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Literacy, education and health development: research priorities.

How education and health are linked in developing countries and what educational activities produce change are quite uncertain. Questions for research on these concerns are noted, and it is suggested that prospective longitudinal studies, household surveys, and field observations might well be added to the more usual multivariate analyses of records. Analyses of educational program implementation alternatives are also suggested.

Developing Countries↗

Post-intervention effectiveness of a computerized personalized cognitive stimulation program adapted according to cognitive reserve in older adults without cognitive impairment in Primary Care: A randomized clinical trial.

BACKGROUND: Cognitive reserve may influence responsiveness to cognitive interventions, yet it is rarely used to tailor computerized stimulation. OBJECTIVE: To evaluate the effectiveness of a computerized cognitive stimulation program personalized according to cognitive reserve on cognition, reserve-related activities, and digital competence in community-dwelling older adults without cognitive impairment in Primary Care. METHODS: In this randomized clinical trial, 102 adults aged ≥65 years with normal cognitive performance were recruited from three primary care centers in Zaragoza, Spain, and stratified by cognitive reserve level before random allocation to intervention or control. The intervention comprised digital literacy sessions followed by 8 weeks of home-based computerized cognitive stimulation tailored to participants' cognitive reserve profiles and life history. Controls received a single group-based health education session focused on maintaining everyday cognitive activity. Outcomes were assessed at baseline and post-intervention using global cognition (MEC-35), the Cognitive Reserve Questionnaire, the Mobile Device Proficiency Questionnaire-16, and domain-specific neuropsychological tests. A total of 100 participants completed the final evaluation and were included in complete-case analyses. RESULTS: Compared with controls, the intervention group showed greater adjusted post-intervention improvements in global cognition (MEC-35 between-group difference: 1.8 points) and several cognitive measures, including temporal orientation, calculation, attention, praxis, verbal fluency, processing speed, executive functions, and verbal learning. CRQ scores and digital competence also improved, with small-to-large effect sizes. CONCLUSIONS: A computerized cognitive stimulation program adapted according to cognitive reserve appears feasible in Primary Care and may improve cognition, engagement in reserve-related activities, and digital competence in older adults without cognitive impairment.

Humans↗

Teaching computer classes at the University Hospital of Münster--evaluation of long-term results.

With the increasing use of computers in the hospital, staff have to face working with a new medium and technology. Computer training is required to increase user acceptance. After a brief presentation of the current teaching concept, the effectiveness and long-term results of computer classes that have been offered at the University Hospital of Münster since August 1998 are evaluated. A questionnaire was sent to 300 course participants covering aspects of motivation, confidence, satisfaction, reluctance and some general data. Overall results were very positive. Some comments have led to considerations regarding some alterations to the program as for instance adjusting the program more to the differing needs of various professional groups or reconsidering the ways of its distribution.

Adult↗

Nutrition education and mega-dose vitamin A supplementation in Nepal.

Two approaches to improve vitamin A nutriture are compared: nutrition education and mega-dose capsule distribution. The impact of these programmes on vitamin A deficiency (VAD), wasting malnutrition, and excessive childhood mortality are compared for approximately 40,000 children who were assigned to either intervention cohorts or a control group from 75 sites within seven districts in two ecological settings (Terai, or lowland, and hills) of Nepal. Twenty-four months after the implementation of the project, the reduction of risk of xerophthalmia was greater among children of mothers who were able to identify vitamin A-rich foods [relative risk (RR) = 0.25; 95% CI = 0.10-0.62] than among children who received mega-dose capsules (RR = 0.59; 95% CI = 0.41-0.84). The risk of mortality at two years was reduced for both the nutrition education cohort (RR = 0.64; 95% CI = 0.48-0.86) and capsule distribution cohort (RR = 0.57; 95% CI = 0.42-0.77). The nutrition education program, however, was more expensive to deliver than the capsule distribution programme. High rates of participation in the supplementation programme were achieved within a short period. The nutrition education message spread rapidly throughout the study population, although practice was slower to change. Where maternal literacy was low and channels of communication were limited, the capsule programme appeared to be more cost-effective. However, economies of scale for nationwide programmes exist for nutrition education programmes that do not exist for capsule distribution programmes. A comprehensive national programme requires both dietary supplementation and nutrition education.

