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PubMed1996

Recruiting minorities into the profession of epidemiology. Surveying the applicants' mail. American College of Epidemiology Committee on Minority Affairs.

The underrepresentation in epidemiology of members of racial/ethnic minority groups is greater than in medicine and health fields in general. Using printed recruitment materials, we evaluated the impression that epidemiology programs might make on prospective minority students. Mainstream recruitment materials were solicited from all identifiable U.S. epidemiology programs (n = 70) by requesting copies of typical mailings to prospective students. Of 51 respondents, 46 sent materials that could be analyzed by tabulating and evaluating minority-related content in text and pictures. Materials reflected a generally low-key approach to epidemiology student recruitment. Most minority-related text referred to affirmative action or financial aid and was at the school level rather than specific to the epidemiology programs. Few minority-related epidemiology course titles or research interests were identified. We recommend including more information about epidemiology and its relevance to minority health in mainstream recruitment materials as one possible strategy for increasing the number of minority applicants.

Career Choice↗
PubMed2005

Designing and evaluating parent educational materials.

Families of infants in the neonatal intensive care unit (NICU) are continually seeking information about their infant. Communicating with and providing education to parents is a crucial focus for nurses, who are often challenged to provide families with culturally sensitive health information they can read, understand, and act on when necessary. Understanding the literacy level of specific parent populations allows healthcare providers to develop and test written educational materials for readability and suitability and to assure that the materials used are targeted at parents' specific learning needs. This article presents pragmatic suggestions for evaluating current written materials and developing new NICU parent-education materials with lower readability levels. Additionally, the article identifies strategies to honor the cultural needs of families and actively involve families in the development of parent-education materials.

Caregivers↗
PubMed2004

Patient adherence to skin self-examination. effect of nurse intervention with photographs.

BACKGROUND: Results from a single case-control study suggest that skin self-examination (SSE) has the potential to reduce mortality from melanoma by 63%. Despite these encouraging results, SSE rates are low. Few prospective studies of interventions to increase SSE in high-risk cohorts have been performed. The purpose of this study was to assess the impact of a brief nurse-delivered intervention using digital photographs on patients' adherence to performing SSE. DESIGN SETTING/PARTICIPANTS: Patients at high risk for melanoma skin cancer (five or more dysplastic nevi) (N=100) were recruited from the outpatient Pigmented Lesion Clinic at Memorial Sloan-Kettering Cancer Center. All participants had baseline whole-body digital photography as part of their clinical evaluation. INTERVENTION: Patients were randomized: Group A (n =49) received a teaching intervention (physician and nurse education module) with a photo book (personal whole-body photographs compiled in the form of a booklet, with nurse instruction on how to use the photographs); and Group B (n =51) received the teaching intervention only without a photo book. MAIN OUTCOMES/MEASURES: Self-administered questionnaires were provided at three intervals: baseline, post-teaching intervention, and at the 4-month post-baseline visit. To assess adherence with SSE, patients were asked, "How many times in the past 4 months did you (or someone else) usually, thoroughly examine your skin?" RESULTS: In Group A (teaching intervention with photo book), 10.2% of the patients at baseline reported skin examination three or more times during the past 4 months, while 61.2% reported skin examination three or more times at the 4-month follow-up (p =0.039 for paired comparison). In Group B (teaching intervention only), nearly 20% of the patients at baseline reported skin examination three or more times during the past 4 months, while 37% reported skin examination three or more times at the 4-month follow-up (p =0.63). The increase in reported skin examination was compared between the two groups (>51% v >17.6%, p =0.001). CONCLUSIONS: The results suggest that a brief nurse-delivered intervention is effective at increasing patient adherence with SSE. Utilizing digital photographs as an adjunct to screening appeared to increase patient adherence to performing SSE.

Adolescent↗
PubMed2004

Physical activity promotion in primary care: bridging the gap between research and practice.

