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PubMed2005

A computerised guidance tree (decision aid) for hypertension, based on decision analysis: development and preliminary evaluation.

This paper discusses the piloting of a computerised decision aid that provides individualised information about hypertension to patients. The program is based on decision analysis, using decision trees as a way of structuring information. It incorporates the Framingham risk equation to assess a users' risk of coronary artery disease, together with a detailed assessment of the patient's current lifestyle and their willingness to change behaviour. Users of the program can decide how much or how little information they access. The program assesses individual's preferences for different treatment outcomes, before providing them with guidance on what might be the best treatment option for them. The program was evaluated by 10 patients with a diagnosis of mild to moderate hypertension and 8 health care professionals. Overall, both health care professionals and patients assessed the program positively. The use of a decision aid based on decision analysis may be a useful way of providing information to patients in order to promote shared decision making.

Aged↗
PubMed2001

Community-based HIV/AIDS education in rural Uganda: which channel is most effective?

A process evaluation was conducted to evaluate four channels (drama, video, community educators and leaflets) used in a community-based IEC (Information, Education and Communication) HIV/AIDS intervention in rural Uganda. Semi-structured interviews (n = 37) and focus groups (n = 3) were held with community members working as field staff. In addition, two questionnaire surveys (n = 105 and n = 69) and eight focus groups were conducted with the target community. Over 85% of the community had seen at least one drama or video show. They rated them as relevant and realistic. However, the messages 'taken home' were not always those intended by the plays. Access to community educators (CEs) was not equal. The CEs had a tendency to avoid the educated, rich and their older relatives. Those who had met with a CE rated them as knowledgeable and trustworthy, but felt they would rather be taught by a trained health worker. Around 80% of the community said they had seen the leaflets, but had not necessarily read them. Although appreciated by some as reference material, low literacy levels and a lack of reading culture meant that some leaflets may have gone astray. These findings suggest that a multi-channel approach may be required to overcome weaknesses inherent in individual channels.

Community Health Services↗
PubMedDate not supplied

Correlates of compliance with measurement protocols in a Latino nutrition-intervention study.

INTRODUCTION: It is well known that attrition and noncompliance in longitudinal health intervention studies contribute to bias in both internal and external validity. However, little is known about rates and correlates of compliance with measurement protocols among Latinos. This article investigates correlates of compliance with follow-up physical measurement protocols among Latino subjects in a nutrition-oriented cardiovascular disease prevention program targeting low-English literate adults. METHODS: Correlates of compliance, measured at baseline, included four classes of variables: demographic characteristics, physical measures, health behaviors, and nutrition-related psychological variables. Subjects were categorized into one of three compliance groups: on-time compliers, late or "reluctant" compliers, and noncompliers. Approximately 36% of subjects complied on time, 25% complied late, and 39% did not comply. RESULTS: Analyses showed that, relative to on-time and late compliers, noncompliers tended to be male, younger, of lower income and Spanish-literacy level, to drink more alcohol, to be less physically active, and to have lower dietary fat avoidance scores. No significant differences were found for other factors considered (e.g., physical health measures). CONCLUSIONS: These results generally reflect those of non-Hispanics that indicate that individuals at greater "risk" are less likely to comply with study protocols. Such results may be useful for designing culturally appropriate cohort maintenance strategies for longitudinal studies with Latinos.

Adult↗
PubMed1999

Health literacy among Medicare enrollees in a managed care organization.

CONTEXT: Elderly patients may have limited ability to read and comprehend medical information pertinent to their health. OBJECTIVE: To determine the prevalence of low functional health literacy among community-dwelling Medicare enrollees in a national managed care organization. DESIGN: Cross-sectional survey. SETTING: Four Prudential HealthCare plans (Cleveland, Ohio; Houston, Tex; south Florida; Tampa, Fla). PARTICIPANTS: A total of 3260 new Medicare enrollees aged 65 years or older were interviewed in person between June and December 1997 (853 in Cleveland, 498 in Houston, 975 in south Florida, 934 in Tampa); 2956 spoke English and 304 spoke Spanish as their native language. MAIN OUTCOME MEASURE; Functional health literacy as measured by the Short Test of Functional Health Literacy in Adults. RESULTS: Overall, 33.9% of English-speaking and 53.9% of Spanish-speaking respondents had inadequate or marginal health literacy. The prevalence of inadequate or marginal functional health literacy among English speakers ranged from 26.8% to 44.0%. In multivariate analysis, study location, race/language, age, years of school completed, occupation, and cognitive impairment were significantly associated with inadequate or marginal literacy. Reading ability declined dramatically with age, even after adjusting for years of school completed and cognitive impairment. The adjusted odds ratio for having inadequate or marginal health literacy was 8.62 (95% confidence interval, 5.55-13.38) for enrollees aged 85 years or older compared with individuals aged 65 to 69 years. CONCLUSIONS: Elderly managed care enrollees may not have the literacy skills necessary to function adequately in the health care environment. Low health literacy may impair elderly patients' understanding of health messages and limit their ability to care for their medical problems.

