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PubMed2004

Effect of education on self-efficacy of Turkish patients with chronic obstructive pulmonary disease.

This study was designed to compare the effect of structured education on self-efficacy in patients with chronic obstructive pulmonary disease (COPD). The study was carried out with an experimental group on which a structured education was provided, and a control group on which only educational advice was provided. There were 30 patients in both groups. Control and experimental group measurements were obtained on the COPD Self-Efficacy Scale (CSES). There was a significant difference between control group and experimental group scores on the CSES. Self-efficacy, as it affects managing or avoiding breathing difficulty, was measured before and after the structured education program and the nursing care. Patients' self-efficacy scores significantly improved after the structured education and remained significantly improved 1-month later. Standard nursing care alone was also effective in significantly improving self-efficacy scores, but patients' scores 1-month later were not significantly better than pre-program scores. This study indicates that a planned education program that is more effective in improving self-efficacy in patients with COPD.

Affect↗
PubMed2004

Literacy demands of product information intended to supplement television direct-to-consumer prescription drug advertisements.

The US Food and Drug Administration (FDA) allows television direct-to-consumer (DTC) prescription drug advertisements that do not fully disclose drug risks if the ads include "adequate provision" for dissemination of the drug's approved labeling. This requirement can be met in part by referring consumers to multiple text sources of product labeling. This study was designed to assess the materials to which consumers were referred in 23 DTC television advertisements. SMOG assessments showed that the average reading grade levels were in the high school range for the main body sections of the materials and college-level range for the brief summary sections. The Suitability Assessment of Materials (SAM) instrument identified specific difficulties with the materials, including content, graphics, layout, and typography features. Stronger plain language requirements are recommended. Health care providers should be aware that patients who ask about an advertised drug might not have the full information required to make an informed decision.

Advertising↗
PubMed2005

Unwanted control: how patients in the primary care setting decide about screening for prostate cancer.

Current guidelines recommend shared decision-making to determine whether the prostate-specific antigen (PSA) test should be performed. At a large family medicine practice in suburban Washington, DC, we administered a sequence of patient and physician surveys to examine the desired and actual level of patient control over PSA screening decisions and the circumstances in which they occur. Both before and after visits, patients expressed a preference for a shared approach to the PSA decision, but the actual decision involved a significant shift toward greater patient control. Almost 25% of patients reported greater decisional control than they desired. Fully 30% of the men who wanted a shared approach made the actual decision themselves. Patients prefer a shared approach to the PSA decision but report greater personal control when the decision is actually made. Further research is needed to understand this phenomenon and to better accommodate patients' desire for shared decision-making.

Aged↗
PubMed2004

Information needs of men regarding prostate cancer screening and the effect of a brief decision aid.

BACKGROUND: Little is known about what information affects men's decisions about prostate cancer screening. METHODS: We developed a four-part decision aid about prostate cancer screening and tested it in men, ages 45-85, to determine how the information in each part--(1) the epidemiology of prostate cancer; (2) the PSA test; (3) prostate biopsy and treatment options for prostate cancer; and (4) balance sheets to aid decision-making--affected men's interest in screening. RESULTS: One hundred eighty-eight men from one general internal medicine clinic participated in our study (response rate 65%). Before the decision aid, 76% were interested in screening; 8% were not; and 16% were undecided. The decision aid increased the proportion of men who knew the advantages (+28%; 95% CI: 21-35) and disadvantages (+55%; 95% CI: 48-63%) of screening. It also increased the proportion who knew enough to make a decision (+24; 95% CI: 16-32%). It did not change men's interest in screening (P = 0.134). Twenty percent of men, however, did change their interest category. Men who were undecided at baseline were more likely to change than those who were interested or not interested. There were no clinically meaningful changes in interest following each component part of the decision aid. CONCLUSION: Interest in prostate cancer screening is high and remained high after a 10 min decision aid. The decision aid increased the proportion of men with sufficient information to decide about screening. It also changed 20% of men's interest in screening. Because no single piece of information was influential to decision-making in all men, clinicians may want to tailor information to men's individual needs.

