability.

Cultural Diversity↗
PubMed2006

Can easy-to-read immunization information increase knowledge in urban low-income mothers?

This article describes a pilot study that (1) assessed the self-report of highest grade completed in school and the actual reading and comprehension skills of low-income mothers whose children receive immunizations in urban public clinics and (2) tested the effectiveness of a nursing intervention on immunization knowledge using revised easy-to-read written education materials. Thirty-seven mothers were randomized either to a control group (asked to read the standard vaccine information sheets) or to an experimental group (asked to read the revised immunization pamphlets). Although there was a modest increase in immunization knowledge for both groups, it was not significant. Thus, simplifying information alone may not increase parental knowledge.

Adolescent↗
PubMed2001

A frequently used patient and physician-directed educational intervention does nothing to improve primary care of prostate conditions.

OBJECTIVES: To measure the impact of an educational intervention directed at both patients and their primary care physicians about prostate-related conditions. METHODS: We used a randomized, control design for 50 physicians in 33 rural primary care practices from New England and Arkansas and a probability sample of 2402 of their male patients. For the physicians, we mailed two newsletters, conducted two face-to-face research staff visits, and provided printed educational manuals about the management of prostate conditions. For the patients, mailed educational pamphlets were targeted to the baseline symptom levels. After 18 months, 87% of patients and 92% of physicians completed a final survey. The patient survey measured health status, urinary symptoms and bother, treatments received, and prostate-related knowledge. The final physician survey asked them about their management of common prostate conditions. RESULTS: Before randomization, most men (59%) said they knew little or nothing about prostate problems that affect urination, and 63% also reported "little" or "no" knowledge about prostate-specific antigen testing. Eighteen months later, we observed no differences between the intervention and control patients in the measures of health status, urinary symptoms and bother, treatments received, and prostate-related knowledge. The intervention, physicians' knowledge, and self-reported practices for managing common prostate conditions were no better than the control physicians'. CONCLUSIONS: This commonly used education strategy had no measurable impact on prostate-related care.

Adult↗
PubMed1997

The comprehensibility of asthma education materials.

Asthma information pamphlets, brochures and other media materials are produced by a range of organisations for a diverse range of educational purposes. It is important to understand the principles of preparing appropriate and intelligible written material, to increase the probability that they will be more likely to improve health outcomes. Asthma patient education material, like many other types of health education material, is often written at a reading age above the target audience, and is less likely to be comprehended. Attention should be paid to the principles of good written communication in the preparation of such material. Such material should ideally be used in conjunction with verbal advice, as part of a medical consultation or asthma education program. Other asthma education media, including public education and mass communications material, should be subject to formative evaluation to assess its suitability and relevance for the proposed target audience.

Asthma↗
PubMed1999

Tailored advice on exercise--does it make a difference?

OBJECTIVE: A controlled trial to compare the effectiveness of verbal advice from a family physician (FP) combined with either "standard" or "tailored" written information on physical activity in increasing the levels of physical activity in sedentary patients. DESIGN: Sedentary patients (n = 763) were recruited through ten family practices and allocated to a control group or one of two intervention groups. Brief advice on physical activity was given by the FP during the consultation and either a standard or tailored pamphlet was mailed to the home address of patients assigned to the intervention groups within two days of their visit to the FP. RESULTS: The response to follow-up, via a postal survey at one, six, and twelve months after the index consultation was 70%, 60%, and 57%, respectively. Treating all nonresponders as sedentary, the results revealed that although more tailored subjects reported some physical activity at each follow-up compared with the standard group, these differences were not significant. Furthermore, there was no significant difference in movement across the stages of readiness to exercise at follow-up between subjects in the tailored group who received material targeting their current stage (precontemplation or contemplation) and the standard group who received generic material that addressed both stages. CONCLUSION: These findings do not concur with the results from previous research in the areas of nutrition and smoking cessation where additional benefits were seen with a tailored intervention. Future research on the application of the principles of "tailoring" to the promotion of physical activity should focus on identifying which, if any, physical, social, psychological or environmental variables should be addressed to produce improved outcomes over and above the effects of well designed generic materials.

