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PubMed2006

Public dialogue on healthcare prioritisation.

The Swedish public healthcare sector is administered by county councils or regions with their own power of taxation. These authorities are facing difficult times as the gap between demand and healthcare resources is widening and the option to further increase county council taxes is not politically tempting. It is becoming ever more apparent that, sooner or later, limits to the public healthcare commitment must be set. In the north-western district of Region Skåne, the district board determined to initiate a public dialogue on prioritisation with local residents. Annual surveys were sent to 1% of the population ( approximately 2500 individuals) during the period 2002-2004. The addressees were also asked if they wanted to participate in public meetings with the healthcare politicians. This study investigates what happened to the preferences and attitudes of the interest group when the participants were not only offered an opportunity to enter into a dialogue with their peers and representatives, but also received information on prioritisation matters. After the intervention, which consisted of two public meetings with politicians and five information booklets on prioritisation issues, the study group was asked to participate in a second survey. At the follow-up, 20% fewer thought that one should always have a right to public healthcare, even if troubles were trivial. Eighty four percent in the study group thought that the general public should participate in prioritisation discussions while only 64% in the control group agreed to this. Eighty two percent of the study group marked the dialogue project "good" or "very good". The results indicate an increased acceptance for reallocations, a strengthened will to participate and more confidence in the politicians and their work. The study is descriptive and designed to make long-term follow-ups possible.

Attitude of Health Personnel↗
PubMed2004

An analysis of information available to relatives in intensive care.

The Comprehensive Critical Care Review published by the Government in 2000 acknowledges that patients are part of family units and critical illness has an extended impact. It outlines information that should be provided to relatives and suggests recommendations be implemented within 3-5 years. The aim of this study was to gauge an overall view of provisions available across general Intensive Care Units in England for relatives, by conducting an analysis of information available and unit policies, and to see the extent that government guidelines have been adhered to. Two hundred and ten units were approached for copies of policy documents and leaflets. There was a 56% response rate. Results were collated and analysed for basic descriptive statistics using software package SPSS version 11.5. The Gunning's Fog Index was performed on 20% of leaflets to measure readability. All leaflets measured above the recommended level. Sixteen percent of units do not have a leaflet and therefore do not comply with the Department of Health recommendations. Huge variation exists nationally over the amount and quality of information that relatives have access to and receive. Only 9% of units had an official policy on how to deal with relatives. The implications of this are discussed.

England↗
PubMed2004

Reducing family members' anxiety and uncertainty in illness around transfer from intensive care: an intervention study.

INTRODUCTION: This intervention study examines anxiety and uncertainty in illness in families transferring from intensive care to a general ward. METHODS: The pre-test, post-test design purposively allocated family members to a control (n = 80) and intervention group (n = 82). The intervention group experienced a structured individualised transfer method whereas the control group received existing ad hoc transfer methods. Families were surveyed before and after transfer. RESULTS: Families' uncertainty was significantly related to their state anxiety (P < 0.000), the relationship to the patient (P = 0.022), and the unexpected nature of patients' admission (P < 0.000). Anxiety increased significantly with reduced social support (P = 0.002). Following transfer, anxiety reduced significantly for both groups whereas uncertainty reduced significantly for the intervention group (P = 0.03). CONCLUSION: Families at the time of transfer experience uncertainty and anxiety, which are significantly related in this study. The intervention significantly reduced uncertainty scores. When the family member was a parent, when admissions were unexpected, and those with fewer social supports represent potential 'at risk' groups whose adaptation to transfer may limit their coping ability. The structured individualised method of transfer is recommended with further research of ICU families to further examine the dimension of uncertainty and how it affects patient outcomes.

Adolescent↗
PubMed2005

Use of an information leaflet to improve general practitioners' knowledge of post dural puncture headache.