BACKGROUND: While a growing literature supports the effectiveness of physical activity interventions delivered in the primary care setting, few studies have evaluated efforts to increase physician counseling on physical activity during routine practice (i.e., outside the context of controlled research). This paper reports the results of a dissemination trial of a primary care-based physical activity counseling intervention conducted within the context of a larger, multi-strategy, Australian community-based, physical activity intervention, the 10,000 Steps Rockhampton Project. METHODS: All 23 general practices and 66 general practitioners (GPs, the Australian equivalent of family physicians) were invited to participate. Practice visits were made to consenting practices during which instruction in brief physical activity counseling was offered, along with physical activity promotion resources (print materials and pedometers). The evaluation, guided by the RE-AIM framework, included collection of process data, as well as pre- and post-intervention data from a mailed GP survey, and data from the larger project's random-digit-dialed, community-based, cross-sectional telephone survey that was conducted in Rockhampton and a comparison community. RESULTS: Ninety-one percent of practices were visited by 10,000 Steps staff and agreed to participate, with 58% of GPs present during the visits. General practitioner survey response rates were 67% (n =44/66 at baseline) and 71% (n =37/52, at 14-month follow-up). At follow-up, 62% had displayed the poster, 81% were using the brochures, and 70% had loaned pedometers to patients, although the number loaned was relatively small. No change was seen in GP self-report of the percentage of patients counseled on physical activity. However, data from the telephone surveys showed a 31% increase in the likelihood of recalling GP advice on physical activity in Rockhampton (95% confidence interval [CI]=1.11-1.54) compared to a 16% decrease (95% CI=0.68-1.04) in the comparison community. CONCLUSIONS: This dissemination study achieved high rates of GP uptake, reasonable levels of implementation, and a significant increase in the number of community residents counseled on physical activity. These results suggest that evidence-based primary care physical activity counseling protocols can be translated into routine practice, although the initial and ongoing investment of time to develop partnerships with relevant healthcare organizations, and the interest generated by the overall 10,000 Steps program should not be underestimated.

Attitude of Health Personnel↗
PubMed2006

The feasibility of connecting physician offices to a state-level tobacco quit line.

BACKGROUND: Telephone counseling for tobacco cessation is an effective and evidence-based approach to address tobacco use. The wide dissemination of region- and state-level quit lines has been a major goal for public health agencies. However, connecting patients in primary care settings to state-level quit lines has not been evaluated. METHODS: Observational study describing two methods (fax referral and providing a brochure) to connect private physician offices with a state-level quit line in Oregon. This study describes the resources required to create a clinical pathway for the 5A's in primary care (ask, advise, assess, assist, and arrange) using a state-level telephone quit line as an intervention for cessation in primary care clinics sharing a common electronic medical record system, focusing on the costs and generalizability of this approach. RESULTS: Of the 15,662 smokers identified in 19 primary care clinics, 745 patients were referred to the Oregon Tobacco Quit Line during the study period. The program cost in the first year was $15 to $22 per patient connected with the quit line; in subsequent years, the cost decreased to $4 to $6 per quit-line connection. CONCLUSIONS: Connecting private physician offices to a state-level quit line is feasible, can be accomplished at low cost with minimal use of resources, and may be cost effective. Regional, state, and local tobacco quit lines should consider a physician office "quit-line connection" as a practical approach to increase utilization.

Adult↗
PubMed2005

[Evaluation of the information given to parents during the planned preanaesthetic consultation in a paediatric hospital].

INTRODUCTION: Information given to the parents of paediatric patients during the preanaesthetic consultation (CS) must be understandable. OBJECTIVE: We have studied the impact of this information given during CS. METHODS: Prospective study over four months with a questionnaire completed by parents after CS and before the hospitalization. The Sfar information booklet was given to the parents before CS. The study evaluated whether the information had been given ("have you received the information on...?"), understood ("Did you understand...?"), and if CS had influenced anxiety of parents/child; on four items of information, anesthetic risk, transfusion, postoperative pain, and anesthetic technique. The questionnaire noted also the parents sociocultural level (NSC), and if they had read the Sfar booklet. Statistical analysis (descriptive, uni-, multivariate), p<0.05. RESULTS: Four hundred questionnaires were distributed, 334 were analyzed. The information on the four items was considered to have been given in 75%, understood 72%, and to have diminished anxiety 68%. These results were not influenced by whether or not (88%) parents had read the Sfar booklet. How much information was given was a function of the physician giving the information. Elevated NSC and amount if information given improved comprehension optimized. Diminution of anxiety was when all four items were understood, CS was performed by a senior physician and the parent's NSC was high. DISCUSSION: Information better adapted to NSC may improve the quality of CS. The Sfar booklet does not contribute to parents understanding in this context.

