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PubMed1999

Assessing and enhancing medical students' computer skills: a two-year experience.

In 1984, the Association of American Medical Colleges (AAMC) issued recommendations for the reform of medical education. One recommendation was that information sciences be incorporated into the medical curriculum. In fall 1996, a survey was conducted to learn more about computer use by medical students at the Rockford regional site of the University of Illinois at Chicago College of Medicine. The purpose of the survey was to gather information not only about computer skills, but also about overall comfort level in using computers and about expectations for enhancing computer skills while attending medical school. Over a two year period, 208 students representing four classes received this survey in their e-mail. Non-respondents received a follow-up print copy in their student mailboxes. Results, based on a 60% response rate, showed a majority of Rockford students entered medical school with good skills in using e-mail and word processing, but many lacked the skills necessary to search the medical literature or to use computer-assisted instructional programs. Overall, 80% of students expected to learn more about computers while attending medical school. Results contributed to an increased effort to integrate computer applications into the medical curriculum and to use computers as a means of communicating with students.

Computer Communication Networks↗
PubMed2001

Health educators' role in promoting health literacy and advocacy for the 21st century.

This article discusses the relationship between health literacy and advocacy for health and health education, cites achievement of advocacy as a critical outcome of health education, and identifies health advocacy competencies for both students and health educators. The paper also delineates a role for health education in developing health-literate citizens and in training health educators to advocate for health and health education. The article draws on recent initiatives in comprehensive school health education and coordinated school health programs to identify content and strategies for developing health advocacy skills among elementary, middle, and senior high school students. The article provides a variety of approaches and strategies for developing advocacy skills among preservice and inservice health educators.

Consumer Advocacy↗
PubMed2006

Nursing information system development in a Brazilian General Public Hospital.

The purpose of this paper is to demonstrate the importance of the nurses' participation in the development process of a computerized nursing information system. The methodology was based in the prototype system life cycle. It was following up into two phases: the definition and the development one. The results demonstrate that the appropriate choice of the project team makes the difference. The team must be constituted by nurses committed with the professional practice and also computer literacy. It was observed that the active participation of the nurses through out the process made possible to determine the basic system requirements and functions.

Brazil↗
PubMed2005

Optimal design features for surveying low-income populations.

Improving Medicaid program effectiveness for underserved populations is hampered by low survey response rates. This study determined how to maximize Medicaid consumer satisfaction survey response rates to the Consumer Assessment of Health Plans Study (CAHPS) survey. In a public immunization clinic, 8 focus groups and 15 extended interviews were used to assess consumer-preferred survey design features and incentives. To test hypotheses, we conducted the following trial. Out of 10,733 total participants in a Kansas Medicaid managed care plan, 3,685 eligible for CAHPS were unduplicated by household. After randomization of the 968 households with valid addresses to one of three groups, a controlled trial was conducted to assess response rates to CAHPS survey formats and incentives. Response rates were 35% for a standard mailing, 44% for a user-friendly low-literacy mailing, and 64% for a user-friendly low-literacy mailing with a $10 contingent incentive. Both experimental arms significantly improved response compared with the control; the response rate of the mailing group with the incentive was higher than the response rate of the group receiving that mailing without any incentive (p<0.0001). Using consumer-based preferences significantly increased response rates to this Medicaid satisfaction survey. Raising CAHPS response rates may increase validity of Medicaid consumer satisfaction information.

Adolescent↗
PubMed2004

Mental health first aid training in a workplace setting: a randomized controlled trial [ISRCTN13249129].

