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PubMed1994

The effects of informational intervention on state anxiety and satisfaction in patients undergoing bone scan.

The aim of the study was to identify the most beneficial mode, in terms of anxiety reduction, of giving patients information prior to them undergoing a bone scan. (Research has identified the scan procedure as having a demonstrative effect on anxiety.) Additionally, satisfaction with the adequacy of the information was examined. On the day of the scan two experimental groups received either written or verbal information, the control group receiving no additional information (all had received the standard letter). All groups completed both the Spielberger's State Anxiety and a satisfaction questionnaire. Anxiety data were analysed by analysis of variance and the Duncan's test, whilst satisfaction was examined in terms of percentages. A significant difference at the 0.029 level was found in terms of anxiety reduction between both the experimental groups compared to the control group. No significant differences were found between the two experimental groups. Findings with regard to satisfaction with the adequacy of the information given showed that 78.6% of the subjects in the experimental group who received verbal information were satisfied compared to 71.4% in the group who received written information and 28.6% in the control group.

Adolescent↗
PubMed2001

Teaching telemetry.

For patients on telemetry monitoring, knowledge is power--and comfort. You can develop informative tools to help critical care nurses put these patients at ease.

Adult↗
PubMed1994

The effect of educational brochures on follow-up compliance in women with abnormal Papanicolaou smears.

OBJECTIVE: To determine whether women with abnormal Papanicolaou smears who received educational brochures at the initial booking for colposcopy were more likely to complete recommended treatment and follow-up after 18-24 months than were those who did not receive the brochures. METHODS: One hundred eight women participated in an earlier randomized study of the effect of educational brochures on emotional distress and knowledge about abnormal Papanicolaou smears. Their medical records were reviewed 18-24 months later for completed treatment and follow-up compliance. RESULTS: Women who received the brochure had more completed treatment and follow-up compliance (75.4%) than did those who did not receive the brochure (45.8%). The difference in compliance was 30% (99% confidence interval [CI] 6-54%, P = .002). There were no significant differences in age, education, marital status, or levels of emotional distress between subjects with complete and incomplete follow-up. Knowledge of the recommended number of follow-up visits was greater in women who completed follow-up (difference in frequency 30.4%; 99% CI 7-54%, P = .002). All women with completed treatment and follow-up who had received the brochure found it helpful. CONCLUSIONS: Given the high patient acceptability and demonstrated effectiveness in improving completed treatment and follow-up compliance, educational brochures should routinely accompany, or immediately follow, notification about abnormal Papanicolaou smears.

Adult↗
PubMed2001

Child literacy promotion in the emergency department.

INTRODUCTION: Studies using primary health care settings to promote literacy have demonstrated success. Since socioeconomically disadvantaged children have less access to primary care, obtaining much of their medical care episodically in emergency departments (ED), the purpose of this study is to investigate the effectiveness of a simple literacy promotion program conducted in the ED and to determine its efficacy and if there is a difference in promoting literacy with a brochure alone versus a brochure plus a children's book. METHODS: Medical student study investigators enrolled patients aged 20 months to 7 years undergoing acute care treatment and evaluation in an ED. Subjects were randomized to a literacy promotion brochure versus a brochure plus a children's book. Phone follow-up interviews were conducted to survey the degree of parental reading taking place at home. RESULTS: Fifty-one families were enrolled, 8 could not be contacted for follow-up, which left 43 families. Twenty-eight were randomized to book + handout and 15 were randomized to handout alone. On follow-up phone interviews, no significant change in reading was demonstrated regardless of whether a brochure alone was given or a book was given with the brochure. CONCLUSION: Literacy promotion in the ED was not associated with any measurable improvement in parent-child reading. This could mean that the ED is not an effective place to promote literacy or confounding factors in this study are responsible for failing to demonstrate a measurable benefit.

Child↗
PubMed1999

Information and advice to patients with back pain can have a positive effect. A randomized controlled trial of a novel educational booklet in primary care.

STUDY DESIGN: A double-blind, randomized controlled trial of a novel educational booklet compared with a traditional booklet for patients seeking treatment in primary care for acute or recurrent low back pain. OBJECTIVE: To test the impact of a novel educational booklet on patients' beliefs about back pain and functional outcome. SUMMARY OF BACKGROUND DATA: The information and advice that health professionals give to patients may be important in health care intervention, but there is little scientific evidence of their effectiveness. A novel patient educational booklet, The Back Book, has been developed to provide evidence-based information and advice consistent with current clinical guidelines. METHODS: One hundred sixty-two patients were given either the experimental booklet or a traditional booklet. The main outcomes studied were fear-avoidance beliefs about physical activity, beliefs about the inevitable consequences of back trouble, the Roland Disability Questionnaire, and visual analogue pain scales. Postal follow-up response at 1 year after initial treatment was 78%. RESULTS: Patients receiving the experimental booklet showed a statistically significant greater early improvement in beliefs which was maintained at 1 year. A greater proportion of patients with an initially high fear-avoidance beliefs score who received the experimental booklet had clinically important improvement in fear-avoidance beliefs about physical activity at 2 weeks, followed by a clinically important improvement in the Roland Disability Questionnaire score at 3 months. There was no effect on pain. CONCLUSION: This trial shows that carefully selected and presented information and advice about back pain can have a positive effect on patients' beliefs and clinical outcomes, and suggests that a study of clinically important effects in individual patients may provide further insights into the management of low back pain.

