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Health literacy education and training: a student-professional collaboration.

A Healthy People 2010 objective is to improve the health literacy of persons with inadequate or marginal literacy skills. We designed a nutrition education module for dietetics students that allowed learning about health literacy while teaching this information to interested practitioners. Students designed a workshop for nutritionists by conducting a learning needs assessment and then developing learning objectives, content/methods, and process/outcome objectives. Students presented interactive sessions on using literacy assessment tools and developing low-literacy education materials. Handout packets included a list of relevant literacy Web sites. Evaluations unanimously rated the workshop as excellent or good. By helping teach others, students' learning experience was enhanced.

Adult↗

[A computer-assisted patient databank for the ENT field].

In this study, a patient database program was prepared for patients admitted to the ENT Department of Ege University Hospital, Izmir. The algorithm of the program was created by using dBASE IV. In order to develop a patient database, a careful preparation and running stage had to be accomplished. However, the most important factor was proper maintenance. The greatest problem during the maintenance stage was compliance of the doctors or secretaries using the program. This was overcome by choosing or making a user-friendly, flexible, practical and beneficial patient database program. The study also showed that doctors could make their own patient databases and use them efficiently if they are interested in computers.

Algorithms↗

Self-reported medication use in community-residing older adults: A pilot study.

BACKGROUND: Older adults (ie, those aged > or = 65 years) are at increased risk of developing drug therapy problems, which may lead to poor health outcomes and decreased quality of life. OBJECTIVE: The primary goal of this pilot study was to evaluate and report medication use and potential drug therapy problems in older adults who received Eldercare program assistance through the Orange County Department on Aging in North Carolina. METHODS: Between May and July 2002, subjects were consecutively sampled from a registry of adults aged > or = 60 years enrolled in the Eldercare program. To be eligible for the study, individuals had to be receiving the services of the Eldercare program, speak English, and reside independently in the community of Orange County. The older adults were contacted by the program director to determine interest in participating in the study. If interested, the individual was contacted by a trained pharmacy doctoral student to verify study eligibility and arrange a home visit. At the home visit, information was collected via self-report on medication use and medical history. Nonadherence, potentially inappropriate prescribing, health literacy, and functional capacity were also assessed. All home visits were conducted between May and July 2002. RESULTS: A total of 100 subjects were interviewed. The mean (SD) age of respondents was 77.5 (8.7) years; 85% were women, 66% were white, 34% black, and 70% lived alone. The mean (SD) number of prescription medications used per patient was 9.6 (4.1). Adequate health literacy, defined as a score > or = 23 (range of possible scores, 0-36) on the Short Test of Functional Health Literacy in Adults, was documented in only 35% of individuals. Twenty-five percent of the sample (25/100) had reduced functional capacity when evaluated on the Functional Activities Questionnaire, with total scores > or = 10 (range of possible scores, 10-30) indicative of reduced functional ability. Rates of nonadherence, defined as a score of 0 to 3 on the 4-item Morisky instrument, were 53%. When evaluating inappropriate prescribing based on the Beers criteria, 34% of individuals used > or = 1 potentially inappropriate medication. In bivariate analyses, there was a statistically significant relationship between race and number of medications (P < 0.002), adherence (P < 0.001), health literacy status (P < 0.001), and functional capacity (P < 0.027). No differences were noted when examining the effects of age on the same variables. CONCLUSIONS: In this study, older adults residing independently in the community were responsible for managing and taking a considerable number of medications on a daily basis. In addition, inadequate health literacy, poor adherence, and potentially inappropriate medication use were prevalent in this sample. The results also suggest that race may have played an important role in the risk of developing medication-related problems.

Black or African American↗

Diarrhea and the social marketing of oral rehydration salts in Bangladesh.

An anthropological study of knowledge, attitudes and practices relating to child diarrhea and specifically to ORS was carried out in Bangladesh. The purpose of the study was to help design a culturally-sensitive social marketing program. Information was gathered on indigenous classification of diarrheas, patterns of therapy recourse and diarrhea management, and understanding of dehydration symptoms as well as use and attitudes regarding ORS. Among the findings were that 58% of households sampled had tried ORS at least once; ORS was perceived as a medicine with several positive attributes; literacy was positively related to ORS use; and there were no significant cultural barriers to ORS adoption.

Attitude to Health↗

Students' evaluation of online course materials in fixed prosthodontics: a case study.