BACKGROUND: The Mental Health First Aid training course was favorably evaluated in an uncontrolled trial in 2002 showing improvements in participants' mental health literacy, including knowledge, stigmatizing attitudes, confidence and help provided to others. This article reports the first randomized controlled trial of this course. METHODS: Data are reported on 301 participants randomized to either participate immediately in a course or to be wait-listed for 5 months before undertaking the training. The participants were employees in two large government departments in Canberra, Australia, where the courses were conducted during participants' work time. Data were analyzed according to an intention-to-treat approach. RESULTS: The trial found a number of benefits from this training course, including greater confidence in providing help to others, greater likelihood of advising people to seek professional help, improved concordance with health professionals about treatments, and decreased stigmatizing attitudes. An additional unexpected but exciting finding was an improvement in the mental health of the participants themselves. CONCLUSIONS: The Mental Health First Aid training has shown itself to be not only an effective way to improve participants' mental health literacy but also to improve their own mental health. It is a course that has high applicability across the community.

Adolescent↗
PubMed1995

Family practice educators' perceptions of computer-based patient records.

BACKGROUND: Despite the National Institute of Medicine's endorsement of computer-based patient records (CPRs), the majority of family practice residency programs continue to use paper records. This study examined the perceptions of family medicine educators about CPRs to understand their limited use of computerized patient record systems. METHODS: A survey was mailed to the directors of 247 family practice residency programs; 199 were completed and returned (response rate 81%). Respondents were asked to identify their concerns about CPRs, what they perceived as the advantages and disadvantages of CPRs compared with paper records, and the likelihood that their program will implement a CPR within the next year and within the next 5 years. RESULTS: The perceived benefits of CPR were greater efficiency, accuracy, and quality in patient care. However, many respondents were concerned about cost, mechanical breakdowns, conversion hardships, training needs, and physicians' attitudes. Despite these objections, the majority of respondents reported it is ¿somewhat¿ or ¿very¿ likely that their program will implement a CPR system within the next 5 years. CONCLUSIONS: Although the surveyed family medicine educators believed that CPRs offer significant benefits, they also perceived several disadvantages of converting from paper to computer-based patient records. Widespread use of CPRs among family practice programs in the near future depends on the extent to which vendors and others heighten awareness and knowledge about the benefits of CPRs and address concerns about cost, mechanical breakdowns, and transition difficulties.

Attitude of Health Personnel↗
PubMed2005

Educational interventions--computers for delivering education to children with respiratory illness and to their parents.

Educational interventions for children with asthma can result in both clinical and psychological improvements. However, traditional education programs have been hampered by lack of resources and doubts concerning long-term benefits. Researchers have looked to computer technology to overcome some of these obstacles and respiratory conditions have been the focus for a number of educational computer programs. Computer education packages should have a robust theoretical basis. Many programs aim to improve children's confidence, self-esteem and feelings of control, all of which are linked to compliance and positive health behaviours. The specific skills and knowledge needed for effective self-management also need to be taught in order to equip the child for future independent self-care. Programs tend to be either a stand-alone game, promoting self-regulation and practicing of skills, or an internet-enabled package, which may provide a link to their healthcare provider and/or other people with a similar condition. Computer technology is flexible, can be tailored to individuals' information needs, provides ongoing educational support and promotes active learning. However, there can be problems around accessibility, both in terms of computer ownership and technological literacy. Furthermore, internet sites are largely unregulated and of variable quality. It is essential that educational computer interventions are evidence-based and rigorously evaluated to identify who will benefit most from these packages.

Adolescent↗
PubMed2005

Health literacy and functional health status among older adults.

