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PubMed2001

A randomized trial of a brief intervention to increase fruit and vegetable intake: a replication study among callers to the CIS.

BACKGROUND: Results are reported from a large randomized trial designed to increase fruit and vegetable consumption among callers to the National Cancer Institute's Cancer Information Service (CIS) (n = 1,717). METHODS: CIS callers assigned to the intervention group (n = 861) received a brief proactive educational intervention over the telephone at the end of usual service, with two follow-up mailouts. Key educational messages and print material derived from the NCI 5 A Day for Better Health program were provided to intervention participants. Participants were interviewed by telephone at 4 weeks (n = 1,307), 4 months (n = 1,180), and 12 months for follow-up (n = 1,016). RESULTS: Results obtained from a single-item measure of fruit and vegetable consumption indicate a significant intervention effect of 0.88 servings per day at 4 weeks follow-up (P < 0.001), 0.63 servings per day at 4 months follow-up (P < 0.001), and 0.43 servings per day at 12 months follow-up (P < 0.001). Using a 7-item food frequency measure, an intervention effect of 0.63 servings per day was obtained at 4 weeks follow-up (P < 0.001), compared with 0.39 servings per day at 4 months follow-up (P = 0.002) and 0.44 servings per day at 12 months follow-up (P = 0.002). A 24-h recall assessment included in the 4-month interviews also yielded a significant intervention effect of 0.67 servings per day (P = 0.015). The vast majority of callers (90%) endorsed the strategy of providing 5 A Day information proactively within the CIS. CONCLUSIONS: This brief educational intervention was associated with higher levels of self-reported fruit and vegetable intake at both short- and long-term follow-up. Additional research is recommended to test this or a similar intervention in diverse populations.

Adult↗
PubMed1998

Controlled trial of the effect of length, incentives, and follow-up techniques on response to a mailed questionnaire.

Mailed questionnaires are an economical method of data collection for epidemiologic studies, but response tends to be lower than for telephone or personal interviews. As part of a follow-up study of volunteers who provided a brief health history and blood sample for a blood specimen bank in 1989, the authors conducted a controlled trial of the effect of length, incentives, and follow-up techniques on response to a mailed questionnaire. Interventions tested included variations on length of the questionnaire, effect of a monetary incentive, and effect of a postcard reminder versus a letter accompanied by a second questionnaire. Response was similar for the short (16-item, 4-page) and long (76-item, 16-page) questionnaire groups. The non-monetary [corrected] incentive did not improve the frequency of response. The second mailing of a questionnaire was significantly better than a postcard reminder in improving responses (23% vs. 10%). It is important to systematically test marketing principles to determine which techniques are effective in increasing response to mailed questionnaires for epidemiologic studies.

Adolescent↗
PubMed2003

Repeat chlamydia screening by mail, San Francisco.

OBJECTIVES: To assess the feasibility and acceptability of home screening for repeat chlamydial infection using urine test kits sent through the mail. METHODS: A letter offering home rescreening was mailed to 399 adults who previously tested positive for chlamydia. Kits were then mailed to anyone who did not actively decline. The home testing kits contained instructions on how to collect a urine specimen and return the specimen by mail. Specimens were tested with strand displacement amplification. A short survey asked individuals their level of concern about confidentiality, safety, and privacy of mail screening. RESULTS: Among the 313 potential test kit recipients, 22.4% responded. Response rates were highest among homosexual and bisexual men (38.6%), people 35 years or older (34.3%), and white people (34.6%). The overall positivity rate was 3.2% (2/63). In women 18-25 years old, the positivity was 13.3% (2/15). CONCLUSIONS: Home testing with mailed urine collection kits is feasible and an acceptable method to screen for recurrent chlamydial infection. Young women would probably benefit most because of their higher rates of reinfection and risk for sequelae.

Adolescent↗
PubMed2005

Patient preferences for notification of normal laboratory test results: a report from the ASIPS Collaborative.