BACKGROUND: The number of women receiving neuraxial anaesthesia for labour and delivery is increasing. Women are also being discharged into the community sooner after delivery. Thus, complications arising from neuraxial anaesthesia may present to general practitioners, so it is of vital importance that they are familiar with and can manage potential problems associated with these anaesthetic techniques. METHODS: A questionnaire was sent to 126 local general practitioners to discover their knowledge of the symptoms, diagnosis and treatment of post dural puncture headache in the parturient. An information leaflet was then circulated to all general practitioners in the region, detailing headaches and other potential problems following epidural analgesia for childbirth, and the questionnaire was reissued. RESULTS: The first questionnaire demonstrated that they had poor knowledge of the symptoms, diagnosis and treatment of post dural puncture headache in the parturient. Following the dissemination of the information leaflet, responses to the second questionnaire showed a significant improvement. CONCLUSION: By comparing the two sets of answers, we demonstrated that the leaflet has successfully improved knowledge of post dural puncture headache and other potential sequelae of obstetric epidural analgesia among general practitioners.

Analgesia, Epidural↗
PubMed2005

Hand hygiene posters: motivators or mixed messages?

Poster campaigns regarding hand hygiene are commonly used by infection control teams to improve practice, yet little is known of the extent to which they are based on established theory or research. This study reports on the content analysis of hand hygiene posters (N=69) and their messages (N=75) using message-framing theory. The results showed that posters seldom drew on knowledge about effective ways to frame messages. Frequently, they simply conveyed information 'telling' rather than 'selling' and some of this was confusing. Most posters were not designed to motivate, and some conveyed mixed messages. Few used fear appeals. Hand hygiene posters could have a greater impact if principles of message framing were utilized in their design. Suggestions for gain-framed messages are offered, but these need to be tested empirically.

Advertising↗
PubMed2004

Prescribing wellness: a case study exploring the use of health information brochures.

OBJECTIVE: A case study was undertaken to ascertain the potential usefulness of brochures as a strategy for encouraging short-term and longer-term acquisition of healthy behaviors at the consumer-health care system interface. METHOD: Purposive sampling of chiropractic clinics and convenience sampling of patients attending these primary contact practitioners were undertaken. Patients were asked to complete a questionnaire. Interested patients were given a health information brochure on topics of their choice. Patients who had requested health information brochures were phoned at 3 weeks, 3 months, and 1 year after completing the initial questionnaire and asked if they had implemented any of the suggestions for health promotion or risk prevention. A minimum of 4 attempts were made to contact each participant by telephone. Data were analyzed using descriptive statistics. RESULTS: Twenty-one chiropractic clinics and 781 patients participated. Although every third patient requested one or more health information brochures, fewer than 1 in 4 of those receiving brochures implemented some health-promoting behavior. Although some patients persisted with their newly initiated health-promoting behaviors, compliance diminished over time. Exercise and dietary change were the behaviors most likely to be modified. CONCLUSION: Implementation of even one healthy behavior can have a ubiquitous health benefit. Despite dwindling compliance, it is therefore suggested that suitably formulated health information brochures that inform and encourage adoption of healthy behaviors by motivated patients deserve consideration by all health professionals working at the consumer-health care system interface.

Adult↗
PubMed2006

Should 'Cyrus the Centipede' take a hike? Effects of exposure to a pedestrian safety program on children's safety knowledge and self-reported behaviors.

INTRODUCTION: We report the first evaluation of the popular "Cyrus the Centipede" child pedestrian safety program. METHOD: A pre-test/post-test control versus experimental condition design was used to assess Cyrus' impact on third graders' pedestrian safety knowledge, and self-reported pedestrian behaviors. RESULTS: Although some beneficial effects were observed, the program was not reliably effective. In particular, the impact of exposure to Cyrus was strongly influenced by the individual teacher who delivered it, likely due to the highly unstructured nature of the curriculum. SUMMARY: We suggest that: (a) the effectiveness and reliability of such programs be demonstrated before they are widely adopted; and (b) programs that focus on training children in actual or simulated traffic environments may be more effective than those that primarily focus on teaching safety facts and rules.