BACKGROUND: Individuals with limited health literacy have less health knowledge, worse self-management skills, lower use of preventive services, and higher hospitalization rates. We evaluated the association between health literacy, self-reported physical and mental health functioning, and health-related activity limitations among new Medicare managed care enrollees. METHODS: A cross-sectional survey of 2923 enrollees was conducted in Cleveland, Ohio; Houston, Tex; Tampa, Fla; and Fort Lauderdale-Miami, Fla. Health literacy was measured using the short form of the Test of Functional Health Literacy in Adults. We used outcome measures that included scores on the physical and mental health functioning subscales of the Medical Outcomes Study 36-Item Short-Form Health Survey, difficulties with instrumental activities of daily living and activities of daily living, and limitations because of physical health and pain. RESULTS: After adjusting for the prevalence of chronic conditions, health risk behaviors, and sociodemographic characteristics, individuals with inadequate health literacy had worse physical function (67.7 vs 78.0, P<.001) and mental health (76.2 vs 84.0, P<.001) than individuals with adequate health literacy. Individuals with inadequate health literacy were more likely to report difficulties with instrumental activities of daily living (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.74-2.92) and activities of daily living (OR, 2.83; 95% CI, 1.62-4.96), limitations in activity because of physical health (OR, 1.79; 95% CI, 1.39-2.32), fewer accomplishments because of physical health (OR, 1.90; 95% CI, 1.48-2.45), and pain that interferes with normal work activities (OR, 2.01; 95% CI, 1.46-2.77). CONCLUSION: Among community-dwelling older adults, inadequate health literacy was independently associated with poorer physical and mental health.

Activities of Daily Living↗
PubMed2006

Development and evaluation of a youth mental health community awareness campaign - The Compass Strategy.

BACKGROUND: Early detection and treatment of mental disorders in adolescents and young adults can lead to better health outcomes. Mental health literacy is a key to early recognition and help seeking. Whilst a number of population health initiatives have attempted to improve mental health literacy, none to date have specifically targeted young people nor have they applied the rigorous standards of population health models now accepted as best practice in other health areas. This paper describes the outcomes from the application of a health promotion model to the development, implementation and evaluation of a community awareness campaign designed to improve mental health literacy and early help seeking amongst young people. METHOD: The Compass Strategy was implemented in the western metropolitan Melbourne and Barwon regions of Victoria, Australia. The Precede-Proceed Model guided the population assessment, campaign strategy development and evaluation. The campaign included the use of multimedia, a website, and an information telephone service. Multiple levels of evaluation were conducted. This included a cross-sectional telephone survey of mental health literacy undertaken before and after 14 months of the campaign using a quasi-experimental design. Randomly selected independent samples of 600 young people aged 12-25 years from the experimental region and another 600 from a comparison region were interviewed at each time point. A series of binary logistic regression analyses were used to measure the association between a range of campaign outcome variables and the predictor variables of region and time. RESULTS: The program was judged to have an impact on the following variables, as indicated by significant region-by-time interaction effects (p < 0.05): awareness of mental health campaigns, self-identified depression, help for depression sought in the previous year, correct estimate of prevalence of mental health problems, increased awareness of suicide risk, and a reduction in perceived barriers to help seeking. These effects may be underestimated because media distribution error resulted in a small amount of print material "leaking" into the comparison region. CONCLUSION: We believe this is the first study to apply the rigorous standards of a health promotion model including the use of a control region to a mental health population intervention. The program achieved many of its aims despite the relatively short duration and moderate intensity of the campaign.

Adolescent↗
PubMedDate not supplied

Competence, continuing education, and computers.

A survey of RNs in South Dakota was performed to determine their perceived level of competence, the extent to which their continuing nursing education (CNE) needs are being met, and their use of computers for CNE. Nationally certified nurses rated themselves significantly more competent than nurses who are not nationally certified. Fewer than half of the RNs reported their CNE needs were being met despite geographic access to CNE and programs available in their specialty. Three-fourths of nurses had computers at home while 76% had computers at work, yet fewer than 20% of nurses used these computers for CNE.

Attitude of Health Personnel↗
PubMed1995

Using electronic mail for a small-group curriculum in ethical and social issues.

