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PubMedDate not supplied

Screening and referral for brief intervention of alcohol-misusing patients in an emergency department: a pragmatic randomised controlled trial.

BACKGROUND: Alcohol misuse is highly prevalent among people attending emergency departments, but the effect of intervention by staff working in these departments is unclear. We investigated the effect of screening and referral of patients found to be misusing alcohol while attending an emergency department. METHODS: We undertook a single-blind pragmatic randomised controlled trial. Patients received either an information leaflet or an information leaflet plus an appointment with an alcohol health worker. Outcome data were collected by patient interview and examination of hospital records at 6 and 12 months. FINDINGS: 599 patients were randomised over a 12-month period. At 6 months, those referred to an alcohol health worker were consuming a mean of 59.7 units of alcohol per week compared with 83.1 units in the control group (t -2.4, p=0.02). At 12 months those referred were drinking 57.2 units per week compared with 70.8 in controls (t -1.7, p=0.09). Those referred to the alcohol health worker had a mean of 0.5 fewer visits to the emergency department over the following 12 months (1.2 compared with 1.7, t -2.0, p=0.046). Differences in quality of life were not found. INTERPRETATION: Opportunistic identification and referral for alcohol misuse in an emergency department is feasible, associated with lower levels of alcohol consumption over the following 6 months, and reduces reattendance at the department. Short-term reductions in alcohol consumption associated with referral for brief intervention for alcohol misuse benefit patients and reduce demand for accident and emergency department services.

Adult↗
PubMed1984

Does a booklet on breast self-examination improve subsequent detection rates?

Of 28 788 women aged 40 to 74 registered at 28 university teaching practices in greater Belfast, half were randomly selected to receive a booklet on breast self-examination from their general practitioner at the start of the study and 1 year later. The frequency of breast abnormalities was identical in both groups (0.83%) during the 2-year follow-up. Early malignant breast cancers (stages TX, TO, Tla) were significantly more frequent in the intervention group (53.6%) than in the control group (24.3%). Among women in the intervention group with malignant lesions, 2 sites, left nipple and left inner/upper quadrant, were significantly less frequently involved. These findings in relation to staging and site were confirmed by multivariate comparisons. The intervention group also had a smaller average tumour size (24.0 mm compared with 32.6 mm) due to significantly smaller benign tumours and the absence of the relationship between delay and tumour size evident in the control group.

Adult↗
PubMed1989

The "Help Your Patient Stop" initiative. Evaluation of smoking prevalence and dissemination of WHO/UICC guidelines in UK general practice.

The World Health Organisation and the International Agency against Cancer in 1988 published joint guidelines on smoking cessation for primary health care teams. A booklet entitled Help Your Patient Stop was produced in the United Kingdom as a model for the international dissemination of these guidelines. This booklet was sent to UK general practitioners by post; about 4 weeks later, a random sample of 5000 were asked to complete a postal questionnaire about the booklet and their smoking habits. The response rate was 75%. About half (50.5%) remembered receiving the booklet, 27.7% had read it, and only 8.8% could write down any of the three essential activities in smoking cessation which the booklet was intended to promote and which were printed in bold letters on the inside back cover. Although the booklet itself might be an adequate model for other countries, unless dissemination and marketing of the information it contains can be improved, its achievement will be limited. However, the survey did have one optimistic feature: only 13.5% of general practitioners reported that they smoke; and only a third of those who gave full details of their smoking habit smoke cigarettes.

Adult↗
PubMed1999

Readability of skin cancer prevention brochures targeting parents of young children.

Long-term exposure to UV radiation and severe sunburns increase one's risk of experiencing malignant melanoma later in life, so parents need to be informed about how to protect children from overexposure to the sun. We attempted to determine readability of skin cancer brochures targeted toward parents of young children. SMOG and FOG readability formulas were applied to 8 brochures published by the American Cancer Society, Skin Cancer Foundation, American Academy of Dermatology, and the Anti-Cancer Council. Readability levels of the brochures ranged between the 8th and 12th grade levels. To reduce the incidence of skin cancer, sun-safe knowledge and behavior should start in childhood. Pediatricians need access to brochures written at readability levels for the average parent. Skin cancer brochures written at the eighth or ninth grade comprehension levels may allow pediatricians to educate more parents about the importance of skin cancer prevention in childhood.

Child↗
PubMed1999

Patient education model for increasing handwashing compliance.

