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PubMed1989

The role of communication in the alteration of patient-care practices in hospital--a prospective study.

In infection control, ward practices often need alteration, as in Queen Mary Hospital, Hong Kong, when a policy was introduced to discontinue the recapping of needles among nurses. Nine randomly selected wards were divided into three groups (A, B and C) of 3 wards each. From an initial survey, nurses were divided into those who agreed with the discontinuation (the 'agreeables') and those who did not (the 'non-agreeables'). Methods used to introduce the policy included a simple announcement through the nursing hierarchy in group A (control), a passive method (posters and pamphlets) was added in group B and both passive and active methods (in-service lectures) were used in group C. Five weeks later, behavioural change was assessed by another survey and by an unannounced direct needle-count. Only 21% of the nurses changed their practice by simple announcement. For the 'agreeables', 85% changed by the passive method and no further improvement was observed when the active method was added. However, 83% of the 'non-agreeables' changed their practice when the active method was used while the passive method alone changed only 21%. Six months later, a third survey indicated that when the active method was included the change persisted at over 85%, while a 36% change was noted for the 'agreeables' who were only exposed to the passive method.

Communication↗

PubMed1991

Patient awareness of health precautions after splenectomy.

Sepsis after splenectomy is a lifelong risk, and patients who have had splenectomy should be educated about this risk. This study examines patient knowledge after splenectomy. We reviewed hospital records of 118 patients who had splenectomies performed between 1982 and 1988 at New Hanover Memorial Hospital. Twenty-four patients have died since their surgery; one death was suspected to be due to postsplenectomy sepsis. Of the 89 patients alive and eligible for follow-up, we were able to query 63. Only 16% were aware of any health precautions. After prompting, patient awareness improved to 40%. We also surveyed 11 of the 14 surgeons who performed the splenectomies. They indicated that they always discuss with their patients the immunologic consequences of spleen removal and the increased risks of infection, although they do not always recommend pneumococcal vaccine. We conclude that splenectomy patients have a low level of knowledge about postsplenectomy infection risks and precautions. We developed an educational pamphlet to aid the surgeon in patient education.

Awareness↗

PubMed1990

Breast feeding promotion in an urban and a rural Jamaican hospital.

Breast feeding promotion has been a national priority in Jamaica since the mid-1970s. Despite this effort, breast feeding rates have continued to decline there, especially in urban areas. Studies of the role of health professionals in promoting breast feeding have shown that specific practices encourage breast feeding, while others discourage it. In the context of declining breast feeding in a nation committed to promoting it, the goal of this study was to explore the relationship between specific health professional practices, mothers' breast feeding, and mothers' knowledge of breast feeding in rural and urban Jamaica. To accomplish this goal, a structured interview was administered to 113 mothers of infants age 0-6 months at one urban (n = 62) and one rural (n = 51) hospital, regarding (1) physician and nurse practices known to affect breast feeding, (2) mothers' own breast feeding practices, and (3) mothers knowledge of breast feeding issues. Physician and nurse visits were also directly observed to confirm responses given to the questionnaire and to assess the resources devoted to teaching mothers about breast feeding. While extensive lectures, posters and pamphlets promoting breast feeding were provided for mothers at the urban hospital, far fewer educational resources were available for mothers at the rural hospital. Overall, however, health professional practices discouraging breast feeding were observed more frequently at the urban hospital than at the rural hospital, whereas practices promoting breast feeding were more common at the rural hospital. At the rural hospital, mothers' breast feeding practices more closely approximated recommendations than at the urban hospital.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1984

Seeking an effective strategy for promoting breast self-examination among women.

Breast self-examination (BSE) may be effective in the early detection of breast cancer, but women must be aware of both the benefit of the procedure and the need for regular practice. The purpose of this study was to ascertain the effects of modeling plus rehearsal with respect to knowledge, attitudes, and subsequent frequency of BSE among women. The sample for this study consisted of 292 college students randomly assigned to one of two groups and exposed to: a facilitator-conducted program using modeling plus rehearsal (treatment group); or pamphlets addressing breast cancer and BSE (comparison group). A posttest-only comparison-group design was used. At completion of the programs, subjects responded to knowledge and attitude inventories. Three months later, a questionnaire requesting information on BSE practice was mailed to all subjects. Performance on the knowledge inventory indicated no group differences (P = 0.05). However, there were significant differences between groups in practice frequency and in selected attitudes (P less than 0.05). At three-month follow-up, significantly more members of the treatment group indicated practicing BSE at least once since exposure to the educational program. Conclusions support those of earlier investigations and indicate that modeling with rehearsal can be a useful method for promoting the practice of BSE.