Aged↗
PubMedDate not supplied

Lessons learned from the implementation of a Web-based nursing intervention.

The emergence of the World Wide Web in the last decade has introduced the belief that the Internet has the potential to revolutionize healthcare delivery and empower consumers. Given the power of technology to change the way we live, the healthcare community has begun to explore the feasibility of delivering interventions via the Web, including personalized care with chronic disease management. The purpose of this article is to describe this researcher's experience with the development and implementation of a Web-based intervention to enhance diabetes self-management for older adults. Challenges faced by the project involved inadequate funding to cover technology issues (programming, graphics design, etc),decisions regarding the appropriate environment/framework, and questions on how to merge the practice and theory of a given discipline with the limitations of Internet technology. This article will examine and discuss these issues and make recommendations on possible methods of improving the process.

Adaptation, Psychological↗
PubMed2005

Multimedia quality of life assessment: advances with FLAIR.

Assessing impact of functional dependency on quality of life (QOL) among older adults can provide an in-depth understanding of health preferences. Utilities as a measure of preferences are necessary in conducting cost-effectiveness evaluations of healthcare interventions designed to improve overall QOL. We describe further development of a multimedia utility elicitation instrument that is highly portable and easily accessible. An earlier version, FLAIR1, introduced features designed for older adult, computer inexperienced users. FLAIR2 includes modifications such as migration to a web-based platform, consistency checks, audio/visual updates, and more response methods. As compared with FLAIR1, more FLAIR2 respondents (n=318) preferred using the computer and found the computer program to be enjoyable, easy to use, and easily understood. There were also fewer inconsistencies among FLAIR2 respondents. FLAIR2 enhancements have increased portability, minimized invariance and inconsistency, and produced a more user friendly design.

Activities of Daily Living↗
PubMed2005

An investigation of two-way text messaging use with deaf students at the secondary level.

Deaf and hard-of-hearing students are often delayed in developing their independent living skills because of parental restrictions on activities outside the home due to worries about their child's inability to communicate, their whereabouts, and their general safety. Recent accounts of the use of two-way text messagers suggests that, like electronic mail, distance communication problems that have long plagued deaf people may be ameliorated--by the use of such technology (M. R. Power & D. Power, 2004; S. S. Rhone & Cox News Service, 2002). This project was designed as an initial foray into investigating the use of two-way text messaging technology as a way of increasing the independence of deaf adolescents and reducing their parents' anxiety about their safety and responsibility. All the deaf and hard-of-hearing students in the deaf and hard-of-hearing programs at two urban high schools (ages 13-19), the staff of the deaf departments at these two schools, and the parents/guardians of the students participated in this study. Preuse surveys, postuse surveys, and monthly statistics on the number of times each pager was used enabled us to chart how often the participants used the technology. The data were used to identify concerns that parents have about student independence and safety, the extent to which deaf students engage in independent activities, and expectations surrounding how two-way text messaging use might increase independence and literacy skills. The data collected on this project to date confirm that two-way text messaging technology is indeed useful for deaf adolescents and helps alleviate some of the concerns that have kept them from developing independence as quickly or readily as their hearing peers. The potential policy implications for this research are discussed.

Adolescent↗
PubMed2003

Health literacy affects peritoneal dialysis performance and outcomes.