PURPOSE: To initiate an electronic mail (e-mail) program as a supplement to a medical humanities curriculum focusing on ethical and social issues. METHOD: In 1991-92 an e-mail track (called NET) was established for second-year students participating in Medicine in Contemporary Society, a four-year curriculum in medical humanities at the State University of New York at Stony Brook School of Medicine. In 1991-92 ten students volunteered to form a NET group; in 1992-93 22 students, forming two groups, were randomly selected from a volunteer pool of 76 students (from a class of 100). In both study years, the NET students analyzed and discussed electronically a series of cases posted sequentially through the academic year. Faculty tutors reviewed the students' responses, interacting with the groups and with individual students by e-mail. NET was evaluated in two ways: at the end of the course, the students completed e-mail questionnaires that included quantitative and qualitative assessments; and throughout the course, the tutors assessed the students' participation, quality of case analysis and discussion, and quality of writing. RESULTS: The students' assessments indicated that they considered NET to be more educational than the lectures, "live" group discussions, problem-based learning exercises, and formal papers in the medical humanities curriculum; that they made gains in computer literacy; and that NET enhanced their abilities to think about ethical and social issues. The tutors judged that the students had improved their written self-expression as the course progressed. CONCLUSION: NET adequately accomplished the goals set for it as an adjunct to the small-group sessions and other components of the medical humanities curriculum.

Attitude↗
PubMed2006

Issues with prescribed medications in Aboriginal communities: Aboriginal health workers' perspectives.

INTRODUCTION: The health of Indigenous Australians remains appalling. The causes of this situation are multi-factorial, however one contributing factor is poor medication compliance within Aboriginal populations. Anecdotal evidence provided by Aboriginal health workers in western New South Wales (NSW), Australia, has suggested that there are problems associated with the use of prescribed medications within the Aboriginal community. Aboriginal health workers form a core component of the Aboriginal health service sector and they have an in-depth knowledge of the community and its healthcare provision, as well as a familiarity with clinic patients and families. As such they are an important group whose opinions and beliefs about medication use in the Aboriginal population should be investigated. While there have been studies on the issues of prescribing in Aboriginal communities and access to medications, limited investigation into the use of prescribed medicines in Aboriginal communities and the role of the pharmacist in that process, has taken place. Therefore, this research aimed to identify the type of and reasons for inappropriate use of prescribed medications within Aboriginal communities serviced by the Mid Western Area Health Service (since incorporated into the Greater West Area Health Service) as perceived by the Aboriginal health workers in the area, and to explore strategies in conjunction with those Aboriginal health workers to address identified issues. METHODS: Qualitative, in-depth interviews were held with 11 Aboriginal health workers employed in Community Health Centres and hospitals in the Mid Western Area Health service of NSW. The interviews were audiotaped and transcribed verbatim. The transcripts were content analysed for emerging themes. The interviews explored the beliefs, perceptions and experiences of the Aboriginal health workers regarding prescribed medication use, the role of the pharmacist, and identification of future strategies to improve medication use in local Aboriginal communities. RESULTS: The Aboriginal health workers reported a general lack of access to medications and frequent inappropriate use of medications due to limited understanding, literacy and information all of which lead to non-compliance with instructions. Medication sharing was common in their communities. They reported that many Aboriginal people were uncomfortable seeking medicines advice, and the consumer medicine information provided was often difficult to understand, culturally inappropriate and unlikely to be utilised. Strategies suggested to improve pharmacist services and access to the services were a more 'Aboriginal friendly' environment, relationship development between pharmacists and Aboriginal health workers, cultural awareness programs for pharmacists and their staff, provision of disease state management services and medicine education programs by pharmacists for Aboriginal health workers. CONCLUSION: Medication misunderstandings and non-compliance within the Aboriginal community frequently occur. Suggestions to improve access, understanding and compliance, along with the education and training of Aboriginal health workers may provide tools for self-determination. Pharmacists may be well positioned to provide Aboriginal health workers with medicines information and patient education skills, and encourage the effective use of medicines within the Aboriginal community.

Attitude of Health Personnel↗
PubMedDate not supplied

Safety words inventory and literacy screener: standardization and validation.