Breast Neoplasms↗

PubMed1989

Promoting child passenger safety in children served by a health maintenance organization.

A patient education program, based on the health belief model, promoting child passenger safety was developed and implemented at a health maintenance organization. The program included individual counseling by pediatricians, use of audiovisual materials and pamphlets, and (for newborn infants) a home visit by a child safety specialist. Based on parking lot observations, child safety device use increased to greater than 60% in both intervention and comparison-group children 1-4 years of age. During the child health supervision visit, pediatricians can play a leadership role in promoting child passenger safety.

Accident Prevention↗

PubMed1995

Benefits of a computer-assisted education program for hypertensive patients compared with standard education tools.

ISIS (Initiation Sanitaire Informatisée et Scénarisée), a French computer-assisted hypertension and cardiovascular risk education program, was developed to provide patients at cardiovascular risk with a modern interactive educational tool combining rigorously scientific information with the aesthetic attractiveness of multimedia communication. To test the impact of this tool on patient health information retention, 158 hypertensives hospitalized for initial work-up (day hospital) or therapeutic adjustments (3 days) were randomized into control (n = 79) and ISIS (n = 79) groups. Both groups received cardiovascular education through standard means: physicians, nurses, dietitians and pamphlets. In addition, ISIS patients underwent a 30- to 60-min session on the computer with the ISIS program. Cardiovascular knowledge was tested by the same investigator administering a standardized 28-item questionnaire before and 2 months after education. Retesting was made by telephone. At the time of first assessment, all patients were aware that they would be retested. A total of 138 completed questionnaires (69 from each group) was analyzed. Overall mean cardiovascular knowledge score before education improved significantly after education. This improvement was greater in the ISIS than the control group. These results confirm the potential of computer-assisted education in hypertensives from a specialized center.

Adult↗

PubMed2005

Randomized trial of a physician-based intervention to increase the use of folic acid supplements among women.

OBJECTIVE: Fewer than one third of American women take folic acid daily, although many women report that they would take folic acid if their physicians advised them to do so. This study determined the impact of a physician intervention during routine gynecologic visits on folic acid supplementation. STUDY DESIGN: Patients were assigned randomly to receive brief folic acid counseling, a reminder phone call, and 30 folic acid tablets (n = 162 women; intervention group) or to receive counseling about other preventive health behaviors and a folic acid informational pamphlet (n = 160 women; control group). Self-reported folic acid use was compared at baseline and at 2 months. RESULTS: Of the 279 patients who completed the study, weekly folic acid intake increased in the intervention group by 68%, compared with 20% in the control group ( P =.008). No significant differences were found in daily intake. The women who were most influenced by the intervention were black and lower income and not planning pregnancies. CONCLUSION: With little effort expended to encourage folic acid use, gynecologists could potentially reduce the risk of folate-preventable birth defects among their patients by as much as 11%.

Adolescent↗

PubMed2004

Balloon mania: news in the air.

The hot-air balloon, invented by the Montgolfier brothers in 1783, enabled the French King to project his glory, the nobility to exhibit their valor, the literary public to transmit the ideal of the Enlightenment and the plebian public to rejoice in a scientific spectacle. The ensuing balloon mania helped create an integrated public that, because of its size and composition, can only be described as 'democratic' just a few years before the French Revolution. The monumental impact of the balloon was well represented in a flood of poetry, pamphlets, books, journal reports, academic papers and consumer items. Sifting through these artifacts and considering the crowd that witnessed the ascent of the balloon will bring us to the historical moment when things, spectacles, and events (rather than words) shaped public and popular opinion.

Air↗

PubMed2005

Long-term improvement in unsafe injection practices following community intervention.

BACKGROUND: A study in 1994 identified frequent unsafe injections as the cause of widespread hepatitis C virus infection in Hafizabad, Pakistan. A simple low cost community education program was assessed to see if it improved injection safety. METHODS: A local health organization developed educational materials on hepatitis C including advice on how to avoid unnecessary injections and, when injections were necessary, to use a new syringe and needle. Beginning in 1995, this advice was communicated through multiple channels including health education meetings, announcements in mosques, and via pamphlets. In 1998 study workers revisited controls from the 1994 case-control study (along with three of their neighbors of a similar age) to collect information on injection practices in the previous 12 months. RESULTS: Thirty-three percent of the study's participants in 1998 received >or=5 injections in the preceding 12 months compared to 40% of the hepatitis C virus negative controls reported in the year prior to the 1994 study (p=0.85). In 1998 52 persons (34%) brought their own syringe for their most recent injection, a practice that was unreported in 1994. Overall, in 1998 59% of patients received their most recent injection with a new syringe and needle compared to 24% in 1994 (p=0.003). CONCLUSIONS: Following this low cost health communication effort, community members took steps to protect themselves from unsafe injections.

