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PubMed2006

Enhanced provider communication and patient education regarding return to work in cancer survivors following curative treatment: a pilot study.

BACKGROUND: For employed cancer survivors, returning to work and maintaining employment is an important aspect of their quality of life. We developed an intervention aimed at enhancing this by means of (a) providing the patient with an educational leaflet on return to work and (b) enhancing communication between attending and occupational physicians. The purpose of this study is to test the feasibility of this intervention and to examine the relation of patient adherence to the advice of the leaflet and return to work. METHODS: A patient series of 35 employed cancer survivors was used to evaluate the intervention. Survivors completed a baseline questionnaire prior to their treatment. Survivors and occupational physicians were interviewed by telephone eight weeks following all curative treatment. Our measure of feasibility included satisfaction of survivors with the intervention, adherence to the advice, time to return to work, satisfaction of occupational physicians with the intervention, and perceived influence on their rehabilitation efforts. RESULTS: Interviews of 26 survivors and 24 occupational physicians, revealed that those groups perceived the leaflet as useful (i.e., 7 on a 0-10 scale. Also seven out of ten suggestions in the leaflet was adhered to and half of the occupational physicians perceived the guidance they provided was helpful. However there was no effect of level of adherence on actual return to work. CONCLUSION: This pilot study demonstrated the feasibility of the approach used. However level of adherence to educational leaflet was not associated with an improvement in return to work in cancer survivors.

Adult↗
PubMed2006

Cross-cultural adaptation and evaluation of a home-based program for alcohol use prevention among urban youth: the "Slick Tracy Home Team Program".

The current study describes the extensive cross-cultural adaptation of a brief home-based alcohol prevention program for racially and ethnically diverse sixth grade students and their families, using a randomized controlled trial design involving 60 public schools in the city of Chicago (N = 3,623 students). The adapted program achieved high participation levels (73%) overall, as well as in single parent families, non-English homes, and low-income students, among other at risk groups. Lower levels of factors associated with the onset of alcohol use (i.e., normative expectations and outcome expectations) were achieved in the intervention group compared to the control group. However, no differences were observed for several other protective factors or alcohol use.

Adolescent↗
PubMed2006

Inhaler technique in Turkish people with poor English: a case of information discrimination?

OBJECTIVES: (a) To compare metered dose inhaler (MDI) technique in users with poor English and fluent English, (b) to evaluate two interventions: a translated patient information leaflet (PIL) plus support from an translator (PIL + verbal) and a multimedia touch screen system (MTS) using video clips and own-language instruction. METHODS: (a) Inhaler technique was videotaped and key steps rated blind for 105 fluent English-speakers (FE) and 69 Turkish-speakers with poor English (EP). (b) The EP group was randomised to receive information by MTS (n = 34) or PIL + verbal (n = 35). Inhaler technique was videotaped before and after information. MAIN OUTCOME MEASURES: (a) Global inhaler technique; (b) breathing-in time; (c) co-ordination of inspiration and inhaler actuation. RESULTS: Global technique, co-ordination and breath-holding were all significantly worse in MDI users with poor English. Only 17% of that group had adequate technique compared to over half (62%) of FE. The EP group were significantly less likely than the FE group to report ever seeing the practice nurse about their asthma. After information, global technique was rated as improved in 50% of the MTS group compared to 28% of those given a translated PIL. A further six people (17%) in the PIL group improved after subsequent verbal advice in their own language. Both information methods significantly increased inhaler shaking and mouthpiece checking, but co-ordination only improved in a small number of people. CONCLUSIONS: The study suggests that Turkish-speaking MDI users with poor English may be disadvantaged in terms of access to medicines information in the UK. The acceptability of pharmacy-based support services for this, and other specific language groups should be explored. Multimedia offers an alternative to a translator for brief explanations, particularly for first-time users, but improving poor co-ordination requires individualised "hands on" teaching from health professionals.

Administration, Inhalation↗
PubMed2006

Development of written information for antiretroviral therapy: comprehension in a Tanzanian population.

OBJECTIVE: To design and develop a simple, easily readable patient information leaflet (PIL) for a commonly used antiretroviral (ARV) regimen and to evaluate its readability and acceptability in a Tanzanian population. METHOD: A PIL incorporating simple text and pictograms was designed for the antiretroviral regimen of stavudine, lamivudine and efavirenz. The PIL was designed according to established good design guidelines, modified during a multi-stage iterative testing process and piloted in a South African Xhosa population. The PIL was made available in both English and Kiswahili. Sixty Tanzanian participants who were not taking ARVs were interviewed. They were asked to read the PIL in the language of their choice and were then asked a series of two-part questions; the first part required participants to locate the information in the PIL, after which they were asked to explain the information in their own words. Acceptability was assessed through close-ended questions and open-ended feedback. The influence of selected patient characteristics on comprehension of the PIL was investigated using one-way ANOVA and t-tests for independent samples with a significance level set at 0.05. MAIN OUTCOME MEASURE: Comprehension of the written information in an overall percentage understanding. RESULTS: The overall average percentage comprehension of the PIL was 95%. The target set by the EC guideline that at least 80% of participants correctly locate and understand the information was achieved for 19 of the 20 questions. Five of the six instructions illustrated by pictograms were correctly understood by all participants. The only patient characteristics significantly associated with comprehension were educational level and self-reported ease of reading the PIL. Acceptability of the PIL was high and positive comments were associated with simplicity, good design, easy readability and user-friendliness, the latter enhanced by the inclusion of pictograms. CONCLUSION: The PIL designed for this study was shown to be effective in communicating information about ARVs. Patient characteristics must be taken into account when developing written information, and the final document must be tested for comprehension in the target population.