When evaluating a school-aged patient, particularly for such issues as attention deficit disorder, or learning disabilities, health-care providers are encouraged to appraise children's school performance. Although some clinicians seek teachers' comments, recent research suggests that teachers' appraisals have limited value. As a consequence, health-care providers need brief methods, functional for busy primary care clinics, for detecting school problems. Because well-visits also include other services such as anticipatory guidance and safety and injury counseling, it would be helpful for detection tools to facilitate delivery of more than one aspect of well-child care. This study was undertaken to develop a brief method for evaluating school performance for elementary-age children and test its accuracy in identifying children with reading and other academic problems. By using common safety signs as the test stimuli, such a tool should also serve as a springboard to injury prevention counseling. Data were drawn from the standardization and validation data of an individually administered wide-range diagnostic achievement test using a geographically diverse, nationally representative sample of 934 children between 5 and 13 years of age. Children were administered the Comprehensive Inventory of Basic Skills-Revised (CIBS-R), which includes among its 10 subtests a 57-item measure of safety word recognition. Data were collected from previously administered measures of academics and intelligence. Forty-one children were administered the measure twice to assess inter-rater reliability. Logistic regression analyses were deployed using children's performance on the nine other subtests of the CIBS-R as the grouping variable, and as predictors, recognition of 57 safety words/phrases. Of these, 22 safety signs (e.g., "Keep out," "No Trespassing," "Danger") were significant predictors of overall academic performance. An additional seven safety words were added due to their ecological significance (e.g., "High Voltage," "Beware of Dog," "Poison," etc.). Receiver operating characteristic was used to determine cut scores based on children's ages in relation to overall academic performance. Cut scores increased with age and produced sensitivity of 78% (range, 73%-88%) and specificity of 84% (range, 77%-87%) to academic performance above and below the 25th percentile--the point where children typically fail to benefit from group instruction and become eligible for remedial reading programs (such as Title I). Children with performance below cut scores were 11 times more likely to have been retained in grade and five times more likely to receive a teacher rating of below average than were children performing above cut scores. Nevertheless, 72% of children with poor performance were not receiving special education or Title I services. Interrater reliability coefficients were high and ranged from .64 to .98. Extrapolating administration times from data on the CIBS-R as a whole suggests the reduced safety words measure takes 3 to 4 minutes to administer and score. The new measure, called the Safety Word Inventory and Literacy Screener (SWILS), consists of 29 words, takes little time to administer and score, and has a high degree of sensitivity and specificity to academic deficits. Use of the SWILS in primary care should enable clinicians to provide focused safety counseling while also screening for school problems.

Adolescent↗
PubMed2002

Functional health literacy and the risk of hospital admission among Medicare managed care enrollees.

OBJECTIVES: This study analyzed whether inadequate functional health literacy is an independent risk factor for hospital admission. METHODS: We studied a prospective cohort of 3260 Medicare managed care enrollees. RESULTS: Of the participants, 29.5% were hospitalized. The crude relative risk (RR) of hospitalization was higher for individuals with inadequate literacy (n = 800; RR = 1.43; 95% confidence interval [CI] = 1.24, 1.65) and marginal literacy (n = 366; RR = 1.33; 95% CI = 1.09, 1.61) than for those with adequate literacy (n = 2094). In multivariate analysis, the adjusted relative risk of hospital admission was 1.29 (95% CI = 1.07, 1.55) for individuals with inadequate literacy and 1.21 (95% CI = 0.97, 1.50) for those with marginal literacy. CONCLUSIONS: Inadequate literacy was an independent risk factor for hospital admission among elderly managed care enrollees.

Aged↗
PubMed2006

Employment barriers for persons with psychiatric disabilities: update of a report for the President's Commission.