PURPOSE: The purpose of this study was to assess a new online course format for dental students. Preclinical Fixed Prosthodontics I is a didactic and laboratory course given in the first year of the dental school curriculum. In the spring semester of 1999, the didactic portion of the course was offered in a web-based format as a supplement to the traditional lecture format. METHODS: The study population was 53 first year dental students at one school. The study design was a one group post test without a control group. The online questionnaire consisted of multiple choice questions, Leikert scale questions and open-ended questions. Data were collected using Filemaker Pro and analyzed using Epilnfo. RESULTS: Student response rate was 96% (52/53). All of the students responded that they felt comfortable with their computer skills in utilizing this course format. Most (96%) responded that the online materials were either very helpful or helpful to them. About half, (54%) recommended that the online format be continued as a supplement to traditional lectures, while 28% recommended replacing traditional lectures with the new format in order to provide more laboratory time in the course. The syllabus, lecture materials, bulletin board and handouts were found to be the most helpful online features. The least helpful features were the listserve, decision tree, and e-mail options. Most frequently mentioned strengths of the online material were listed as 1) the ability to view material at their own pace and at a time convenient to them, 2) quality photographs in lecture materials and 3) online quizzes. Weaknesses of the course were ranked by students as 1) problems with access to the materials and the intranet system, 2) taking quizzes online and 3) difficulty in printing the web-based lecture materials. CONCLUSIONS: The delivery of web-based material as a course supplement in Fixed Prosthodontics I was determined to be an overall success. Fine tuning of problems with access to the materials took place throughout the course. The student feedback will help direct future development of web-based course materials in the dental school curriculum.

Adult↗

Women's health nursing in the context of the National Health Information Infrastructure.

Nurses must be prepared to participate in the evolving National Health Information Infrastructure and the changes that will consequently occur in health care practice and documentation. Informatics technologies will be used to develop electronic health records with integrated decision support features that will likely lead to enhanced health care quality and safety. This paper provides a summary of the National Health Information Infrastructure and highlights electronic health records and decision support systems within the context of evidence-based practice. Activities at the Columbia University School of Nursing designed to prepare nurses with the necessary informatics competencies to practice in a National Health Information Infrastructure-enabled health care system are described. Data are presented from electronic (personal digital assistant) encounter logs used in our Women's Health Nurse Practitioner program to support evidence-based advanced practice nursing care. Implications for nursing practice, education, and research in the evolving National Health Information Infrastructure are discussed.

Adolescent↗

Webcasting: a new instructional technology in distance graduate nursing education.

Webcasting is a new instructional technology used to deliver audio and video presentations via the Internet, enabling learners to participate in a live class via a personal computer. In this article, we describe the workflow involved in producing a Webcast class and provide a detailed account of the process of adopting Webcasting as a medium to provide distance education at a state university in a rural setting. This article addresses the team members required to seamlessly integrate Webcasting into the curriculum: information technology specialists, faculty, students, and administrators. We also identify problems encountered with implementation of Webcasting and methods used to resolve them.

Adult↗

Community-based ivermectin distributors: onchocerciasis control at the village level in Plateau State, Nigeria.

The use of community residents as agents for distributing mass ivermectin therapy for onchocerciasis provides a component of community participation absent from mobile team delivery methods. Community-based distribution, however, presupposes preexisting human resources in the endemic villages capable of fulfilling the essential functions of an ivermectin distribution process: mobilizing and educating the population, dispensing the drug, maintaining records, and monitoring and treating adverse reactions. Even when such human resources exist, the community workers must continue to receive tangible support from both external (government and donor agencies) and internal (community) sources. Donor and government agencies must accept that their data collection demands will be limited by the literacy standards of the communities being served. Community leaders must agree to set and use their own local standards of payment (including food stuffs or exchange in kind) to compensate the distributors for their time and efforts. The use of locally available human and remunerative resources is a prerequisite for true community ownership of a program.

Antinematodal Agents↗

Effect of a computer-based decision aid on knowledge, perceptions, and intentions about genetic testing for breast cancer susceptibility: a randomized controlled trial.