BACKGROUND: Many medical errors occur during the laboratory testing process, including lost test results. Patient inquiry concerning results often represents the final safety net for locating lost results. This qualitative study sought to identify, from a patient perspective, specific preferences and factors that influence the process of communicating normal (negative) laboratory test results to patients. METHODS: We conducted 30-minute guided interviews with 20 adult patients. Patients were recruited from two practice-based research networks in Colorado that were participating in a medical errors study. A semi-structured interview elicited the participant's experience with and preference for laboratory test result notification. Quantitative descriptive statistics were generated for demographic and preference data. Qualitative results were analyzed by a team of experienced qualitative researchers using multiple styles of qualitative analyses, including a template approach and an editing approach. RESULTS: Ninety percent of participants wanted to be notified of all tests results. Important issues related to notification included privacy, responsive and interactive feedback, convenience, timeliness, and provision of details. Telephone notification was preferred, followed by regular mail. Electronic notification was perceived as uncomfortable because it was not secure. While 65% preferred being notified by a provider, participants acknowledge that this may be impractical; thus, they wanted to be notified by someone knowledgeable enough to answer questions. Participants do not normally discuss their preferences for test result notification with their providers. CONCLUSION: Privacy, responsive and interactive feedback, convenience, and timeliness with detailed information may be critical for patient satisfaction and for improving patient safety, and are features that may be incorporated into emerging communication channels.

Adult↗
PubMed2003

Influence of seminar and mailed guidelines on knowledge of school teachers regarding emergency treatment for dental injuries.

OBJECTIVE: To evaluate the influence of two different modes for delivering guidelines on school teachers' knowledge on emergency treatment for dental injuries. DESIGN: Cross sectional questionnaire study. SETTING: Primary schools in Dar es Salaam city council in Tanzania. PARTICIPANTS: Primary school teachers. INTERVENTION: Provision of guidelines by mail or through seminar or no guidelines (control). MAIN OUTCOME MEASURES: Knowledge on emergency management of dental injuries RESULTS: The teachers did not have adequate knowledge on the emergency management of traumatised teeth. Significant differences were observed between the study groups. Teachers from the seminar group were likely to re-implant an avulsed tooth (five times more likely than the control group) or otherwise would transport it in the recommended medium. No significant differences were observed between the groups on their willingness to take the avulsed tooth to a doctor or dentist or on the method or liquid they would use to clean a dirty avulsed tooth. CONCLUSION: Compared to provision of information through mailed guidelines, seminar discussions better improved the school teachers' knowledge regarding emergency treatment for dental injuries.

Cross-Sectional Studies↗
PubMed2002

Use of resident-origin data to define nursing home market boundaries.

Previous studies of nursing home markets have assumed that a nursing home's market is coincident with the boundaries of the county in which it is located. We test this assumption by using the zip code of residence for Medicare beneficiaries admitted into a nursing home in New York state in the periods 1992-93 and 1996-97. We find that nursing homes located in urban areas have markets that are a fraction of the size of the county in which they are located. We calculate the Herfindahl-Hirschman Index (HHI) to measure the competitiveness of each nursing home's market. This shows that nursing home markets tend to be more concentrated than those that result from assuming countywide markets. These results suggest that studies of nursing home markets should not use counties as markets.

Aged↗
PubMed2005

A pilot study evaluating a minimal contact telephone and mail weight management intervention for primary care patients.

OBJECTIVE: This study examined an 8-week telephone and mail weight management intervention for Veterans who are unable to attend frequent clinical visits. METHODS: A mail and phone based intervention was compared to a "usual care" intervention in a Hospital clinic. 26 participants (80% male; mean wt=246.2 lbs, BMI=34.7) completed the study. All participants received weight management counseling at weeks 1 and 8. Participants in the intervention group received phone calls and mailings during weeks 2-7. RESULTS: The intervention group lost more weight, although it was not statistically significant. Multivariate analyses showed stage of change was associated with weight loss and attendance. Treatment group and role limitations due to emotional problems were related to weight loss. The intervention group significantly increased their intake of fruits and vegetables. CONCLUSION: This pilot study suggests that minimal interventions may be a method to reach populations that do not have access to more intensive treatments for weight management.

Exercise↗
PubMed1997

Analysis of non-response bias in a mailed health survey.