Adolescent↗
PubMedDate not supplied

Assessing cultural sensitivity in printed cancer materials.

OBJECTIVES: Printed cancer education materials (PCEMs) (pamphlets and fact sheets) are used to educate individuals about cancer prevention and awareness. Culture is an important variable affecting the retention and use of information in printed materials to African Americans that has not been fully addressed in the literature. MATERIALS AND METHODS: The major goal of the Cancer Prevention Materials for African Americans project, funded by the Texas Cancer Council, was to assess cultural sensitivity of currently disseminated PCEMs targeting African Americans. The project consisted of conducting focus groups, forming an advisory committee, and developing and using the Printed Cancer Education Materials for African Americans Cultural Sensitivity Assessment Tool. RESULTS: Cultural sensitivity of PCEMs was assessed in terms of format, visual message, and written message. The majority of the PCEMs (56.2%) were culturally insensitive, with the visual message being the weakest component of all the materials. CONCLUSION: Future PCEMs targeting African Americans should include culturally sensitive visual messages to be more effective in delivering the cancer prevention message. The use of the assessment tool can assist cancer control specialists in developing culturally sensitive materials.

Black or African American↗
PubMed1999

Practical methods to increase use of advance medical directives.

OBJECTIVE: To compare the effectiveness of two means for increasing the use of advance medical directives: written materials only versus written materials and an educational videotape. DESIGN: Population-based, randomized controlled trial with 3-month follow up. SETTING: Kaiser Permanente Colorado Region, a not-for-profit group-model health maintenance organization. PARTICIPANTS: A population-based sample of all 1,302 members aged 75 years and older who used the Franklin Medical Office, excluding 55 persons who died or disenrolled during the study period or were identified by their physicians as blind or cognitively impaired. INTERVENTIONS: All subjects were mailed a 10-page cartoon-illustrated educational pamphlet on patient choices, a selection of Colorado advance medical directive forms, and a guide to their completion; 619 subjects also were mailed a 20-minute videotape on advance directives. Both groups had access to a study nurse for assistance in completing and placing advance medical directives. MEASUREMENTS AND MAIN RESULTS: The main outcome measure is the proportion of subjects who placed a directive in their medical record for the first time. Placement rates increased almost identically, from 21.2% to 35.0% in the written materials-only group and from 18.9% to 32.6% in the group receiving the videotape (95% confidence interval for difference -0.04, 0.04, p =.952). CONCLUSIONS: In an elderly population with a substantial baseline placement rate, mailing of written materials substantially increased placement of an advance directive in the medical record, but the addition of a videotape did not. Mailing the video did increase the use of treatment trials and made patients more aware of reasons not to use advance directives.

Advance Directives↗
PubMed2003

The addition of coaching to cognitive strategies: interventions for persons with compromised urinary bladder syndrome.

Compromised urinary bladder syndrome (CUBS) is defined as urinary frequency (UF) and/or urinary incontinence (UI) sufficient to be a problem. This term is an expansion of separate mainstream concepts referring to UF and UI, because the new term entails both phenomena considered at one time. Cognitive strategies (CS) offer one way to enhance the effectiveness and implementation of behavioral interventions directed to assist persons with CUBS. Two hypotheses predicted that persons receiving bladder health information would show less improvement on the outcomes than those receiving CS only or those receiving CS plus coaching after adjusting for type of UI. Secondly, persons receiving CS only would show less improvement on the outcomes than those receiving CS plus coaching. Data were collected at 3 time points, and the outcomes measured were comfort, bladder function, incidents of UF/UI (as recorded by participants in a diary), and perception of health. Neither hypothesis was fully supported. However, persons receiving information and information with CS plus coaching improved on comfort and UI/UF; all groups increased on bladder function; and perception of health did not change in any of the groups. Explanations for the mixed findings are proposed. In general, these findings support the application of conservative, noninvasive cognitive interventions innovatively applied through the use of pamphlets and audiotapes to help persons with CUBS experience increased comfort and improved bladder function. Implications for clinical practice are to provide a two-tiered intervention: education followed by CS with coaching if needed to enhance bladder function. A nursing role (as coaching) to augment specific interventions for CUBS is supported and should be differentiated for persons with symptoms of urgency.