Adult↗
PubMed2006

Information booklets to patients' family and relatives. Survey of practice in a sample of 59 intensive care units, in France.

OBJECTIVE(S): To assess the content of the intensive care unit (ICU) information booklet delivered to patient families, and that of the general information booklet of the hospital in a sample of intensive care, in France. STUDY DESIGN: Survey. METHODS: A sample of 105 ICU was obtained at random from a national database. A survey form was sent to each ICU medical director. The ICU information booklet, that one from the hospital and the corresponding questionnaire of each participating ICU have been studied to assess the percentage of information items present which matched the recommendations of at least one of three different professional guidelines. RESULTS: Fifty-nine ICU answered. We observed a significant (P<0.01) heterogeneity by the kind ICU considered (general, medical, or surgical). The percentage of information items matching guidelines remained low (median: 41%) even if higher (P<10(-3)) than the percentage of items not matching guidelines (median: 6%). Among a panel of items we considered as important, we observed a significant discrepancy (P<10(-3)) between a low citation rate in ICU booklets (median: 14%) and the opinion of doctors who judged it should included in booklets (median: 68%). CONCLUSION: Guidelines in terms of patient and family information in ICU seem to have a mild impact on the information booklets which are also very different among the types of ICU. There is a gap between what doctors judge to be included in booklets and what they effectively write in these documents.

Data Collection↗
PubMed2006

[The role of an information booklet or oral information about back pain in reducing disability and fear-avoidance beliefs among patients with subacute and chronic low back pain. A randomized controlled trial in a rehabilitation unit].

OBJECTIVES: To compare the efficacy of an information booklet or oral information about back pain in reducing disability and fear-avoidance beliefs among patients with subacute and chronic low back pain referred to a rehabilitation department. METHODS: An alternate-month design was used for 142 patients with subacute or chronic low back pain who were hospitalized for treatment. Seventy-two patients received written standardized information about back pain (the "back book") and usual physical therapy (intervention group), and 70 received usual physical therapy only along with nonstandardized oral information (control group). The main outcome measure was disability (measured on the Quebec back-pain disability scale), and secondary outcome measures were pain intensity (measured on a visual analog scale), fear-avoidance beliefs (measured on the Fear-Avoidance Beliefs Questionnaire [FABQ] Physical component), and knowledge of the relation of back pain to physical activity assessed at baseline, just before discharge from the hospital and 3 months after discharge. Satisfaction related to the information received was assessed on the day of discharge. RESULTS: Receiving the "back book" had a significant impact on disability at 3 months, from 48.40+/-14.55 to 34.57+/-18.42 in the intervention group and from 52.17+/-16.88 to 42.40+/-14.95 in the control group (p=0.03). Receipt of the book also had a significant impact on patients' knowledge and satisfaction about information but a nonsignificant effect on fear-avoidance beliefs. CONCLUSIONS: Providing an information booklet about back pain to patients with subacute and chronic low back pain referred to a rehabilitation unit contributes to reduced disability in these patients.

Adult↗
PubMed2004

Does preoperative hip rehabilitation advice improve recovery and patient satisfaction?

The goal of the current study was to investigate whether preoperative rehabilitation advice reinforced by a patient information booklet can aid recovery after total hip arthroplasty in terms of pain, function, satisfaction, and quality of life. Thirty-five patients awaiting primary total hip arthroplasty were recruited into this study and randomly allocated before admission to receive either the standard pathway of care or the rehabilitation program and booklet. All patients showed increases in function and psychological variables with time. The preoperative class and booklet, however, seemed to have the greatest impact on length of hospital stay, reducing the hospital stay by 3 days, and therapy input required, significantly influencing the cost of the procedure (the rehabilitation class led to a cost saving of 587 British pounds; approximately 810 dollars, per patient). In addition, patients attending the class reported higher levels of satisfaction (99% satisfied in the preoperative rehabilitation class compared with 80% in the control group 3 months postoperatively) and had more realistic expectations of surgery.