Child↗

Overview of computerized dietary assessment programs for research and practice in nutrition education.

Computerized dietary assessment programs are often used for nutrition education research and practice. This article provides an informal overview of 29 dietary assessment programs mentioned in the literature covered by MEDLINE from 1996 to 2003, along with the components and capabilities of these programs derived from additional sources as needed. According to the literature, the advantages of using computers for dietary assessment include standardization of the questioning sequence, fast and easy processing, immediate results, and increased flexibility. The disadvantages include the need for typing skills and computer literacy, as well as potential bias in the responses if an interviewer is required.

Diet↗

An IT awareness programme for the health sector in Ireland.

This paper describes an Awareness Programme delivered throughout Ireland which aims to increase the level of understanding of healthcare professionals as to the benefits of Information and Communications Technology (ICT) and of emerging trends in Health Informatics in Europe. The programme examines the use of ICT across the whole health sector--primary, secondary and tertiary. It has been delivered at over 30 centres to more than 1500 health professionals.

Computer Literacy↗

Library-sponsored instruction improves core informatics competencies among allied health students: a research-based case study.

Since 1999, a librarian-administered course entitled Computer Literacy for Healthcare Professionals has been required of all incoming occupational, physical, and respiratory therapy students at Stony Brook University. Outcome data from pretests/posttests and student self-assessments over a 3-year period from 2000 to 2002 demonstrate the effectiveness of the training program and of library-sponsored instruction. This study evaluated whether curriculum-integrated informatics training by librarians is effective in enabling allied health students to acquire and retain literature-searching skills. Pretests and posttests measured the impact of instructional intervention upon student acquisition of literature-searching skills; a second posttest ("post5-test") measured skill retention. The intervention group consisted of 179 subjects enrolled in baccalaureate occupational, physical, and respiratory therapy programs between 2000 and 2002; the control group consisted of 48 physician assistant students who had no formal instruction in literature searching. Student self-assessments provided qualitative outcome measures. Paired t test analysis showed that the mean posttest score for the intervention group was considerably greater at the p < 0.01 level (t = 14.868; p < 0.001) than the mean pretest score. The change is statistically significant, and the null hypothesis can be rejected. The results of this study support the conclusion that library-sponsored informatics instruction is effective in improving student acquisition and retention of literature-searching skills.

Allied Health Personnel↗

Protecting you/protecting me: effects of an alcohol prevention and vehicle safety program on elementary students.

This paper describes an evaluation of Protecting You/Protecting Me (PY/PM), a classroom-based, alcohol-use prevention and vehicle safety program for elementary students in first through fifth grades developed by Mothers Against Drunk Driving. PY/PM lessons and activities focus on teaching children about (I) their brains (why their brain is important, how their brain continues to develop throughout childhood and adolescence, what alcohol does to the developing brain, and why it is important to protect their brain); (2) vehicle safety (what to do to protect themselves should they ever ride with an impaired driver); and (3) life skills (decision making, stress management, and media literacy). Fourth- and fifth-grade students from schools in the fourth year of PY/PM implementation were surveyed. Results indicated that, relative to comparison students from matched schools, PY/PM students increased their knowledge of alcohol's effect on development; gained decision-making, stress-management, and vehicle safety skills; and demonstrated changes in attitudes toward underage alcohol use and its harm. Further, students retained lessons learned in previous years and their scores improved with increased exposure to PY/PM. In addition, the findings demonstrate that it is possible to design and implement a program that can improve young children's knowledge regarding alcohol and their developing brains, teach them skills to protect themselves in dangerous situations, increase already high antialcohol attitudes, and change perceptions of alcohol's harmfulness.