Aged↗
PubMed2005

The general public's information needs and perceptions regarding hereditary cancer: an application of the Integrated Change Model.

The Integrated Change Model (the I-Change Model) was used to analyse the general public's need and perceptions concerning receiving information on the role of hereditary factors with regard to cancer. The results from a study in 457 Dutch adults showed that 25% correctly indicated the types of cancer where hereditary factors can play a role. Respondents, however, overestimated the role of hereditary factors causing breast cancer. Recognition of warning signs was low, as was the recognition of inheritance patterns. Participants wanted to know the types of cancer with hereditary aspects, how to recognise hereditary cancer in the family, personal risks and the steps to be taken when hereditary predisposition is suspected. The most popular information channels mentioned were leaflets, the general practitioner, and the Internet. Respondents interested in receiving information on heredity and cancer were more often female, had had experiences with hereditary diseases, had more knowledge, perceived more advantages, encountered more social support in seeking information, and had higher levels of self-efficacy. Education should outline the most important facts about hereditary cancer, how to get support, and create realistic expectations of the impact of genetic factors.

Adolescent↗
PubMed2004

Information versus experience: a comparison of an information leaflet on antidepressants with lay experience of treatment.

The quality of patient information leaflets has been criticised for being too medico centred. Written information produced by a patient organisation should be tailored to members' expressed needs, and based on their experience and therefore useful in helping patients to self-manage their condition. Views expressed in semi-structured interviews with 30 members of a self help group for depression were compared with the content of an antidepressant leaflet produced by the parent organisation. The information leaflet used six frequently asked questions to deliver a biomedical discourse on antidepressants. Members of the group had questions not included in the leaflet around self help, stigma and sense of self, and more complex answers to the six questions. It cannot be assumed that information leaflets written by lay led organisations are patient centred and promote self help. To assist in facilitating concordance between patient and prescriber medicine information leaflets should draw on patient experience of the condition and treatment for it.

Antidepressive Agents↗
PubMed2005

Long-term efficacy of a checklist to improve patient education in cardiology.

In a randomised controlled trial a Frequently Asked Questions (FAQ) checklist intended to prepare coronary artery disease (CAD) outpatients for a medical check-up visit at the cardiologist was evaluated. The checklist was mailed to patients in preparation to their visits after 1, 4 and 10 months following patients' discharge from hospitalisation for CAD. It was hypothesised that the intervention would result in lower state anxiety, better patient-doctor communication, more knowledge of CAD and greater patient satisfaction, while it would not result in longer visits. Repeated measurements analyses of covariance showed that experimental patients (N = 46) were less anxious before the first visit. This visit was shorter than in the controls, though the third visit was longer. Control patients (N = 59) showed more CAD knowledge than experimental patients at the first and third visit. Experimental patients found the checklist useful, though its value diminished at subsequent visits. Using the checklist thus decreased anxiety prior to the first visit and the duration of that visit, while negatively affecting knowledge. No conclusions about long-term effects could be drawn, due to the likelihood of type II and type III errors. Process evaluation indicated that the approach used is not sufficiently stimulating for patients to use as a preparation to every visit.

Aftercare↗
PubMed2005

A short educational intervention on communication skills improves the quality of screening for Chlamydia in GPs in Belgium: a cluster randomised controlled trial.

An accurate algorithm for screening for chlamydial infections is available in general practice, but GPs experience numerous barriers to sexually transmitted infections (STI) counselling. In this study we assessed if a short educational package, under the form of a commented video footage on communication skills, was helpful in implementing the screening strategy. A cluster randomised controlled trial was carried out in 36 general practitioners in Antwerp, Belgium. Main outcome measures were: number of patients included in the risk assessment, number of patients tested, and proportion of appropriately tested patients. The results show that GPs in the intervention group did not include more patients overall, but that the quality of the screening process was significantly better (81.6% versus 56.2% appropriate tests, P = 0.02). Conclusively, GPs who participated in a short educational package on communication skills, selected eligible candidates for screening more accurately and decreased the risk of overscreening.