Adult↗
PubMedDate not supplied

Beliefs, practices, and experiences of Korean women in relation to childbirth.

Korean women's health beliefs and childbirth experiences in the United States were examined. A convenience sampling procedure was used, and face-to-face interviews were conducted in Korean. Interviews were audiotaped, typed, and translated from Korean to English. These women had a holistic concept of health. Some practices were influence by ancient Chinese medicine. Childbirth experiences indicated that language is a barrier requiring specific interventions. Recommendations include (a) development of an assessment tool with which health-care professionals can identify individual health beliefs early in pregnancy; (b) development of a bilingual pamphlet about medical terms and the U.S. health-care system; (c) development of a short bilingual dictionary of common foods for use in menu selection during hospitalization; and (d) provision of English practice periods based on anticipatory guidance principles to prepare women to ask for specific assistance.

Adult↗
PubMed1994

General practitioners' use of health education material. Results from a nationwide survey in Denmark in 1991. The Danish Health Education Study Group.

In November 1991 69% of a random sample of 998 Danish general practitioners (GPs) participated in a survey by anonymously filling in a mailed questionnaire concerning the way in which they use health education in their practices. Among the participating GPs, 97% used health education material. The study showed differences in attitudes towards and use of health education material. The material most often used by GPs at the consultation concerned diet/overweight, allergy and pregnancy. Pamphlets and posters in the waiting room mainly dealt with vaccination, alcohol and smoking. The female practitioners were generally most sympathetic to the use of health education material, but they are also those most critical of material advertising for medicine. The male practitioners thought that there was too much material and that they did not have enough time to use it.

Adult↗
PubMed2001

The influence of medical information on the perioperative course of stress in cardiac surgery patients.

UNLABELLED: Cardiac surgery correlates with increased perioperative stress and anxiety. We tested whether preoperative extensive oral information in combination with more personal attention by the surgeon is associated with any effect on patients' perioperative stress, anxiety, and well-being. Sixty patients awaiting open heart surgery were divided into two groups. Group I consisted of 30 patients who received routine medical information through an informative pamphlet. In Group II (n = 30 patients), additional, extensive oral medical information and more personal attention by the surgeon was provided before surgery. Salivary cortisol, plasma cortisol, state anxiety, and patients' well-being were measured perioperatively. Extensive preoperative oral information in combination with more personal attention by the physician did not have any significant influence on the perioperative psychoendocrinologic course of stress. During transport to the operating room, salivary cortisol increased significantly (P < 0.001) in both groups (ranges are 95% confidence intervals) (Group I, 23.2 nmol/L [17.1-31.5]; Group II, 14.6 nmol/L [9.9-21.3]) versus the first day in the hospital (Group I, 8.4 nmol/L [6.2-11.4]; Group II, 6.7 nmol/L [5.3-8.6]). After the induction of anesthesia, plasma cortisol decreased significantly (P < 0.001) in both groups (Group I, 170.1 nmol/L [143.6-201.4]; Group II, 172.0 nmol/L [142.2-208.1]) versus preoperative levels. After surgery, well-being decreased (P = 0.003) in all patients, and patients' state anxiety was reduced (P = 0.001) after surgery. Our data demonstrate a lack of effect of extensive oral medical information that was presented as part of clinical routine on the perioperative psychoendocrinologic course of stress. High levels of stress during transport to the operating room were detected. IMPLICATIONS: The quantity of stress during transport to the operating room and the perioperative psychoendocrinologic course of stress in combination with two different methods of preoperative medical information are described in 60 consecutive patients awaiting cardiac surgery.

Aged↗