Adult↗

PubMed2004

Influence of dietitian presence on outpatient cardiac rehabilitation nutrition services.

To describe variations in nutrition services offered in a nationally representative sample of out-patient cardiac rehabilitation programs by presence of a registered dietitian (RD), a survey was conducted of 250 randomly selected centers from 1,111 US outpatient cardiac rehabilitation centers in the 1998/1999 Cardiac Rehabilitation Directory of the American Association of Cardiovascular and Pulmonary Rehabilitation. A total of 190 of the 250 surveys (76%) were returned. Nutrition services offered by programs polled included distribution of nutrition pamphlets, one-on-one nutrition counseling, group nutrition classes, guest lectures on nutrition, and cooking demonstrations. Cardiac rehabilitation programs with an RD offered significantly more nutrition services on average (4.2+/-1.2) than programs without an RD (3.5+/-1.1, P=.01). Programs with RDs were more likely to offer one-on-one nutrition counseling than programs without them (98% and 80% respectively, P<.001), and they were also more likely to offer cooking demonstrations (43% and 17% respectively, P=.02). More, and a greater variety of, nutrition services are offered in cardiac rehabilitation programs that have an RD. Without an RD, exercise physiologists and registered nurses often provide some, but fewer and different, nutrition services.

Cooking↗

PubMed2006

An informed decision? Breast cancer patients and their knowledge about treatment.

OBJECTIVE: Although involving women in breast cancer treatment decisions is advocated, there is little understanding of whether women have the information they need to make informed decisions. The objective of the current study was to evaluate women's knowledge of survival and recurrence rates for mastectomy and breast conserving surgery (BCS) and the factors associated with this knowledge. METHODS: We used a population-based sample of women diagnosed with breast cancer in metropolitan Los Angeles and Detroit between December 2001 and January 2003. All women with ductal carcinoma in situ and a random sample of women with invasive disease were selected (N=2382), of which 1844 participated (77.4%). All participants were mailed surveys. The main outcome measures were knowledge of survival and recurrence rates by surgical treatment type. RESULTS: Only 16% of women knew that recurrence rates were different for mastectomy and BCS, and 48% knew that the survival rates were equivalent across treatment. Knowledge about survival and recurrence was improved by exposure to the Internet and health pamphlets (p<0.01). Women who had a female (versus male) surgeon, and/or a surgeon who explained both treatments (rather than just one treatment) demonstrated higher survival knowledge (p<0.01). The majority of women had inadequate knowledge with which to make informed decisions about breast cancer surgical treatment. CONCLUSION: Previous explanations for poor knowledge, such as irrelevance of knowledge to decision making and lack of access to information, were not shown to be plausible explanations for the low levels of knowledge observed in this sample. PRACTICE IMPLICATIONS: These results suggest a need for fundamental changes in patient education to ensure that women are able to make informed decisions about their breast cancer treatment. These changes may include an increase in the use of decision aids and in decreasing the speed at which treatment decisions are made.

Adult↗

PubMed2005

The effects of different knowledge-dissemination interventions on the mastitis knowledge of Tanzanian smallholder dairy farmers.