Accidents, Traffic↗

Promoting and evaluating competence in on-line dietetics education.

Professional organizations, such as the American Dietetic Association are challenged to assure competency of their practitioners. Competency includes higher-level skills such as critical-thinking, cooperative work, effective communication, and use of lifelong learning resources. Information literacy via computer technology is a key component of competency, which needs to be included in dietetic education and training. This dietetic internship examined use of online technology to develop competency using the key-feature exam. Seventy-five dietetic interns from three different programs were divided into those with (n = 44) and without (n = 31) online instruction, to which pre- and post- test key feature exams were administered. Those with online instruction had greater improvement (P < 0.05) on key-feature exams in nutrition support and pediatric nutrition. Competency is complex and difficult to assess, thus tools to better assess the comprehensive scope of practitioner competency are needed. The key-feature exam may be a tool to assess and verify practitioner competency in dietetics professionals.

Adult↗

The Deaf Mentor Experimental Project for young children who are deaf and their families.

The Deaf Mentor Experimental Project investigated the efficacy of deaf mentor services to young deaf children and their families. These services focused on deaf adults (mentors), who made regular home visits to the children and their families; shared their language (American Sign Language), culture, and personal knowledge of deafness with the families; and served as role models for the children. The children also received regular home visits from a hearing parent adviser who helped the family promote the child's early listening, English, and literacy skills. The result was a bilingual-bicultural home environment for these children. The children who received deaf mentor services were compared to matched children who did not receive these services but who received parent adviser services. Children receiving this early bilingual-bicultural programming made greater language gains during treatment time, had considerably larger vocabularies, and scored higher on measures of communication, language, and English syntax than the matched children.

Adult↗

A comparison of on-campus first year undergraduate nursing students' experiences with face-to-face and on-line discussions.

Only limited pedagogical use has been made of information and communications technology (ICT) in nursing education in Norway. In this study the use of ICT was linked to assignments in the first year undergraduate nursing program and included four on-line discussions. There is evidence to suggest that on-line discussions can enhance the learning environment. The students' experiences of the on-line discussions are compared to those of the students participating in traditional group discussions. The results show little difference between the two groups' opinions of the discussions' fruitfulness and the ease in which they expressed their feelings, thoughts and ideas. However, there is a marked difference between the two groups regarding their experience of how the discussions affected the amount of contact between group members outside the discussions. Possible reasons for these findings are discussed.

Adult↗

Predictors of student satisfaction in distance-delivered graduate nursing courses: what matters most?

This article describes a study designed to investigate graduate nursing students' satisfaction with a course taught via interactive video teleconferencing (IVT) and the World Wide Web/Internet (WWW/INT). A correlational research design examined the relationships among 5 learner attributes and 3 instructional variables and student satisfaction. Regression analyses identified learner attributes and instructional variables predictive of student satisfaction. Forty-three graduate nurse students were surveyed using a 59-item Student Satisfaction Survey (SSS). Learner attribute predictors included: (1) previous technology courses, (2) technology competence, (3) between-class technology usage, (4) age, and (5) remote-site group size. Instructional predictors were clustered into 3 dimensions: instructor/instruction, technology, and course management. Student satisfaction was a composite of overall satisfaction with the course and comparison with conventional classroom courses. Instructor/instruction explained 21 percent of the variance in course satisfaction scores. Overall instructor rating strongly correlated with satisfaction. The most potent finding was that good pedagogy is important to students' perceived satisfaction with distance education. Students acclimate to the instructional reality-traditional, campus-based face-to-face instruction, or technology-mediated distance education-and once accustomed, it is the quality and effectiveness of instructor and instruction, not the technology, that is associated with satisfaction. The findings of this study provide essential information to faculty responsible for the design and delivery of effective instruction and to students pursuing flexible and convenient options for advanced education.