A major public policy problem is the extremely low labor force participation of people with severe mental illness coupled with their overrepresentation on the public disability rolls. This situation is especially troubling given the existence of evidence-based practices designed to return them to the labor force. This article reviews research from the fields of disability, economics, health care, and labor studies to describe the nature of barriers to paid work and economic security for people with disabling mental disorders. These barriers include low educational attainment, unfavorable labor market dynamics, low productivity, lack of appropriate vocational and clinical services, labor force discrimination, failure of protective legislation, work disincentives caused by state and federal policies, poverty-level income, linkage of health care access to disability beneficiary status, and ineffective work incentive programs. The article concludes with a discussion of current policy initiatives in health care, mental health, and disability. Recommendations for a comprehensive system of services and supports to address multiple barriers are presented. These include access to affordable health care, including mental health treatment and prescription drug coverage; integrated clinical and vocational services; safe and stable housing that is not threatened by changes in earned income; remedial and postsecondary education and vocational training; benefits counseling and financial literacy education; economic security through asset development; legal aid for dealing with employment discrimination; peer support and self-help to enhance vocational self-image and encourage labor force attachment; and active involvement of U.S. business and employer communities.

Achievement↗
PubMed1990

Childhood survival in Haiti: protective effect of measles vaccination.

To evaluate the impact of measles vaccination on survival of children residing in a periurban slum in Haiti, a total-population survey was conducted 2.5 years after completion of a one-time study of the serologic response to measles vaccine administered in the same population. Pregnancy histories from the 16,400 women in the population revealed that 1499 children had been born during a 7-month interval that would have made them eligible for participation in the measles vaccine program. Of these children, 1381 (92.1%) survived to 9 months of age, the median age that measles vaccine had been administered. Seventy-three infants had died between 9 and 39 months of age. Mortality of infants who were seronegative before receiving measles vaccine was significantly lower (P = .0013) than that of unvaccinated infants (3/235 vs 70/1056, respectively). Other factors positively associated with survival between 9 and 39 months of age included socioeconomic status (P = .0002), maternal literacy (P = .0020), maternal knowledge and use of oral rehydration solution (P = .0002), and an interval of greater than 24 months to the birth of the next younger sibling (P = .0012). Multivariate stepwise logistic regression analysis was used to evaluate the independent association of measles vaccination by adjusting for other factors that also correlated with survival and that might have been associated with maternal seeking of vaccinations.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗
PubMed1992

Introducing computer literacy skills for physicians.

Computers are integral to medical practice, education, and research. While medical students learn computer skills during their training, many practicing physicians do not have the same computer experience. To familiarize this group with the exciting developments in medical informatics, the Himmelfarb Health Sciences Library and Department of Computer Medicine at the George Washington University Medical Center organized a workshop "Introducing Your Office Computer!" for attending physicians. The workshop featured a short lecture/video presentation on computer applications in medicine followed by a "computer fair" of five computer applications. Eleven physicians attended the workshop. Feedback was very positive; many called later to request more detailed instructions on using the programs demonstrated. It was a valuable experience for the staff, and new bridges were built between departments and clients.

Computer User Training↗
PubMedDate not supplied

Implementing Essentials of Critical Care Orientation: one hospital's experience with an online critical care course.

Critical care is a specialty area that requires a significant investment of time and money for clinical and classroom learning. One solution for learning that is flexible and cost-effective is the American Association of Critical Care Nurses' Essentials of Critical Care Orientation (ECCO). ECCO lays the theoretical groundwork for nurses to practice safely in critical care. Utilization of ECCO in one community hospital has been a 3-year process, which is continually refined by the critical care education team. Advantages to using ECCO include that it is self-paced, maintained by the American Association of Critical Care Nurses, and allows learners to flex their time and location for learning. Obstacles encountered include difficulties associated with computer learning, lack of hard copy notes, lack of face-to-face time interaction between orientees and education staff, increased work load for one education staff member, and keeping learners on track with their time and orientation. This article describes one hospital's experience with implementation of ECCO as the classroom portion of orientation to several critical care units.

Attitude of Health Personnel↗