Adult↗
PubMed2005

Using expert patients' narratives as an educational resource.

In this article, we examine the topic of patient participation in health care and report on how we have drawn on the concept of patient expertise to produce a new kind of information booklet for chronic arthritis patients. The booklet is patient-generated and contains the illness narratives of patients with three kinds of arthritis. The booklet draws upon the knowledge of patients who feel they are flourishing despite their condition. By communicating information through the powerful medium of narrative it is hoped the booklet will be a useful educational and supportive resource for other patients with a similar condition. We would encourage health professionals to acknowledge patient expertise and to consider the expertise of certain patients as a valuable educational resource both for themselves and for other patients.

Activities of Daily Living↗
PubMed2005

A community-based randomised controlled trial of three different educational resources for men about prostate cancer screening.

Randomised evaluations of resources to facilitate informed decisions about prostate cancer screening are rarely conducted. In this study, 421 men recruited from the community were randomly allocated to receive a leaflet (n = 140) or one of two resources meeting criteria for a decision-aid: a video (n = 141) or an evidence-based booklet, developed by the authors (n = 140). Men in all three groups demonstrated significant increases in knowledge scores from pre to post-test. Scores were significantly higher at post-test amongst those who had received our evidence-based booklet compared with men who received the leaflet or video (P < 0.001). Scores were significantly modified by men's preferences for decisional control (P = 0.002). Decisional conflict was significantly lower amongst men receiving the evidence-based booklet (P = 0.038). Men receiving the evidence-based booklet also were less likely to accept a recommendation by a GP to undergo prostate-specific-antigen (PSA) screening (P = 0.003). Men require detailed information about the pros and cons of PSA screening in order to make an informed decision. Resources are not equivalent in achieving these outcomes.

Aged↗
PubMed2006

Evaluation of generic patient information: effects on health outcomes, knowledge and satisfaction.

OBJECTIVE: To establish whether the provision of commercially produced written information in addition to routine hospital information can improve patients' knowledge and satisfaction and affect their health-related quality of life. METHODS: Elective surgical patients were randomised into an experimental group (N = 54) who received three commercially produced information booklets at pre-assessment, before surgery and at discharge, and a control group (N = 55) who received standard hospital information only. RESULTS: The experimental group were significantly less anxious immediately before their operation, and reported greater perceived control compared to controls post-operatively. Two weeks after discharge, health status for the two groups was similar except the experimental group reported significantly less pain. Overall satisfaction was fairly high and similar in both groups. The experimental group demonstrated greater knowledge at pre-admission, but not at discharge or follow-up. DISCUSSION: Patients increasingly expect written information; however amount, quality and timeliness vary considerably. Combining commercially produced information with standard hospital information may be to the patient's benefit. PRACTICE IMPLICATIONS: Providing patients with commercially produced standardised information in addition to internally produced hospital information could have an additional, though limited, benefit to patients' health outcomes. This could be a way of incorporating the expertise of both providers to the patient's benefit.

Adult↗
PubMed2006

The "extent of information desired"-scale in psychiatric in-patients: a behavioural approach.