We developed three different knowledge-dissemination methods for educating Tanzanian smallholder farmers about mastitis in their dairy cattle. The effectiveness of these methods (and their combinations) was evaluated and quantified using a randomised controlled trial and multilevel statistical modelling. To our knowledge, this is the first study that has used such techniques to evaluate the effectiveness of different knowledge-dissemination interventions for adult learning in developing countries. Five different combinations of knowledge-dissemination method were compared: 'diagrammatic handout' ('HO'), 'village meeting' ('VM'), 'village meeting and video' ('VM+V'), 'village meeting and diagrammatic handout' ('VM+HO') and 'village meeting, video and diagrammatic handout' ('VM+V+HO'). Smallholder dairy farmers were exposed to only one of these interventions, and the effectiveness of each was compared to a control ('C') group, who received no intervention. The mastitis knowledge of each farmer (n=256) was evaluated by questionnaire both pre- and post-dissemination. Generalised linear mixed models were used to evaluate the effectiveness of the different interventions. The outcome variable considered was the probability of volunteering correct responses to mastitis questions post-dissemination, with 'village' and 'farmer' considered as random effects in the model. Results showed that all five interventions, 'HO' (odds ratio (OR)=3.50, 95% confidence intervals (CI)=3.10, 3.96), 'VM+V+HO' (OR=3.34, 95% CI=2.94, 3.78), 'VM+HO' (OR=3.28, 95% CI=2.90, 3.71), 'VM+V' (OR=3.22, 95% CI=2.84, 3.64) and 'VM' (OR=2.61, 95% CI=2.31, 2.95), were significantly (p<0.0001) more effective at disseminating mastitis knowledge than no intervention. In addition, the 'VM' method was less effective at disseminating mastitis knowledge than other interventions. Combinations of methods showed no advantage over the diagrammatic handout alone. Other explanatory variables with significant positive associations on mastitis knowledge included education to secondary school level or higher, and having previously learned about mastitis by reading pamphlets or attendance at an animal-health course.

Animals↗

PubMed2005

What accounts for the relationship between social class and smoking cessation? Results of a path analysis.

Despite the overall decline in cigarette smoking prevalence in the US, social class inequalities in smoking are likely to persist, or even to widen. One possible reason for the increasing gap in smoking prevalence across social class could be our lack of understanding of causal mechanisms: in other words, what accounts for the social gradient in smoking behavior? In this paper, we examine the mechanisms behind social gradients related to smoking cessation by use of path analysis techniques. The data come from a 3-year follow-up telephone survey of a cohort of US adults. The sample for the present analysis was drawn from the 481 respondents who reported being smokers and employed at baseline and who completed the follow-up interview. We examined two social class indicators, educational attainment and household income, in relation to smoking cessation. We tested the potential mediating effects of the following variables: differential use of resources for smoking cessation (e.g., booklet, pamphlet, quit line, nicotine replacement therapy and smoking cessation program), differential environments in terms of smoking at worksite and home, and differences in peer smoking. Our path analyses suggest that smokers from high social class are likely to use effective resources for smoking cessation and have restrictive home environment in terms of smoking, which leads to a relatively higher smoking cessation rate compared to those from low social class. The results of this study suggest that interventions should target resources for smoking cessation and home environments in terms of smoking to reduce socio-economic disparities in smoking cessation.

Adult↗

PubMed2026

Experimental validation of an AI-driven digital healthcare platform for oral health behavior and plaque assessment among vietnamese children.

BACKGROUND: Oral health among children in developing countries, including Vietnam, remains a significant public health concern. Innovative approaches leveraging artificial intelligence AI-based digital health platforms may offer effective strategies for managing dental plaque and promoting better oral hygiene behaviors among school-aged children. This study aimed to evaluate the effectiveness of an AI-driven oral healthcare platform (Denti-i Vietnam) in improving oral hygiene and behavioral outcomes among Vietnamese primary school students. METHODS: A total of 204 primary school students aged 8-10 years in Hanoi, Vietnam, participated in this experimental study. Participants were randomly assigned to an intervention group (n = 107), which used the AI-driven oral healthcare platform, and a comparison group (n = 97), which received traditional oral health education via pamphlets. Oral health behaviors, dental plaque levels (Simplified Oral Hygiene Index; OHI-S), and caries indices (dft/DMFT) were assessed at baseline and after the intervention period. RESULTS: The intervention group demonstrated a significant reduction in the OHI-S score compared to baseline (2.49 ± 0.60 to 1.70 ± 0.76, p < 0.001), particularly in the debris component, indicating enhanced plaque control. Notable improvements were also observed in oral hygiene behaviors, including increased frequency of toothbrushing before and after breakfast (p < 0.01) and more frequent parental assistance during brushing (p = 0.03). Furthermore, parental awareness of dental caries significantly increased in the intervention group (p = 0.001). CONCLUSIONS: The AI-driven oral healthcare platform significantly improved both oral hygiene behaviors and plaque control among Vietnamese primary school children. These findings suggest that AI-driven digital health tools can serve as practical and scalable solutions for promoting oral health in developing countries.

Humans↗

PubMed1988

Quality interpersonal care. A study of ambulatory surgery patients' perspectives.