Adolescent↗
PubMed2006

Cross-cultural validation of the Decisional Conflict Scale in a sample of French patients.

INTRODUCTION: The Decisional Conflict Scale (DCS, 16 items, 5 dimensions) designed to measure the level of decisional conflict experienced by patients making health care decisions has not yet been validated in French. METHODS: A national sample of French cancer patients (n=644) facing the decision to undergo BRCA genetic testing was tested for this purpose, including a control group and an experimental group who had received an information booklet. Reliability and criterion validity were investigated. To check the validity of the factors selected, an exploratory factor analysis was then conducted, followed by confirmatory factor analyses. RESULTS: Reliability was satisfactory (alpha=0.913). Women who definitely wanted to undergo genetic testing showed significantly lower DCS scores than uncertain women (p<0.001). Exploratory factor analysis suggested an optimal 4-dimensional model. In the control group, confirmatory factor analyses showed that the French model was more accurate than the original one. When the decision-making conflicts decreased (in the experimental group), both models yielded only fairly accurate indices. CONCLUSION: The French version of the DCS was found to give a reliable overall score. However, special care should be taken when using the individual subscores. In addition, it is necessary to take into account the context in which the decision-making occurs.

Breast Neoplasms↗
PubMed1984

Influence of removal of intrauterine contraceptive devices on colonisation of the cervix by actinomyces-like organisms.

An overall prevalence rate of actinomyces-like organisms (ALO) in cervical smears from intrauterine contraceptive device (IUCD) users of 3% (79/2, 734) was found, with a rate of 2% and 22.6% for copper and inert IUCD users. Although the users of the inert IUCDs were older, and their devices had been in situ longer, these factors did not account for the significant difference between the two types of IUCD. Fifty-five patients were counselled and given a leaflet on ALO. Fourteen IUCD users with ALO positive smears who had their devices removed had mild or moderate pelvic pain or discharge. Six others who were asymptomatic had the IUCD removed at their own request. All fifty-five patients were re-examined six months to one year later, and a smear was repeated. Only one woman required later removal of the IUCD because of dyspareunia with pelvic tenderness. After removal of the IUCD, and without antibiotic therapy, in 100% (20/20) of the women, ALO colonisation was no longer found six to twelve months later. This applied even to seven women who had had a new copper IUCD inserted immediately after removal of the index device.

Actinomyces↗
PubMed1986

A study of changes in the information routines in a neurological ward.

The purpose of this study was to investigate whether changes in the method of organizing medical and nursing care in the neurological ward would affect the patients' satisfaction with information during their stay in the ward. The changes consisted of systematic information routines, systematic follow-up and feedback of information which was provided by a 'mentor' system and systematic routines for written communication between informants and 'mentors' about the patients' need for information. A general improvement of the information to the patients occurred. General information was judged almost completely adequate with the aid of the new routines. The effect of the organizational changes upon the patients' satisfaction with medical information could not be fully studied. The physicians continued to give information about diagnosis, prognosis and after-care very late during the patients' hospital stay and this information was not followed up at all during the experimental period.

Adolescent↗
PubMed1989

Comparison of oral, written and audio-visually based information as preparation for intravenous pyelography.

Four different ways of giving information in advance to patients about to undergo a threatening medical procedure (intravenous pyelography) are compared; oral, written, slide-tape based and film-sound based. The effectiveness of the methods is measured through patients' ability to recall key point topics in the information spectrum and through their estimates of the degree of overlap between the mental images built up from the information and the reality experienced during the examination. The result is that no significant differences were found, except for one case of overlap. The relative merits of the four methods as they emerge from patients' comments are briefly discussed.

Adolescent↗
PubMed1995

Improving compliance among women with abnormal Papanicolaou smears.