OBJECTIVE: The purpose of this study was to investigate the "extent of information desired" (EID)-scale through a behavioural approach. METHODS: Standardised interviews consisting of the EID-scale and four (half) open questions were conducted in a convenience sample of psychiatric in-patients and information seeking behaviour was measured. At the same time, socially desirable behaviour was assessed by means of Marlowe-Crowne social desirability (MCSD). RESULTS: 39 patients were interviewed. The behavioural approach yielded mixed results, but there was no correlation between EID- and MCSD-scores. DISCUSSION: From the calculated correlations information seeking behaviour is perceived as socially undesirable, whereas EID-scores seem unaffected by social desirability. CONCLUSION: It is difficult to define independent variables which would reflect information seeking behaviour. The ones we used might have been confounded. We found a correlation between the EID-scale used and the information seeking behaviour, without a strong correlation with social desirability. PRACTICE IMPLICATIONS: The EID-scale used may predict patients' desire for information within a well-defined clinical context. The step to validation requires more robustness of the research model and a better profiling of patients.

Adolescent↗
PubMed2005

Analysis of stroke patients' and carers' reading ability and the content and design of written materials: recommendations for improving written stroke information.

OBJECTIVE: This study (a) evaluated the reading ability of patients following stroke and their carers and the reading level and content and design characteristics of the written information provided to them, (b) explored the influence of sociodemographic and clinical characteristics on patients' reading ability, and (c) described an education package that provides well-designed information tailored to patients' and carers' informational needs. METHODS: Fifty-seven patients and 12 carers were interviewed about their informational needs in an acute stroke unit. Their reading ability was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM). The written information provided to them in the acute stroke unit was analysed using the SMOG readability formula and the Suitability Assessment of Materials (SAM). RESULTS: Thirteen (22.8%) patients and 5 (41.7%) carers had received written stroke information. The mean reading level of materials analysed was 11th grade while patients read at a mean of 7-8th grade. Most materials (89%) scored as only adequate in content and design. Patients with combined aphasia read significantly lower (4-6th grade) than other patients (p=0.001). CONCLUSION: Only a small proportion of patients and carers received written materials about stroke and the readability level and content and design characteristics of most materials required improvement. PRACTICE IMPLICATIONS: When developing and distributing written materials about stroke, health professionals should consider the reading ability and informational needs of the recipients, and the reading level and content and design characteristics of the written materials. A computer system can be used to generate written materials tailored to the informational needs and literacy skills of patients and carers.

Adult↗
PubMed2005

Expressing medicine side effects: assessing the effectiveness of absolute risk, relative risk, and number needed to harm, and the provision of baseline risk information.

OBJECTIVE: To assess the effectiveness of absolute risk, relative risk, and number needed to harm formats for medicine side effects, with and without the provision of baseline risk information. METHODS: A two factor, risk increase format (relative, absolute and NNH)xbaseline (present/absent) between participants design was used. A sample of 268 women was given a scenario about increase in side effect risk with third generation oral contraceptives, and were required to answer written questions to assess their understanding, satisfaction, and likelihood of continuing to take the drug. RESULTS: Provision of baseline information significantly improved risk estimates and increased satisfaction, although the estimates were still considerably higher than the actual risk. No differences between presentation formats were observed when baseline information was presented. Without baseline information, absolute risk led to the most accurate performance. CONCLUSION: The findings support the importance of informing people about baseline level of risk when describing risk increases. In contrast, they offer no support for using number needed to harm. PRACTICE IMPLICATIONS: Health professionals should provide baseline risk information when presenting information about risk increases or decreases. More research is needed before numbers needed to harm (or treat) should be given to members of the general populations.

Adolescent↗
PubMed2005

Does stimulating self-care increase self-care behaviour for minor illnesses of Dutch and Turkish inhabitants of a deprived area in The Netherlands?

OBJECTIVE: The aim of the present study was to examine whether self-care behaviour increases after a self-care stimulating intervention that proved to be successful in reducing care-seeking behaviour for minor illnesses of Turkish and Dutch inhabitants of a deprived area in the Netherlands, and to see whether there are cultural differences. METHOD: This longitudinal study was based on a "pre-test/post-test one group" design. Data were collected during three structured face-to-face interviews: before the intervention, and 6 months and 1 year after the intervention, in which GPs personally handed out booklets to their patients containing guidelines on the management of 12 minor illnesses. RESULTS: The number of self-reported self-care actions did not increase. In contrast to the Dutch, the Turkish participants reported a decrease in the number of self-care actions, their attitude towards self-care became more negative, and they perceived less control. CONCLUSION: Apparently, a reduction in formal health care utilisation is not engendered by an increase in self-care behaviour. In order to make sure that interventions like these will have the intended effect, more research is needed, particularly among non-western populations. PRACTICE IMPLICATIONS: In developing future healthcare-reducing interventions, one should be aware of possible unwanted side effects in non-western populations.