Accidents, Traffic↗
PubMed2004

Risk perception of oral cancer in smokers attending primary care: a randomised controlled trial.

To encourage the public to attend and accept oral cancer screening, further understanding is required of the ability of structured information to alter patient knowledge and risk perceptions. Previous work has shown the benefit of written information for those at high risk of oral cancer, especially for tobacco smokers. This study investigated three hypotheses: first that a patient information leaflet (PIL) would enhance risk perceptions, and second that the effect of the leaflet on knowledge would be confirmed as in previous studies and third that these improvements would be associated with smoking behaviour. Patients (N = 995) attending 20 general dental practices in Northern Ireland were invited to participate, 28 refused (response rate = 97%). Patients were randomised into two groups. The experimental group received a PIL and then completed a self-report questionnaire, whereas the control group followed same procedure without the PIL. Measures included a 36 item oral cancer knowledge scale and two items to assess risk perception. Usable data were available from 944 patients; mean (SD) age = 42 (15), 65% female. Risk perceptions of oral cancer were minimally effected by the PIL (p = 0.023). This effect was demonstrable in smokers. Smokers were sixteen (95% CI: 8-30) times more likely to believe that they were at greater risk of oral cancer than non-smokers. A clear benefit of the PIL on patients' oral cancer knowledge was found, particularly for smokers and those with a history of smoking. These findings demonstrate that public awareness of smokers can be raised with written information although health beliefs such as risk perceptions require more intensive intervention.

Adolescent↗
PubMed2006

Oral cancer knowledge and awareness: primary and secondary effects of an information leaflet.

Information leaflets can be stored and read several times at the patient's own convenience and speed and, therefore, might contribute to increasing the long-term oral cancer knowledge and awareness. This hypothesis was investigated in a sample of adults living in a small central Italian town. The two groups of patients selected (Intervention, 100 subjects; Control, 84 subjects) were all aged 40 years and had never received oral cancer counselling or examination previously. Subjects completed a questionnaire (PRE) containing items regarding oral cancer epidemiology and prevention. Thereafter, the Intervention patients received the oral cancer information leaflet. One year later, patients from both groups were re-contacted and most (97 Intervention, 79 Control subjects, overall participation rate, 95.7%) completed the same questionnaire (POST). The POST questionnaire score, the score increment and the proportion of patients who sought an oral cancer examination during the year follow-up were used as markers of long-term knowledge, knowledge improvement and awareness, respectively. The between group differences in mean PRE score, POST score, score increment and proportion of subjects who had an examination were assessed by conventional statistical tests. The effect of leaflet corrected for confounders also was assessed using multiple regression analyses. No difference in PRE score and awareness was found. However, the mean POST score and the score increment were significantly higher in the Intervention group. The leaflet significantly increased knowledge but not awareness, with statistically significant effects from high educational level and younger age. It is concluded that the information leaflet had a significant effect in raising the long-term oral cancer knowledge in the general public. It also had a secondary effect on disease awareness in the locale.

Adult↗
PubMed2004

Health promotion for survivors of childhood cancer: a minimal intervention.

We report the evaluation of an information booklet aimed to explain the purpose of follow-up to survivors of childhood cancer. Evaluations drew on theoretical concepts in the elaboration likelihood and stages of change models. We predicted that survivors who adopt central rather than peripheral processing would show greater understanding and increased readiness to change health behaviour. Forty-eight survivors were shown an example page of the booklet in the clinic and then completed questionnaires about attitude to clinic, readiness to change behaviour, and the importance and scariness of the information. They were then given the whole booklet and asked to complete a second questionnaire at home. After reading the booklet, survivors reported a more positive attitude to clinic. Survivors using central processing rated information as more important and were more ready to change health behaviour than peripheral processors. We recommend that methods to encourage central processing should be routinely included when providing children with health information.

Adolescent↗
PubMed2004

Development and pilot testing of a disease management program for low literacy patients with heart failure.