Health literacy (HL) is the ability to perform the basic reading, writing, and numerical skills required to function in a health care setting. Patients with adequate HL are able to read, interpret, and respond to health care information provided by health care providers and health plans. Several means of assessing HL are available for English- and Spanish-speaking patients. A review of the English-language literature on HL indicated that no prior studies included a subset of peritoneal dialysis (PD) patients. I administered the Rapid Estimate of Adult Literacy in Medicine (REALM) assessment tool to PD patients. I also asked patients for information about their highest education level completed. Following completion of the REALM, patients were classified as having adequate, marginal, or inadequate HL. As other studies have shown, patients with lower levels of education have inadequate HL. Patients with some college education or higher have adequate HL. However, at the average education level of patients, most patients have marginal HL. Relative lack of HL affects a patient's ability to make decisions regarding care as part of a home self-management program for end-stage renal disease (ESRD) and other chronic illnesses. Consequently, relative HL level affects the method of instruction and the time required for instruction during training of PD patients.

Adult↗
PubMed1998

Impact of health service provision on mothers and infants in a rural village in North West Frontier Province, Pakistan.

OBJECTIVE: The objective of this paper is to examine the impact of the Health Service Research Project of the Pakistan Medical Research Council (PMRC) on mothers and infants in Budhni village, North West Frontier Province (NWFP), Pakistan. METHODS: Information from the PMRC records on the socioeconomic and demographic situation over the last 10 years and anthropometric measurements made on all infants from 1986-96 were collected and analysed. RESULTS: The demographic data showed a number of changes, namely a reduction in birth rate and improvements in perinatal, neonatal, infant and child mortality rates. Literacy in the village was poor (27 and 39% literate in 1986 and 1996, respectively) and female literacy showed no improvement (14%). Improvements in sanitation and in the water supply introduced by the PMRC had limited success, as clean water was subsequently contaminated by unclean hands and utensils, and 50% of the population continued to use open fields for sanitation. In 1986 only 27% of children 0-5 years were vaccinated, but by 1996, 96% of children had completed polio, diphtheria/pertussis/tetanus (DPT) and bacille Calmette-Guérin (BCG) vaccination programmes and 95% of women of child-bearing age were vaccinated against tetanus. Protection against tetanus reduced neonatal deaths and from 1993 onwards there have been no further cases. Anthropometric data for the period 1986-96 for infants (0-24 months) showed that at birth the majority of infants were close to the 50th National Centre for Health Statistics (NCHS) centile for weight and length, and only 5% of birth-weights were less than 2.5 kg. Growth charts showed faltering in length and weight and by 24-months length in both boys and girls was below the 3rd NCHS centile and weights were just above. CONCLUSIONS: Reductions in child mortality have occurred over the period 1986-96. However, the slow progress in adopting hygienic practices, despite health education, and the low literacy rates, particularly in women, may hamper continued improvement.

Adolescent↗
PubMedDate not supplied

Pulse polio immunization in Delhi--1995-96: a survey.

A coverage evaluation survey of the campaign for mass Pulse Polio Immunization (PPI) on 9th December, 1995 and 20th January, 1996 in Delhi was carried out using the modified cluster sampling technique and a pre-structured proforma. Six-hundred-and-nine children of under-3 age group were covered in the survey. Overall coverage for both the doses was found to be 77%. While coverage for 9th December dose was found to be 80%, it rose to 90.2% on 20th January, 1996. Coverage levels for male and female children were similar. Parental literacy was seen as a definite factor, positively affecting the coverage levels. Proportion of not covered under PPI was significantly higher in the 0-6 months age group. Television and health workers were found to be the main sources of awareness about PPI.

Child, Preschool↗
PubMedDate not supplied

Testing a nurse-tailored HIV medication adherence intervention.