CONTEXT: As the availability of and demand for genetic testing for hereditary cancers increases in primary care and other clinical settings, alternative or adjunct educational methods to traditional genetic counseling will be needed. OBJECTIVE: To compare the effectiveness of a computer-based decision aid with standard genetic counseling for educating women about BRCA1 and BRCA2 genetic testing. DESIGN: Randomized controlled trial conducted from May 2000 to September 2002. SETTING AND PARTICIPANTS: Outpatient clinics offering cancer genetic counseling at 6 US medical centers enrolled 211 women with personal or family histories of breast cancer. INTERVENTIONS: Standard one-on-one genetic counseling (n = 105) or education by a computer program followed by genetic counseling (n = 106). MAIN OUTCOME MEASURES: Participants' knowledge, risk perception, intention to undergo genetic testing, decisional conflict, satisfaction with decision, anxiety, and satisfaction with the intervention. Counselor group measures were administered at baseline and after counseling. Computer group measures were administered at baseline, after computer use, and after counseling. Testing decisions were assessed at 1 and 6 months. Outcomes were analyzed by high vs low risk of carrying a BRCA1 or BRCA2 mutation. RESULTS: Both groups had comparable demographics, prior computer experience, medical literacy, and baseline knowledge of breast cancer and genetic testing, and both counseling and computer use were rated highly. Knowledge scores increased in both groups (P<.001) regardless of risk status, and change in knowledge was greater in the computer group compared with the counselor group (P =.03) among women at low risk of carrying a mutation. Perception of absolute risk of breast cancer decreased significantly after either intervention among all participants. Intention to undergo testing decreased significantly after either intervention among low-risk but not high-risk women. The counselor group had lower mean scores on a decisional conflict scale (P =.04) and, in low-risk women, higher mean scores on a satisfaction-with-decision scale (P =.001). Mean state anxiety scores were reduced by counseling but were within normal ranges for both groups at baseline and after either intervention, regardless of risk status. CONCLUSIONS: An interactive computer program was more effective than standard genetic counseling for increasing knowledge of breast cancer and genetic testing among women at low risk of carrying a BRCA1 or BRCA2 mutation. However, genetic counseling was more effective than the computer at reducing women's anxiety and facilitating more accurate risk perceptions. These results suggest that this computer program has the potential to stand alone as an educational intervention for low-risk women but should be used as a supplement to genetic counseling for those at high risk.

Adult↗

Personal computers and urological research.

The value of a computer in urological research depends not only upon an appropriate and informed choice of hardware, but also the purchase of software programs which will facilitate input, manipulation and transfer of relevant data. Acquaintance with the Data Protection Act is essential, as is registration as a data user in most cases.

Computer Literacy↗

Can nursing facility staff with minimal education be successfully trained with computer-based training?

This study compares the effects of computer-based and instructor-led training on long-term care staff with a high school education or less on fire safety knowledge, attitudes, and practices. Findings show that both methods of instruction were effective in increasing staff tests scores from pre- to posttest. Scores of both groups were lower at follow-up three months later but continued to be higher than at pretest. Staff with a high school education increased scores more than those without a high school diploma.

Adult↗

Using information technology for patient education: realizing surplus value?

Computer-based patient information systems are introduced to replace traditional forms of patient education like brochures, leaflets, videotapes and, to a certain extent, face-to-face communication. In this paper, we claim that though computer-based patient information systems potentially have many advantages compared to traditional means, the surplus value of these systems is much harder to realize than often expected. By reporting on two computer-based patient information systems, both found to be unsuccessful, we will show that building computer-based patient information systems for patient education requires a thorough analysis of the advantages and limitations of IT compared to traditional forms of patient education. When this condition is fulfilled, however, these systems have the potential to improve health status and to be a valuable supplement to (rather than a substitute for) traditional means of patient education.

Adult↗

Discharge information needs of patients after surgery.

Patients who have undergone surgical procedures often have self-care concerns in their preparation for discharge from the hospital. This article examines the research literature about information needs of postoperative patients prior to their discharge. The most common concerns were the incision/wound care, pain management, activity level, monitoring for complications, symptom management, elimination, and quality of life. Because of their clinical knowledge of the perioperative experience, wound, ostomy, and continence nurses and other advanced practice nurses have a critical role in the development of discharge-educational programs for postoperative patients and caregivers. Because unmet discharge needs can contribute to poor patient outcomes and readmission, it is critical that wound, ostomy, and continence nurses, advanced practice nurses, and clinical staff nurses accurately identify patients' informational needs and find ways to meet these needs especially with the aging population, new/advanced surgical procedures, vulnerability/poverty, and literacy level of patients.

Attitude to Health↗

Sharing science: characteristics of effective scientist-teacher interactions.