OBJECTIVE: To determine whether a clinic-based intervention, consisting of motivational brochures and a tracking system, increases adherence to recommendations for treatment in women with abnormal Papanicolaou smears. METHODS: Three pairs of clinics--two family planning clinics, two family practice clinics, and two dysplasia clinics--were randomized within pairs either to provide the intervention or to maintain usual contact procedures with women having abnormal Papanicolaou smears. Baseline adherence rates were assessed through chart review during 3 randomly selected months of the previous year. Intervention clinics received the tracking system and motivational brochures, which were sent to women on notification of their cervical abnormalities. Comparison clinics also used the tracking system but did not include the brochures when notifying women of their abnormalities. Adherence rates were assessed prospectively for approximately 100 consecutive nonpregnant women with abnormal Papanicolaou smears (inflammatory benign atypia, or cervical intraepithelial neoplasia I, II, or III) at each clinic. RESULTS: Within clinics, baseline adherence rates ranged from 34-69% for atypia and 33-88% for dysplasia. For dysplasia patients, the overall analysis indicated a significant increase in adherence for the intervention clinics (P = .03); however, for atypia patients, the observed difference was not statistically significant (P = .23). Extensive analyses of the data from family planning clinics indicated that women receiving the intervention were more likely to obtain follow-up treatment (odds ratio [OR] 2.6, 95% confidence interval 1.15-5.85). There was a suggestion that the intervention could have a greater effect among African-American women (OR 15.7) compared with white women (OR 1.8) (P = .09). White women, those with dysplasia, nonsmokers, and nulliparas were most likely to adhere to treatment recommendations. CONCLUSION: A motivational brochure can enhance adherence to treatment recommendations among women with abnormal Papanicolaou smears. Future studies should focus on techniques for enhancing adherence among more resistant participants.

Adult↗
PubMed1992

"Don't shake the baby": the effectiveness of a prevention program.

The suggestion has been made that a systematic approach to informing all parents of newborns about the dangers of shaking a baby is needed. The purpose of this study was to determine whether an educational campaign about the dangers of shaking a baby could influence parental knowledge, and would be perceived as helpful by new parents. A total of 15,708 parents of newborns in one urban county received a "Don't Shake the Baby" packet over a one year period. Moms ranged in age from 14 to 44 years, and 90% were white. A response postcard in the educational packet was returned by 3,293 parents (21%). More than three-fourths of respondents said the information was helpful to them, and 49% indicated that subsequent to reading the materials, they were less likely to shake their babies. Ninety-one percent said they thought other parents of newborns should read the material.

Brain Damage, Chronic↗
PubMed1990

The development of a testicular self-examination instructional booklet for adolescents.

Testicular cancer (TC) is the most common cancer in 15-34-year-old males, but many young men are unaware of their risks, symptoms, and possibility of detection by testicular self-examination (TSE). After a pretest to determine baseline knowledge and TSE activity, 66 young men, 15-20 years old (means = 18.5 +/- 1.5), were given a programmed-learning self-instructional booklet to read. A posttest after completion of reading the booklet assessed attitudes and new knowledge. A 2-year follow-up tested knowledge and current TSE activity. Pretest analysis revealed that only 15% of the subjects were aware of their risks of TC, and only 6% had been taught TSE by a health professional. Subjects were unable to correctly identify the symptoms of TC, and only 1.5% reported regularly performing TSE. At 2-year follow-up, 95% (p less than .001) knew that a small lump was the most common symptom of TC, and 67% reported performance of TSE (p less than .001). These results suggest that adolescent males are not being taught about TC and TSE, and that our booklet is effective in teaching young men about TC risks and symptoms and how to perform TSE. This self-instruction method may be useful in health education classes for high school and college age youth.

Adolescent↗
PubMed1993

Knowledge of wisdom tooth removal: influence of an information leaflet and validation of a questionnaire.

Different methods are now being employed to increase patient's knowledge of operative procedures for the purpose of ensuring informed consent and improving satisfaction with the service provided. Information leaflets are being used as an additional aid in general practice and in hospital units but many are ambiguous and poorly designed. The evaluation of such written information is seldom conducted. Where evaluation has been reported, the measures employed to assess the benefit of the intervention are poorly validated. This study was conducted to help validate a measure of knowledge concerning removal of impacted third molar and to assess in the longer term the effect of the introducing an information leaflet for patients attending the oral surgery clinic at a dental teaching hospital. Predictions were made about how the knowledge scale would perform under certain conditions. These predictions were subsequently tested in a sample of 156 subjects: dental students (n = 55), sixth-formers (n = 50) and relatives of patients attending a dental hospital (n = 51). All the predictions made about the behaviour of the new scale were confirmed, thereby strengthening the validity of the newly designed measure. This approach of conducting preliminary work to gain an understanding of a new measure's behaviour is advocated as an essential first step in the evaluation of initiatives to provide patient information about dental and oral surgical procedures.

Adolescent↗
PubMed1991

An evaluation of the preoperative information given to patients by intensive care nurses.

In many hospitals it is common practice for nurses working in intensive care units to visit patients on the ward when a stay in the intensive care unit is anticipated following elective surgery. The purpose of the preoperative visit is to minimise fear and anxiety by preparing patients for their admission by providing information about the unit, the equipment used and responding to any questions. However, although there is extensive evidence to support the advantages of information--giving prior to stressful events the author could find no evaluation of the type of information given by intensive care staff. The purpose of the study was three fold. Firstly to discover the type of information patients would like to receive. Secondly to use this data in compiling a booklet which could be used to supplement the preoperative visit. Thirdly to evaluate the contents of the booklet. Postoperatively 20 patients evaluated the booklet by means of a self-administered questionnaire. These were completed 48 h after their transfer from the unit. Overall patients were satisfied with the information contained in the booklet but felt they required additional advice about their proposed surgery and needed more time to absorb the information they had been given.

Consumer Behavior↗