Adult↗
PubMed2001

Helping patients decide about back surgery: a randomized trial of an interactive video program.

STUDY DESIGN: A randomized trial of 100 patients with low back pain who were potential surgical candidates. OBJECTIVES: To determine whether an interactive videodisc with a booklet is superior to a booklet alone for informing patients about back surgery. SUMMARY OF BACKGROUND DATA: Substantial geographic variation has been observed in lumbar spine surgery. Informed patient preferences should play an important role in decisions about surgery. However, little is known about optimal strategies for informing patients. METHODS: Subjects were randomized to receive an interactive videodisc (with a booklet) or a booklet alone. A knowledge test administered at baseline and follow-up was used to measure improvement in knowledge about treatment options for lumbar spine problems. Patients' reactions to the videodisc and booklet and preferences for treatment were also assessed. RESULTS: The patients' knowledge improved after exposure to either intervention. Multivariate analyses adjusted for baseline score, age, education, gender, and diagnosis showed a significant advantage for the videodisc with booklet over the booklet alone. The videodisc-booklet group showed significantly greater gains in knowledge among subjects with the worst baseline knowledge scores. A larger proportion of subjects in the videodisc-booklet group rated the materials easy to understand (93% vs.- 72%,P = 0.04), containing the right amount of information (93% vs.- 80%,P = 0.3), and adequate to assist in choice of treatment (75% vs.- 51%,P = 0.2). Those who viewed the videodisc expressed a somewhat lower preference for surgery than those who received the booklet alone (23% vs.- 42%,P = 0.4). CONCLUSIONS: Both the booklet alone and the combination of videodisc and booklet improved knowledge. The combination produced greater knowledge gains than the booklet alone for the subgroup with the least knowledge at baseline. Patients preferred the combination and had a slightly lower preference for surgery if they had viewed the video presentation. For some patients, the video may enhance involvement in clinical decisions.

Adult↗
PubMed2001

Should we give detailed advice and information booklets to patients with back pain? A randomized controlled factorial trial of a self-management booklet and doctor advice to take exercise for back pain.

STUDY DESIGN: Randomized controlled factorial trial. OBJECTIVE: To assess the effectiveness of a booklet and of physician advice to take regular exercise. SUMMARY OF BACKGROUND DATA: Educational booklets are one of the simplest interventions for back pain but have not been shown to alter pain and function. Although there is evidence that advice to mobilize is effective, doctors have also been advised to encourage regular exercise-but there is no evidence that such advice alone improves outcomes. METHOD: Eight doctors from six practices randomized 311 patients with a new episode of back pain using sealed numbered opaque envelopes to receive a detailed self-management booklet, advice to take regular exercise, both, or neither. All groups were advised to mobilize and to use simple analgesia. Patients were telephoned during the first week after entry into the study, and after 3 weeks to assess a validated numerical pain/function score (0 = no pain normal activities to 100 = extreme pain no normal activities). Patients also returned a postal questionnaire in the first week with the Aberdeen pain and function scale, a knowledge score, and a reliable satisfaction scale (mean score of 4 items: 0 = not satisfied to 100 = extremely satisfied). RESULTS: Pain/function scores were obtained in 239 (77%) patients. There were interactions between exercise and booklet groups for both pain/function scores and the Aberdeen scale, which are unlikely to have been chance findings (P = 0.009 and P = 0.012, respectively). In comparison with the control group, there were reductions in the pain/function score in the first week with a booklet (-8.7, 95% CI -17.4 to -0.03) or advice to exercise (-7.9; -16.7 to 0.8) but much less effect with both together (-0.08, -9.0 to 8.9). Similarly, the Aberdeen scale was lower in the booklet group (-3.8, -7.7 to 0.07) and in the exercise advice group (-5.3; -9.3 to -1.38) but much less with both combined (-1.9, -5.8 to 2.1). There was no significant difference between groups in pain/function scores by week 3, when 58% reported being back to normal. Satisfaction was increased in booklet (7.9, 1.3 to 14.4) and exercise groups (7.4, 0.8 to 13.9)), and a booklet also increased knowledge (Kruskal-Wallis chi2 27.2, P = 0.001). CONCLUSION: Doctors can increase satisfaction and moderately improve functional outcomes in the period immediately after the consultation when back pain is worst, by using very simple interventions: either by endorsing a self-management booklet or by giving advice to take exercise. Previous studies suggest that simple advice and the same written information provide reinforcement. This study supports evidence that it may not be helpful to provide a detailed information booklet and advice together, where the amounts or formats of information differ.

Activities of Daily Living↗
PubMed2002

The back home trial: general practitioner-supported leaflets may change back pain behavior.