Age Factors↗
PubMed2006

Paediatric 99mTc-DMSA imaging: Reducing distress and rate of sedation using a psychological approach.

AIM: To evaluate the effect of a psychological approach on distress and sedation rates in children undergoing dimer captosuccinic acid-labelled with technetium-99 (99mTc) DMSA imaging. MATERIALS AND METHODS: Baseline data, on a retrospective consecutive sample of children examined using DMSA over a 6-month period (n = 81), were collected via medical note search and postal questionnaire. A further consecutive sample of 40 children was recruited prospectively to the intervention, which consisted of distraction during medical procedures and environmental manipulation. In addition half of the intervention group were provided with a photo-booklet depicting a coping child model, together with a letter offering advice to parents on how to prepare their child for the procedure. RESULTS: Sedation rates were lower (p = 0.003) and service satisfaction ratings higher (p = 0.002) in the Intervention group as compared with the Baseline group. Within the intervention condition, children who received the photo-booklet displayed less distress before the procedure (p = 0.01) than those who did not. Also families who received the photo-booklet were more likely to attend the appointment (p = 0.024). CONCLUSION: In this study, the use of a psychological approach was associated with lower rates of distress and sedation in children undergoing 99mTc-DMSA imaging, without compromising image quality.

Adaptation, Psychological↗
PubMed2005

Intention to test for prostate cancer.

The aim of this study was to assess intention among men to take a prostate-specific antigen (PSA) test, when this test was: (i) offered by a doctor or (ii) based on the men's own initiative. A further aim was to use the Theory of Planned Behaviour (TPB) to predict the most important determinants for taking a PSA test. In addition, the intention to take a PSA test among men who had the opportunity to read a PSA leaflet published by the Swedish Cancer Society was compared with men who had not read the leaflet. A total of 1000 men, age range 40-70 years, were selected randomly from a population database. The TPB model was used to measure attitudes about PSA testing. The constructed questionnaire was posted to the selected sample. Half of the sample received only the TPB questionnaire and the other half also received a PSA leaflet. The response rate was approximately 63%. The results showed that men would be less likely to request a PSA test if their doctor did not suggest the test (mean approximately 3.8 (range 1-7 from not likely to very likely)). However, if they were offered the test, most would take it (mean approximately 6.0 (range 1-7)). The positive "Attitude factor" towards the test was the most salient predictor of both behaviours. In addition, the probability of requesting a test was higher among those who had already taken a PSA test. The men who did not receive the PSA leaflet reported a higher intention to take the test than those who had received it. Overall, 47% of the variance was explained concerning men's intention to take a PSA test when offered by a doctor and 25% of men's intention to request the PSA test themselves. In conclusion, the majority of men in this study had a positive attitude towards PSA testing. The results indicate that most men could be expected to accept screening. The intention to take the PSA test was lower among the men who had received the PSA leaflet.

Adult↗
PubMed2006

Impact of an information booklet on satisfaction and decision-making about BRCA genetic testing.

The aim of this study was to assess the impact of a standardized patient information booklet on decisions women make about genetic testing. This French national multi-centre survey included all women with cancer to whom genetic testing for BRCA1/2 mutation had been proposed. The control group was surveyed before the booklet became available (n = 263), and the experimental group, after being given it personally (n = 297). After multivariate adjustment, the booklet had a positive impact on satisfaction with the information provided (Odds ratio (OR) = 2.9; 99% confidence interval (CI) = 1.7-5.0; P = 0.001), decreased the decisional conflicts due to lack of information (OR = 1.9; 99% CI = 1.1-3.3; P = 0.002), and had a marginal impact on knowledge (R2-gain = 3%; P = 0.001). The women in the experimental group decided more frequently to undergo testing (99% vs. 95%; P = 0.009). In addition to a consultation providing more tailored information, a standardized written document improved the decision-making process involved in giving informed consent to genetic testing.

Breast Neoplasms↗
PubMed2006

Information provision for patients by breast cancer teams about the side-effects of hormone treatments.