Cross-Cultural Comparison↗
PubMed2006

Patient information at discharge--a study of a combined approach.

OBJECTIVE: To describe patients' perceptions of a new information procedure related to going home after urological surgery. This procedure, developed in an action research project, included a discharge talk with the nurse and an information booklet for the patients to keep. METHODS: A convenience sample of 99 patients responded to a survey sent home 1 week after discharge (return 78.6%). The Patient Information and Nurse Interaction Scale (PINI) was used for data collection. RESULTS: The sample were mostly male (81%), older (mean 71.9 years), and hospitalised on average less than 4 days. Patients who got the booklet had significantly more favourable perceptions on information received (p<0.05) on 11 of 21 items, and 91% said they would not have managed very well at home without it. CONCLUSION: The patients who received the booklet knew more about what might happen to them, were less uncertain and had fewer concerns when going home. PRACTICE IMPLICATIONS: The combination of standardised written information and a talk with the nurse where patients participated in individualising the information appears to have had a significant impact on self-management at home.

Adaptation, Psychological↗
PubMed2006

Pictures and text in instructions for medical devices: effects on recall and actual performance.

OBJECTIVE: The present study aimed to contribute to the design of effective health education information. Based on cognitive-psychological theory, pictures were expected to improve understanding of two existing textual instructions for using asthma devices (inhaler chamber and peak flow meter). From an analysis of the affordances and constraints of both devices this effect was expected to be stronger with the inhaler chamber than with the peak flow meter. METHODS: To test this, both instructions were systematically illustrated with seven line-drawings visualizing the actions. In two separate randomized controlled trials with in total 99 participants from the general public, the original text-only versions were compared to the text-picture versions of the same instruction. Dependent variables were participants' recall of the instructions and the quality of their performance with the instruction observed from video-recordings. RESULTS: Conform expectations, the results showed significant positive effects of pictures on recall and performance in both instructions, especially with the inhaler chamber. CONCLUSION: Thus, pictures may contribute to a better comprehension and use of medical devices that are inherently less clear. PRACTICE IMPLICATIONS: Health educators may optimize instruction design by careful analysis of the device with instruction and observational testing with potential users.

Adult↗
PubMed2006

Do themes in consumer medicines information literature reviews reflect those important to stakeholders?

OBJECTIVE: To compare the themes emerging from a stakeholder workshop on consumers' medicines information with themes in relevant published reviews. METHODS: A stakeholder workshop was held to permit consumer orientation of a systematic review of consumer medicines information. Analysis of the workshop outputs was compared to a content analysis of the identified published reviews. RESULTS: The workshop generated a range of responses inductively grouped into 12 over-arching themes. No reviews tackled all of these themes, nor addressed 'informed choice and autonomy'. More recent reviews reflected more workshop themes than older ones, suggesting a temporal trend towards a greater sensitivity to consumer issues. The most common workshop themes were covered by all reviews. Six themes in the reviews were related to traditional professional concerns including compliance, which did not arise in the workshop. CONCLUSION: The results highlight a mismatch between the themes in previous published reviews and the themes emerging from the workshop. The most commonly reflected themes in reviews conform to the 'patient education' model of discourse, while workshop themes less often echoed in reviews reflect the discourse of 'patient empowerment'. PRACTICE IMPLICATIONS: The findings suggest the importance of involving patients in the development of patient literature from the outset.

Aged↗