BACKGROUND: A review of the literature on handwashing has documented the absence of research on the education of the patient as an intervention model for changing staff behavior regarding handwashing compliance. The primary objective of this project was to conduct a prospective control study of the effect of patient handwashing education on staff compliance with handwashing. METHOD: A prospective, controlled, 6-week intervention/control study was performed in 4 community hospitals in South Jersey. Each hospital served as its own control. Patients were educated within 24 hours of admission about the importance of asking their health care workers to wash their hands. Soap usage and handwashing was calculated by bed-days. Patient follow-up was conducted through telephone interviews 2 weeks after discharge. RESULTS: The patient handwashing education model increased soap usage by health care workers an average of 34% (P =.021); this increase was consistent across hospitals regardless of the initial soap usage rates. Of the patients interviewed, 81% read the materials provided, 57% asked health care workers whether they had washed their hands, and 81% of this 57% said they received positive responses. CONCLUSIONS: For the first time, our findings document that education of patients regarding their role in monitoring handwashing compliance among health care workers can increase soap usage and handwashing and provide sustainable reinforcement of handwashing principles for health care workers.

Cost-Benefit Analysis↗
PubMed2003

[Can patients read what we want them to read? Analysis of the readability of printed materials for health education].

OBJECTIVE: To analyze readability and legibility of a systematic sample of health education materials made available at a health center, and to propose recommendations for improvement. DESIGN: Observational, descriptive study. SETTING: An urban health center in Madrid, Spain. MATERIAL: A sample of text from 326 health education documents. MAIN MEASURES: The 326 texts were classified according to target reader, organism responsible for publication, topic, and date of publication. A sample of 500 words from each document was analyzed with Microsoft Word 2000 to determine the Flesch readability score and sentence complexity index, and to calculate the INLEG index. Print size and accompanying graphics were also analyzed. RESULTS: Readability of the materials was generally acceptable, with a mean Flesch score of 13.56. However, the type tended to be too small (mean 11.37 points). In 32% of the documents there were no illustrations, and no date of publication was given in 46%. CONCLUSIONS. The readability and legibility in the group of documents we analyzed could both be improved by following the recommendations offered here. Further research is needed on the techniques used to analyze readability and legibility, especially with regard to the latter.

Cross-Sectional Studies↗
PubMedDate not supplied

[Usefulness of information leaflets about drugs for hospitalized patients with chronic diseases].

To know how patients perceive the information leaflets about medicines, it has been carried out a study in a sample of 65 patients admitted to a hospital for chronic respiratory or cardiac diseases. A 47.7% of patients expressed that the main information provided by the leaflet was such concerning to the purpose of the drug, whereas a 18.5% pointed out such concerning to side effects and management of unexpected circumstances. Sixty three percent of patients expressed that leaflets did not provide them new information. A relevant percentage of patients did not know the meaning of some terms frequently used in leaflets and package-inserts (80% of mistakes in the interpretation of "take the drug on an empty stomach"). It is concluded that the information leaflets can be useful in the framework of a good physician-patient relationship, as a reminder, and to reinforce the knowledge that the patient already has. It is considered that the most appropriate time for the education of chronic patients about drugs is when the treatment is prescribed for the first time.

Aged↗
PubMed1996

The use of an information leaflet for patients undergoing wisdom tooth removal.

Attempts to inform the patient about surgical procedures have increased for the purposes of ensuring informed consent and improving satisfaction with the service provided. Leaflets are being used as an additional aid in general practice and in hospital units. However, such written information is seldom evaluated. This study was conducted to assess the influence of using an information leaflet for patients attending oral surgery clinics at a local dental hospital. Sixty-six patients were included in the study and invited to complete a questionnaire to assess knowledge of wisdom tooth removal at the time of examination and just prior to surgery. The validity of the knowledge measure had been previously tested. At 1 month follow-up a patient satisfaction questionnaire was completed by the sample. Patients were randomised at the examination appointment into four groups. The first group was provided with the leaflet and prompted to read it by the dentist (WTL + Prompt). The second group was given the leaflet but not prompted (WTL only). The two other groups acted as controls. The third group was provided with a dental health education leaflet with no prompting (Control 1). The fourth and final group was given no additional written material (Control 2) but provided with verbal information and routine warnings in a similar way to all other groups participating in the study. The WTL + Prompt Group showed increased knowledge on retest (P < 0.001). The WTL Group showed a trend to greater knowledge (P < 0.06) however the control groups showed no improvement (P > 0.5). Patient satisfaction, although greatest in the group given a leaflet without prompting, was not simply related to leaflet provision.

Analysis of Variance↗
PubMed2001

Writing wrongs? An analysis of published discourses about the use of patient information leaflets.