Adult↗

Dedicated online virtual reference instruction.

To facilitate nursing students' information literacy skills and enhance traditional library user services, academic librarians have developed synchronous (real-time) online virtual reference instruction in nursing research classes. The authors discuss collaborative efforts of nursing and library faculty in planning, implementing, and evaluating a discipline-specific virtual reference pilot program.

Computer-Assisted Instruction↗

Predictability of observed mother-child interaction from preschool to middle childhood in a high-risk sample.

This study examined predictability of observed parent-child interaction from preschool to middle childhood in 283 mother-child dyads. Participants were welfare recipients enrolled in the Observational Study of the Job Opportunities and Basic Skills Training Program. Structured observational sessions were conducted both at preschool age and middle childhood, and were coded for maternal social behavior, child social behavior, and dyadic interaction. Analyses explored direct relations between the assessments; relations between the assessments with possible third-variable influences, such as maternal literacy, covaried out; and moderated relations. Results indicated that observed mother-child interaction in middle childhood could be significantly predicted from observed interaction 4 years earlier. Risk status moderated the relations such that those families with greater risk factors tended to show more stability, although this stability was, at times, through maintaining suboptimal functioning.

Adult↗

Community-directed cancer screening program.

The Atlanta Project, one of six American Cancer Society demonstration projects, is a community-designed and -directed breast and cervical cancer screening program focused on empowering African-American women to accept responsibility for their health maintenance. This article reports the project's goals, objectives, intervention strategies, roles of key project personnel, and outcomes. A total of 3852 women older than 40 years received breast clinical examinations, were taught breast self-examination, and had a screening mammogram; 2689 women obtained a pelvic examination and were screened for cervical cancer with a Papanicolaou smear. Of those women screened, 12 breast and 1 cervical cancers were identified and treated. Important lessons learned and successes achieved from this project were: (1) there is a need for joint planning with community representatives and their involvement in all aspects of the program's implementation and evaluation; (2) in addition to the commitment of the major participants, the community must "buy in" to the proposed health intervention; (3) the focus of the intervention should be on positive health messages; (4) cancer education materials should be culturally and literacy-appropriate; (5) the project's activities were planned to be sustained after the project period; (6) women can be empowered to accept responsibility for and control over their health.

Adult↗

Intervention to increase mammography utilization in a public hospital.

OBJECTIVE: To study the effects of three approaches to increasing utilization of screening mammography in a public hospital setting in Northwest Louisiana. DESIGN: Randomized intervention study. POPULATION: Four hundred forty-five women aged 40 years and over, predominantly low-income and with low literacy skills, who had not had a mammogram in the preceding year. INTERVENTION: All interventions were chosen to motivate women to get a mammogram. Group 1 received a personal recommendation from one of the investigators. Group 2 received the recommendation plus an easy-to-read National Cancer Institute (NCI) brochure. Group 3 received the recommendation, the brochure, and a 12-minute interactive educational and motivational program, including a soap-opera-style video, developed in collaboration with women from the target population. MEASUREMENTS AND MAIN RESULTS: Mammography utilization was determined at 6 months and 2 years after intervention. A significant increase (p = .05) in mammography utilization was observed after the intervention designed in collaboration with patients (29%) as compared with recommendation alone (21%) or recommendation with brochure (18%) at 6 months. However, at 2 years the difference favoring the custom-made intervention was no longer significant. CONCLUSIONS: At 6 months there was at least a 30% increase in the mammography utilization rate in the group receiving the intervention designed in collaboration with patients as compared with those receiving the recommendation alone or recommendation with brochure. Giving patients an easy-to-read NCI brochure and a personal recommendation was no more effective than giving them a recommendation alone, suggesting that simply providing women in a public hospital with a low-literacy-level, culturally appropriate brochure is not sufficient to increase screening mammography rates. In a multivariate analysis, the only significant predictor of mammography use at 6 months was the custom-made intervention.

Adult↗