Despite national guidelines to reform K-12 science education, our students are not learning science any better. Conducted under the auspices of the American Association for the Advancement of Science, a symposium examined several programs where professional scientists interact with classroom teachers to improve science education. Symposium participants described their projects and discussed the factors that contribute or detract from each project's success. The events of this symposium are critically analyzed. Four themes emerged as issues that affect the successful implementation and continuation of science education reform projects: scientific literacy as a primary goal, personal characteristics and commitment of project partners, curricular change built on social and developmental goals, and the incentive/reward structures in universities and school systems. This review of the emergent themes places the opinions of the symposium participants into the larger context of a growing science education research literature to inform others about synergy between professional scientists and classroom teachers. Our aim is to help others learn about the characteristics of effective partnerships to improve science education.

Cooperative Behavior↗

An evaluative case study of online learning for healthcare professionals.

BACKGROUND: This evaluation study assessed the pedagogical and instructional design (e-pedagogy) effectiveness of online continuing professional education (CPE) courses offered by a large Australian CPE provider. METHODS: A naturalistic theory approach and a multilevel evaluation were used to examine the impact of web-based learning on more than 300 healthcare professionals. Participant satisfaction, learning achievement, self-reported practice performance change, and e-pedagogical courseware characteristics were assessed by various qualitative and quantitative data collection methods. RESULTS: Findings revealed that learning online was an effective means for increasing CPE knowledge (p < .05) and improving self-reported practice performance change (p < .05). Courses containing a clinical tool resulted in an increased self-reported practice performance change over courses that did not (Zobs = 3.757). CONCLUSION: Online CPE offers a convenient format for healthcare professionals from educationally and geographically diverse populations to update their knowledge and view best practice.

Analysis of Variance↗

The effect of demographic variables on achievement in and satisfaction with online coursework.

Although an ethnically diverse health care workforce is considered necessary to meet the needs of our multicultural society, little attention has been given to the effect of language in distance-delivered coursework. A population of ethnically diverse nurse practitioner and physician assistant students at three institutions was studied to determine the effect of demographic variables, such as native language, gender, and prior computer experience, on both successful completion of and satisfaction with online coursework. No significant difference was found in academic achievement of native and non-native English speakers, nor in course satisfaction between these two groups. In addition, neither gender nor prior computer experience affected either academic achievement or course satisfaction.

Adult↗

Improving antenatal care for pregnant adolescents in southern Malawi.

BACKGROUND: This paper considers why antenatal care (ANC) programs for adolescents may need to be improved in areas where a high proportion of first pregnancies are to young girls. DESIGN: Descriptive data on the characteristics of 615 adolescents (aged 10-19 years) who attended for a first antenatal care visit at two rural hospitals in southern Malawi are given. For the 41.5% who came for a supervised delivery, details of their pregnancy care and delivery outcome are provided. The Chi-square test is used for determining significant differences between age and parity groups and logistic regression for an analysis of low birthweight. RESULTS: Fifty-two percent of girls were nulliparous, 24.5% were < or =16 years and 73.3% were illiterate. Prevalence of anemia, malaria and HIV infection was high. Girls who were nulliparous, illiterate, made early antenatal care visits or gave a history of stillbirth or abortion were less likely to attend for delivery. Few primiparae required an assisted vaginal delivery or cesarean section but primiparae had more adverse birth outcomes. Forty percent of primiparae <17 years gave birth to low birthweight babies as did 28.3% of multiparae. In a logistic regression (all adolescents) low birthweight was correlated with literacy (p=0.03) and number of antenatal care visits (p=0.01). CONCLUSIONS: Pregnancy morbidity and adverse birth outcomes were common in spite of antenatal care attendance. This partly reflects poor management of malaria during pregnancy. In areas like Malawi, where childbearing starts early, girls in their first pregnancy need good quality care and careful monitoring if problems are not to be perpetuated to a second pregnancy. Many girls start pregnancy with HIV and schistosomal infections which indicates the need for programs before girls become pregnant.

Adolescent↗

The importance of informatics competencies in nursing: an Australian perspective.

Over the past two decades, dramatic changes have occurred in the nature and extent of communication and information technology use in nursing worldwide. The need for student nurses to be well prepared for the use and application of information technology in nursing is arguably now paramount. This article details areas where information and communication technology is used in nursing in Australia and discusses why nurses must be diligent in maintaining skills in this area to facilitate the delivery of safe, quality care in any healthcare setting. It will then discuss the importance of information and communication technology (ICT) skills, knowledge and understanding as an integral aspect of nursing programs in tertiary institutions. The challenge for training providers to prepare nurses for ever-changing ICT technology and technological applications in their workplace is highlighted.

Attitude of Health Personnel↗