The choice of adjuvant hormone treatments in post-menopausal women with breast cancer increasingly includes anastrozole as an alternative to tamoxifen. Clearly there may be overlapping side-effects, but other important differences may have serious implications for health and quality of life. Patients consequently require information regarding the side-effects of recommended treatments and their comparisons. This study evaluates the extent of information provision about the side-effects of adjuvant anastrozole and tamoxifen by respective breast cancer professionals within 16 different breast care teams in the United Kingdom (UK). The study used interviews with individual members of breast cancer multidisciplinary teams (surgeons, oncologists and breast care nurses) from 11 cancer centres and 3 district general hospitals, to examine the information they give to patients relating to the side-effects of tamoxifen and anastrozole. The results show that vasomotor symptoms were the most frequently mentioned side-effect for both treatments. All teams, in large part addressed the adverse effects of both treatments (endometrial cancer and thrombo-embolic events for tamoxifen and anastrozole-associated loss of bone density). There was variation between the different professionals as to how frequently side-effects were mentioned. The greatest discrepancies occurred between the information given by team members and that included in patient information leaflets. In some cases, important information pertaining to side-effects was omitted from leaflets. This study suggests the need to standardise information-provision nationally in the UK and within breast cancer teams regarding the evidence-based side-effects of tamoxifen and anastrozole.

Antineoplastic Agents, Hormonal↗
PubMed2006

There are gender differences in attitudes toward surrogacy when information on this technique is provided.

OBJECTIVE: We analyzed the data of a nationwide opinion survey reported in a previous study and clarified the importance of socioeconomic status and individual belief on people's opinion regarding the pros and cons of gestational surrogacy. In this study, we analyzed the data of this nationwide opinion survey to identify the effect of providing information about assisted reproductive technology (ART) on the people's attitude towards not only gestational surrogacy but also other ART procedures. STUDY DESIGN: This was a cross-sectional study. A nationwide opinion survey on ART was conducted in 2003. The participants included 3647 people (1564 people received only the questionnaire and 2083 people received the questionnaire and a brochure containing information about ART). Multivariate-adjusted odds ratio and 95% confidence interval were obtained using logistic regression models for understanding the manner in which the knowledge about ART affects the attitude of the general population towards ART, which uses donor gametes and surrogacy. RESULTS: With regard to gestational surrogacy, men in the brochure group could not clearly express their opinions when compared with those in the no-brochure group (odds ratio (OR): 0.69; 95% confidence interval (CI): 0.53-0.89). In contrast, with regard to donor insemination, women in the brochure group could clearly express their opinions when compared with those in the no-brochure group (OR, 1.24; CI, 1.02-1.52). Information about ART, especially in men, promoted disapproval of partial surrogacy (OR, 0.59; CI, 0.44-0.78) and gestational surrogacy (OR, 0.64; CI, 0.48-0.86). On the other hand, for other ART procedures, we found no significant association between receiving information via the brochure and people's attitude towards the technology. CONCLUSION: There were gender differences in attitude toward surrogacy that was affected by providing information about ART. Moreover, determining community attitudes, we observed that a good understanding of the information provided facilitates the expression of a clear opinion, thereby assisting respondents in deciding whether or not they approve of a certain technology.

Adult↗
PubMed2005

People with intellectual disabilities and their need for cancer information.

Many people with intellectual disabilities will be affected by cancer in their lifetime. There is a lack of available knowledge about people with intellectual disabilities' understanding and experience of cancer, and about their need for cancer information. The principal aim of the study was to explore the information needs of people with intellectual disabilities who are affected by cancer. This was a qualitative, hypothesis generating study. Nine people with intellectual disabilities who were affected by cancer were identified using a purposive sampling method; five of these participated in the study. Data collection included observation of the use of a pictorial cancer information book designed for people with intellectual disabilities, and semi-structured interviews. Data analysis revealed three themes: (1) "Nobody told me": the desperate need for cancer information; (2) "That reminds me": telling my own story; and (3) "I don't know much about cancer": the difficulties of the staff supporting people with intellectual disabilities to read the cancer information book. The people with intellectual disabilities in this study were not provided with information about cancer. They wanted this information, and appeared to be capable of comprehending it. Further development of accessible information materials around cancer and palliative care is needed.

Adult↗