Much has been written about how to communicate with patients, but there has been little critical scrutiny of this literature. This paper presents an analysis of publications about the use of patient information leaflets. It suggests that two discourses can be distinguished in this literature. The first of these is the larger of the two. It reflects traditional biomedical concerns and it invokes a mechanistic model of communication in which patients are characterised as passive and open to manipulation in the interests of a biomedical agenda. The persistence of the biomedical model in this discourse is contrasted with the second discourse, which is smaller and more recent in origin. This second discourse draws on a political agenda of patient empowerment, and reflects this in its choice of outcomes of interest, its concern with the use of leaflets as a means of democratisation, and its orientation towards patients. It is suggested that the two discourses, though distinct, are not entirely discrete, and may begin to draw closer as they begin to draw on a wider set of resources, including sociological research and theory, to develop a rigorous theoretically grounded approach to patient information leaflets.

Bibliometrics↗
PubMed2001

Efficacy of a minimal intervention to reduce fat intake.

Effective dietary interventions must be developed to reduce fat intake in whole populations, rather than clinical subgroups. This study tested the effects of personalised feedback on fat intake in a general population. Hospital workers (n = 801) were randomised to receive personalised feedback or no personalised feedback. Personalised feedback consisted of one sentence expressing current fat intake as a percentage of total calorific intake. Changes in fat intake from baseline to five months post-intervention were evaluated. The personalised intervention produced significant decreases in total and saturated fat intake, compared with the control group. Total-fat decreased by 8.6% (versus 0.2% in the control group); saturated fat decreased by 9.3% (versus 1.7% in the control group). Fat intake as a proportion of total calorific intake did not decrease significantly in either condition. Findings also revealed differential effects of feedback on high- versus low-fat consumer groups. Personalised feedback significantly reduced fat intake in high-fat consumers, and prevented low-fat consumers from increasing their fat intake. Personalised fat feedback therefore represents an efficacious and low-intensity approach to the reduction of fat intake in the general population.

Adult↗
PubMed2000

Patient education literature and help seeking behaviour: perspectives from an evaluation in the United Kingdom.

Decisions by patients upon when to use health care services are a major influence on the consumption of health care resources. Patient education--often based upon written information on how to identify symptoms of common illnesses, when to seek help and how to self-treat--is an increasingly popular strategy to rationalise demand. A large body of literature, in evaluating the impact of such written information, has though overlooked the possession or acquisition of comparable publications by respondents in the course of the studies. This study attempted to overcome this limitation in considering the impact of a prominent patient education booklet that makes reference to over 40 common ailments. Questionnaire data from a cohort sample of residents (n = 495) in an area within which the booklet was circulated and that from a comparison area (n = 509) suggests that such literature exerts a modest influence in orienting patients towards "appropriate" self-referral and self-care behaviour. Reasons for this limited impact emerged however in semi-structured interviews with a sub-sample of respondents (n = 85). These data show that understanding of the way in which written advice for patients is perceived has to focus upon the ways in which diverse sub-populations process and attribute meaning to "official" and "unofficial" sources of advice. More fundamentally, the increasingly sophisticated and specialised nature of medical and scientific knowledge may be distancing expert knowledge from individuals and society such that "lay" responses to "expert" advice now reflect a continuing process of risk assessment, trust or the withholding of trust.

Adolescent↗
PubMed2003

Interest in self-help materials among a general population sample of smokers.

Previous studies have shown that self-help materials can be effective in helping people quit smoking. However, it is not known what proportion of smokers in the general population are interested in this method of cessation. A representative sample of 267 daily smokers participated in a random digit dialing telephone survey. Respondents were asked about their level of interest in self-help materials that would help them quit smoking. Potential predictors of level of interest were examined first through bivariate analyses, followed by a multinomial logistic regression. Of daily smokers, 27% were very interested in receiving a self-help booklet, 28% were somewhat interested, and 45% were not at all interested. Interest in self-help materials was positively related to intent to quit in the next 6 months and to low family income.

Adult↗
PubMedDate not supplied

A comparison of three "interventions" on pretreatment dropout rates in an outpatient substance abuse clinic.

Studies examining pretreatment dropout in outpatient substance abuse clinics have consistently demonstrated that fewer days between phone contact and scheduled intake appointment result in higher client show rates. To compare time to intake with two other interventions hypothesized to increase show rates, individuals (N = 128) seeking treatment were randomly assigned to one of four groups. Individuals in Group 1 were scheduled within 48 hours of the telephone intake. Individuals in Groups 2, 3, and 4 were scheduled 48 hours or more after the telephone intake and received either a reminder call 24 hours prior to their appointment (Group 2), an appointment card and clinic brochure in the mail (Group 3), or no intervention (Group 4). The results show that Group 1 had a higher show rate as compared to the other three groups, and receiving a reminder call or an appointment card did not improve show rates beyond that of the no-contact control group. Implications for intake procedures are discussed.

Adult↗