BACKGROUND: The relationship between patient adherence and treatment outcomes has been documented across chronic health conditions, but the evidence base for effective adherence interventions in human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) requires more rigorous research and reporting. OBJECTIVES: The aims of this study were to determine whether a tailored, nurse-delivered adherence intervention program--Client Adherence Profiling and Intervention Tailoring (CAP-IT)--improved adherence to HIV medications, compared with standard care, and to identify the relationship among adherence measures. METHODS: A randomized controlled trial (RCT) with repeated measures was used to test the efficacy of CAP-IT over a 6-month period. A convenience sample of 240 participants was recruited from a freestanding public HIV/AIDS clinic in Houston, TX, that provides medical, psychological, and pharmaceutical services for over 5,000 clients. Study instruments and measures included demographics; chart audit to capture CD4 count, viral load, and prescribed medications; health literacy; and five measures of adherence (AIDS Clinical Trial Group-Revised Reasons for Missing Medications, Morisky Self-Report of Medication Non-Adherence, Pill Count, Medication Event Monitoring System [MEMS] caps, and Pharmacy Refill). RESULTS: A logistic regression using generalized estimating equations method showed no significant differences over time on the five medication-adherence measures between the experimental and control groups. Little correlation was documented among the five different adherence measures, and there was minimal correlation with clinical markers. DISCUSSION: It is unclear why the tailored adherence intervention was not efficacious in improving medication adherence. The findings suggest that these measures of medication adherence did not perform as expected and that, perhaps, they are not adequate measures of adherence. Effective and efficient adherence interventions are needed to address the barriers to medication adherence in HIV/AIDS.

Adult↗
PubMed2026

Exploring Implementation of Cantonese Radio Broadcasting as a Mental Health Promotion Initiative for Linguistically Isolated Immigrants.

Digital-first public health efforts often miss linguistically isolated immigrant communities because of structural barriers and stigma. Ethnic legacy media can reach these groups, but keeping programs funded and operational over the long term is frequently difficult. This Practice Note examines a Cantonese-language radio health program in "Los Angeles County" that ran 128 live broadcasts across a full 12-year Chinese zodiac cycle. Instead of a top-down clinical model, the show endured by acting as an informal community navigation hub. We examine two recurring administrative frictions: anonymous off-air calls about urgent economic needs (e.g., hotel job referrals) and on-air audience corrections of mispronounced medical terms. We argue these interactions should be seen not as disruptions but as measurable indicators of structural trust that sustain programs. We offer practical guidance for recruiting undergraduates to expand reach via ethnic print newspapers, using peer-recovery milestones to amplify impact. The note concludes with a pragmatic blueprint for health educators to manage professional boundaries, preserve commercial-clinical separation, and uphold cultural safety in isolated communities.

Chinese American health↗
PubMed2004

Community partnerships for health information training: medical librarians working with health-care professionals and consumers in Tennessee.

In Tennessee, several medical library outreach projects have involved collaborative work with health-care professionals, public librarians, consumers, faith-based organizations and community service agencies. The authors are medical librarians who worked as consultants, trainers and project directors to promote health literacy using PubMed medline and other health information resources in the several funding projects described here. We explain the programmes briefly, focusing on lessons learned and suggestions for those who follow us.

Community-Institutional Relations↗
PubMedDate not supplied

Successfully meeting population goals. Islamic Republic of Iran.

The Islamic Republic of Iran has achieved success in attaining several population goals noted H.E. A. Arabmazar, head of that country's delegation to the 53rd session of the Commission. During the last decade "the infant mortality rate declined from 44/1000 to 26/1000 live births. Life expectancy rose from 61 to 68 years and the literacy rate increased from 62.2% to 85%," he informed the Commission. Further, the population growth rate has declined from 3.2% to 1.7%, he added. Another Iranian representative at the Senior Officials segment of the meeting said that poverty alleviation measures implemented in recent years by the Government have dramatically reduced the incidence of poverty. The number of people living below the poverty line has fallen to 17% of the total population compared with 47% at the end of the decade of the 1970s. Among the measures implemented by the country is the provision of health care, including a very successful family planning program. Others are human resources development and creating productive employment opportunities. "Sustained employment is a major means of poverty alleviation," said the Iranian delegate. "It is essential that programs of human resources development aim at enabling the poor to become qualified for employment opportunities. Moreover, greater attention should be given to the expansion and improvement of social services and the empowerment and capability building of the poor." Currently, a poverty alleviation bill is being discussed by the Parliament and, if it is ratified, will be implemented from 1997.

Asia↗
PubMed2004

Cultural competency as it intersects with racial/ethnic, linguistic, and class disparities in managed healthcare organizations.