UNLABELLED: Development and pilot testing of a disease management program for low literacy patients with heart failure. BACKGROUND: Randomized trials have shown that disease management programs can reduce hospitalizations and improve symptoms for patients with congestive heart failure. We sought to create and pilot test such a program for patients with low literacy skills. METHODS: We used focus groups and individual cognitive response interviews (CRIs) to develop an educational booklet for low literacy patients with heart failure. We incorporated the booklet into a disease management intervention that also included an initial individualized 1-h educational session and scheduled supportive phone calls that were tapered over 6 weeks. We then conducted a 3-month before-after study on patients with low literacy skills (<9th grade literacy level) in a university internal medicine clinic to test the acceptability and efficacy of our program. Outcomes of interest included heart failure-related knowledge, self-care behavior and heart failure-related symptoms measured on the Minnesota Living with Heart Failure (MLwHF) scale. RESULTS: Twenty-five patients were enrolled and 23 (92%) completed 3-month follow-up. Mean age was 60 years (range 35-74), 60% were men, 60% were African-American, and 74% had household income under $15,000 per year. The median reading level was fifth grade with 32% reading at or below the third grade level. Mean knowledge score at baseline was 67% and did not improve after the intervention. The proportion of patients reporting weighing themselves daily increased from 32% at baseline to 100% at 12 weeks. Mean improvement on the MLwHF scale was 9.9 points over the 3-month trial (95% CI: 0.5, 19.2), which corresponds to an improvement in one class on the New York Heart Association heart failure scale. CONCLUSION: A heart failure disease management program designed specifically for patients with low literacy skills is acceptable and is associated with improvement in self-care behavior and heart failure related symptoms.

Adult↗
PubMed2004

Health education on self-management and seeking health care in older adults: a randomised trial.

The aim of this randomised trial was to determine the effects of a health education strategy for older adults living at home on GP attendance. The health education comprised a written booklet on five frequently by GP unnoticed, highly prevalent and potentially treatable health problems: hearing impairment, visual impairment, urinary incontinence, depression and Lower Urinary Tract Symptoms (LUTS). The information comprised structured guidance to enhance decision-making on seeking health care by their GP and contained advice on self-management. The control group did not receive any intervention. Primary outcome was GP attendance of patients regarding the five health problems within 3 months. At this point we expected an increase of GP attendance. Six hundred and eighty-seven subjects completed the study. We can conclude that the health education strategy did not change the GP attendance of older adults. The results suggest that the health education was being appreciated as being useful and informative.

Activities of Daily Living↗
PubMed2004

Evaluation of an evidence-based education package for men with prostate cancer on hormonal manipulation therapy.

Prostate cancer has become a public health problem worldwide with considerable social and economic consequences. Many men have extraprostatic spread at diagnosis, and treatment usually involves hormonal manipulation therapy, which can challenge the stereotypical male image. It is often assumed that merely the provision of educational material for patients in an accessible form is sufficient to address informational needs. However, with the increasing emphasis on evidence-based practice, an essential element of the patient education process is evaluation of the impact of educational interventions. In this study, a randomised controlled trial was used to evaluate the effect of an evidence-based education package on the knowledge of disease and treatment, quality of life, coping and satisfaction of a sample (n=55) of men with prostate cancer on hormonal manipulation therapy in the UK. The men were randomly assigned to experimental (n=28) and control group (n=27). Established instruments with satisfactory reliability and validity were used to measure the dependent variables. The independent variable, namely the education package, had been developed following the results of a previous study, which assessed the informational needs of this client group. This package consisted of an information booklet supplemented by the verbal teaching of a urology nurse. Results demonstrated that delivery of the education package had a significant effect on knowledge, quality of life and satisfaction with care, but not on coping. This study has contributed to the evidence-base for practice in urological nursing. This education package should become a routine, and not merely incidental aspect of care for this client group.

Adaptation, Psychological↗