The objective of this study was to identify characteristics of non-respondents and late respondents to a mailed health survey. Persons who returned and those who did not return the questionnaire were compared using health insurance data, which indicated their age, sex, and health care expenditures in the previous year. Insurance and questionnaire data were used to compare early and late survey respondents and to compare categories of non-respondents. Questions covered use of health services, health status, and sociodemographic characteristics. Participants were members of health insurance plans in Geneva, Switzerland, 19-45 years old (n = 1822). Respondents (n = 1424) and non-respondents (n = 398) were of similar age and sex. The proportion of persons who had health care expenditures greater than zero Swiss francs (SFr) was higher among respondents (75%) than among non-respondents (69%, p = 0.03). Among non-respondents, expenditures of persons who explicitly refused to participate (2378 SFr) were higher than expenditures of persons who moved out of Geneva (1085 SFr) or who failed to return the questionnaire (1592 SFr, p = .02). Among respondents, being born in a Switzerland, having completed elementary school, having generated health care expenditures, and reporting good physical health were independent predictors of early response. In conclusion, low response rates to mailed health surveys may result in overestimating the utilization of health services. However, non-respondents did not constitute a homogeneous group, and the strength and even direction of non-response bias depended on the mechanisms of non-response.

Adult↗
PubMed2002

Income, race, and preventable hospitalizations: a small area analysis in New Jersey.

This research examines the effect of income, race, and cultural factors on preventable hospitalizations, using age and sex-adjusted preventable admissions from 53 contiguous zip codes in New Jersey from 1993 to 1995. Low income was strongly associated with high rates of preventable hospitalization in the study zip codes. Income is likely a proxy for education level, barriers to accessing primary care, and health insurance. A floor effect of income levels was present that may reflect a natural level of preventable hospitalization not affected by income, education, or health insurance status. An independent relationship found between nonwhite race and high preventable hospitalization may be in part the result of delays in seeking care affected by antecedent cultural factors. Removing financial barriers is critical but may be insufficient for reducing preventable hospitalizations if other barriers are not also addressed.

Adolescent↗
PubMed2006

Likelihood of home death associated with local rates of home birth: influence of local area healthcare preferences on site of death.

OBJECTIVES: We tested whether local cultural and social values regarding the use of health care are associated with the likelihood of home death, using variation in local rates of home births as a proxy for geographic variation in these values. METHODS: For each of 351110 adult decedents in Washington state who died from 1989 through 1998, we calculated the home birth rate in each zip code during the year of death and then used multivariate regression modeling to estimate the relation between the likelihood of home death and the local rate of home births. RESULTS: Individuals residing in local areas with higher home birth rates had greater adjusted likelihood of dying at home (odds ratio [OR]=1.04 for each percentage point increase in home birth rate; 95% confidence interval [CI] = 1.03, 1.05). Moreover, the likelihood of dying at home increased with local wealth (OR=1.04 per $10000; 95% CI=1.02, 1.06) but decreased with local hospital bed availability (OR=0.96 per 1000 beds; 95% CI=0.95, 0.97). CONCLUSIONS: The likelihood of home death is associated with local rates of home births, suggesting the influence of health care use preferences.

Adult↗
PubMed1977

Correlates of consumer satisfaction with outpatient therapy assessed by postcards.

This paper presents research findings on the effect of numerous psychotherapy variables on clients' satisfaction with psychotherapy in an outpatient unit of a community mental health center. The surprising result is that so few variables had any significant impact. Those that did have an impact raise some questions about the value of certain kinds of therapy.

Age Factors↗
PubMed2004

Measuring community preferences for public mental health services: pilot test of a mail survey method.

This study tested the feasibility of a simple mail survey approach to measuring community preferences for mental health services. A 38 item survey detected statistically significant differences in preferences for four central goals, finding that community members most value Focus on the Severely Mentally Ill, followed by Community Safety and Environment, Service Quality and Original Community Mental Health Goals. Some procedural problems were encountered that reduced the response rates, however, the study yielded information that suggests improved procedures for future surveys. Simple mail surveys appear to offer a potentially affordable, efficient way to assess community service priorities.

Adult↗