Examining outcome criteria that measure quality is one way of evaluating patient care and emotional support. The method used in this study shows the actual effects of interventions in patient education. The findings suggest that not all patients perceived that the quality criteria that measure emotional support and patient teaching were met. Certain variables were identified as explaining the patients' perception of quality. For example, although patients perceived surgeons who spent time with them before and after surgery to have improved interpersonal quality, they perceived the ambulatory surgery site that required professional nurses to demonstrate caring and concern as providing better quality care. Furthermore, the teaching that enabled most patients to acquire adequate knowledge of self-care was done at the time of discharge, with the family present, and did not rely on written pamphlets, although written instructions were included in the teaching. This examination of different nursing approaches suggests that variations in interventions have a major impact on the outcomes of care. Even with cost-containment measures that threaten to diminish quality, professional nurses can provide direction in establishing quality standards of ambulatory surgery care. There are identifiable nursing interventions that can be implemented to maintain quality. Consistent review of prior nursing care can provide professional nurses with information on meeting quality standards and suggest new approaches to patient care.

Adolescent↗

PubMed1997

Anti-lock brake system: an assessment of training on driver effectiveness.

When activated correctly, Anti-Lock Brake Systems (ABS) can provide drivers with the ability to stop a vehicle in shorter distances and allow for more vehicle control under heavy braking than conventional brake systems. This is especially true under wet or icy road conditions. However, it is believed that many drivers are either unaware of the correct method of activation or they revert back to the old method of pumping the brakes when they are faced with a hard braking situation. This paper examines the effectiveness of implementing low-cost training methods for alerting drivers to the correct brake activation technique. A 4-page, color training pamphlet was developed and subjects were given a short period of time to read it over before being asked to drive on an icy test track. Results indicated that those subjects who received the training were able to stop in shorter distances in a straight line braking event and more often used the correct brake activation technique than those subjects who did not receive the training. However, the stopping distance benefits were not realized in the curved and surprise braking events. These results suggest that the transfer of verbal knowledge may have value as a means for solving the apparent problem of improper ABS usage. However, some additional research should be done to validate these results. Since this experiment was conducted directly after the material was read, the possibility exists that without reinforcement, the trained braking techniques might become extinct in a short period of time.

Accidents, Traffic↗

PubMed1997

Randomized controlled trial of a prenatal vaginal birth after cesarean section education and support program. Childbirth Alternatives Post-Cesarean Study Group.

OBJECTIVE: Our objective was to assess whether, for women with previous cesarean section, a prenatal education and support program promoting vaginal birth after cesarean delivery increases the probability of vaginal delivery. STUDY DESIGN: Women with a single previous cesarean were recruited before 28 weeks' gestation. Women's self-assessed motivation to attempt vaginal birth after a previous cesarean delivery was measured on a 10 cm visual analog scale: stratum I, low motivation; stratum II, high motivation. Women were randomized by stratum to one of two groups. Those in the "Verbal" group participated in an individualized education program. Those in the "Document" group were provided with a pamphlet detailing the benefits of planned vaginal birth after cesarean delivery. RESULTS: Rates of vaginal birth after cesarean section were similar in the verbal and document groups: verbal, 339 of 641 (53%); document, 310 of 634 (49%); relative risk 1.1, 95% confidence interval 1.0 to 1.2. There was no evidence of heterogeneity across motivational strata. Regardless of treatment group, women with low motivation for vaginal birth after cesarean section were more than three times as likely to undergo elective repeat cesarean than were women with high motivation (47% vs 13%). CONCLUSIONS: There was no evidence that an individualized prenatal education and support program, when offered to all women with previous cesarean delivery, results in a clinically significant increase in the rate of vaginal birth after cesarean section.

Adult↗

PubMed1980

Experience with day stay surgery.

Potential advantages of day stay surgery are cost saving, improved utilization of staff and hospital facilities, and reduction of stress for the paediatric patient and his family. The successful program requires careful case selection, full operating and anesthetic facilities and good follow-up. Day stay surgery was initiated at Royal Alexandra Hospital for Children in 1974. Experience is reviewed in relation to the total number and nature of surgical admissions and the daily utilisation of the facility. Utilization has markedly increased in the past 2 yr. Current practice is reviewed with regard to initial assessment, preparation for surgery and overall management during the day admission. Parental attitudes towards day stay surgery were evaluated indicating both the advantages and the problems encountered. These related mainly to insufficient information, transport difficulties and afternoon operations. Recommendations for improving the day stay service are discussed with special reference to: (1) communication with the parents as to adequate pre-operative explanation, revision of the day stay information pamphlet and improved distribution, and clear postoperative instructions, (2) the timing of operations, and (3) transport and parking facilities.

Ambulatory Surgical Procedures↗