Culture in and of itself is not the most central variable in the patient-provider encounter. The effect of culture is most pronounced when it intersects with low education, low literacy skills, limited proficiency in English, culture-specific values regarding the authority of the physician, and poor assertiveness skills. These dimensions require attention in Medicaid managed care settings. However, the promise of better-coordinated and higher quality care for low-income and working-poor racial/ethnic populations--at a lower cost to government--has yet to be fully realized. This paper identifies strategies to reduce disparities in access to healthcare that call for partnerships across government agencies and between federal and state governments, provider institutions, and community organizations. Lessons learned from successful precedents must drive the development of new programs in Medicaid managed care organizations (MCOs) to reduce disparities. Collection of population-based data and analyses by race, ethnicity, education level, and patient's primary language are critical steps for MCOs to better understand their patients' healthcare status and improve their care. Research and experience have shown that by acknowledging the unique healthcare conditions of low-income racial and ethnic minority populations and by recruiting and hiring primary care providers who have a commitment to treat underserved populations, costs are reduced and patients are more satisfied with the quality of care.

Cost Control↗
PubMed2004

America's digital divide: 2000-2003 trends.

Computer ownership and literacy, along with Internet access and its many applications, has become, for many, a trademark for the Americans' lifestyle. Research shows that computer ownership and literacy, along with Internet access and expertise, is rapidly changing how Americans go about their business. The technological industry is providing many opportunities for Americans to operate in markets, global and local, not previously available. These changes are apparent across all U.S. sociocultural and geographic boundaries. Yet, upon close analysis, there are individuals and communities less connected with many completely excluded from participation. Those individuals exist below a line called the Digital Divide. Growth in computer ownership and Internet use, while offering optimism that the Digital Divide is narrowing, also illustrates that, without focused intervention will for certain populations, continue. Public and private programs, focus groups, and pocks of community activism, each hope to correct the disparities among on- and-off line Americans. On many fronts, there is evidence that progress is being made by many. Income, race, age, and geographic location are often the determining factors.

Adolescent↗
PubMed1999

Allied health applications of a computerized clinical log database system.

Preliminary research in the development and use of computerized clinical log records began in 1987 in an allied health college at a midwestern academic health center. This article reviews development and implementation of a computerized system for managing clinical log records to improve and enhance allied health educational programs in the radiation sciences. These clinical log databases are used for quantitative and qualitative analyses of student participation in clinical procedures, and educational planning for each student. Collecting and recording data from clinical log records serves as a valuable instructional tool for students, with both clinical and didactic applications.

Accreditation↗
PubMed1992

Vietnam seeks help expanding voluntary surgical contraception.

Recent surveys by the Vietnamese Ministry of Health suggest that 60% of married women desire no more children. Yet only 2% of currently married women and less than 1/2 of 1% of their partners use sterilization. Underscoring the high unmet need for effective family planning, over 1 million abortions (legal in Vietnam for the past 20 years) are performed annually. This rate corresponds to 1 abortion for every live birth. The Ministry of Health has recently welcomed a variety of organizations, including AVSC, whose assistance can help expand the country's family planning programs. Sorely lacking in supplies, equipment, and trained personnel, Vietnam has merited priority status--2nd only to China and India--from the UNFPA, which has committed $36 million over the next 4 years. Other organizations currently working in Vietnam include the Population Council, the Population Crisis Committee, and the International Planned Parenthood Federation. Despite enormous casualties during the war years, and a decrease since the 1970s in average family size from 6 to 4 children, the population of Vietnam has continued to grow rapidly, far outpacing economic growth. Currently 67 million, the population is expected to reach 80 million by the year 2000. The average Vietnamese annual income is only $195, among the lowest in the world. Doi moi, the process of economic reform begun in 1986, coupled with new government incentives for families who have no more than 2 children, is changing the face of family planning in Vietnam. Newly opened pharmacies sell imported birth control pills and condoms (to those who can afford them), while government hospitals and health clinics provide mainly IUDs, in addition to limited supplies of pills and condoms. Throughout the country, some 8000 community-level health centers are staffed by nurse-midwives trained in family planning. Voluntary sterilization is available at the district, provincial, and national hospitals. All married women may obtain family planning services free on request. Vietnam's system of free and universal primary health care, combined with high female literacy rates, has kept the country's infant mortality rate low in comparison to other very poor countries. 39% of currently married Vietnamese women ages 15-49 use contraception. Of those, 85% use the IUD, making it far and away the most widely used modern method. In fact, some women think family planning is synonymous with the IUD.

Abortion, Induced↗