STUDY DESIGN: A single-blind randomized controlled trial of a leaflet developed for people with acute low back pain was compared with the usual general practitioner management of back pain. OBJECTIVE: To test the effectiveness of a patient information leaflet on knowledge, attitude, behavior, and function. SUMMARY OF BACKGROUND DATA: Despite the commonality of back pain in general practice, little evidence on the effectiveness of simple interventions such as leaflets and advice on self-management has been reported. On the basis of a five-stage needs analysis, a simple leaflet was developed that considered the views of patients and health professionals. METHODS: For this study, 64 patients with acute back pain were assigned to the leaflet or control group. The participants were visited at home after 2 days, 2 weeks, then 3, 6, and 12 months, where they completed a range of self-report measures. Behavioral aspects were discretely recorded by a "blinded" researcher. Primary outcomes were knowledge, attitude, behavior, and function. RESULTS: In all, 272 home visits were undertaken. The findings show that at 2 weeks, knowledge about sitting posture was greater in the leaflet group (P = 0.006), which transferred to a behavioral difference (sitting with lumbar lordosis support) when participants were unaware that they were being observed (P = 0.009). This difference remained significant at 3 months. Patients in the leaflet group also were better at maintaining a wide base of support when lifting a light object than the control subjects throughout all five assessments. There were no significant differences in the functional outcomes tested. CONCLUSIONS: This trial demonstrates that written advice for patients can be a contributory factor in the initial general practitioner consultation because it may change aspects of knowledge and behavior. This has implications for the management of acute back pain, with potential health gain.

Acute Disease↗
PubMedDate not supplied

Utility of a Web-based intervention for individuals with type 2 diabetes: the impact on physical activity levels and glycemic control.

Despite the numerous benefits of physical activity for patients with diabetes, most healthcare providers in busy clinical settings rarely find time to counsel their patients about it. A Web-based program for healthcare providers can be used as an effective counseling tool, when strategies are outlined for specific stages of readiness for physical activity. Seventy-three adults with type 2 diabetes were randomly assigned to Web-based intervention, printed-material intervention, or usual care. After 12 weeks, the effects of the interventions on physical activity, fasting blood sugar, and glycosylated hemoglobin were evaluated. Both Web-based and printed material intervention, compared with usual care, were effective in increasing physical activity (P < .001) and decreasing fasting blood sugar (P<.01) and glycosylated hemoglobin (P < .01). Post hoc analysis for change scores indicated significant differences between Web-based intervention and usual care and between printed material intervention and usual care, but not between web-based and printed material intervention. The findings of this study support the value of Web-based and printed material interventions in healthcare counseling. With increasing Web access, the effectiveness of Web-based programs offered directly to patients needs to be tested.

Analysis of Variance↗
PubMed2005

An audit of informed consent in gastroscopy: investigation of a hospital's informed consent procedure in endoscopy by assessing current practice.

OBJECTIVE: To investigate, by assessing current practice, whether a UK general hospital's informed consent procedure in endoscopy was implemented for all patients, because informed consent is central to the proper conduct of endoscopic procedures. METHODS: A retrospective study of patients' medical notes, in which information written on the UK National Health Service (NHS) consent form and on a departmental leaflet on the gastroscopy procedure completed by the patient was assessed. Sampling began from 9 October 2003 until 100 patients were recorded. For each patient's record, a data collection sheet was completed. RESULTS: Of the 67 patient records assessed (33 were unavailable), all contained the NHS consent form with signatures from the practitioner and patient. The departmental leaflet was present for only 31 patients, and of these, 20 had a signature from the patient and one leaflet had a signature from the practitioner. The multiple choice test was completed for 28 of the 31 departmental leaflets and full marks were awarded for 17 of 28. Although 11 patients answered one or more questions incorrectly, a discussion of the correct answers was only found in two records. CONCLUSION: To achieve improved performance, a training/induction programme should explain the informed consent procedure and its importance. This should be supported by 'booster' training sessions to avoid the emergence of bad practice. These sessions should take advantage of evidence-based medicine via feedback from audits and discussions of litigation cases. Departmental leaflets and NHS consent forms should also be provided in other languages.

England↗
PubMed2002

Providing disease-related information worsens health-related quality of life in inflammatory bowel disease.

BACKGROUND: Patients with inflammatory bowel disease (IBD) have identified a need for more information about their disease. PURPOSE: To assess the effect of an educational intervention on health-related quality of life (HRQOL) in patients with IBD. METHODS: Consecutive ambulatory IBD patients were randomized to receive four IBD-specific educational booklets or usual care. Subjects completed two disease-specific HRQOL questionnaires-the Inflammatory Bowel Disease Questionnaire (IBDQ) (range 1-poor to 7-excellent) and the Quality Index in Crohn's and Colitis (QuICC) (range 1-excellent to 5-poor) at entry and after 2 weeks. The mean change in HRQOL scores at follow-up was compared between the education and control groups. RESULTS: 59 subjects participated, with a mean age of 40.0 +/- 11.9 years. 34 were given educational booklets and 25 received standard care. 6 patients (10%) did not complete the study. Mean IBDQ scores became significantly worse in the education group with a change of -0.17 +/- 0.49 compared with controls at +0.28 +/- 0.62 (p = 0.006). This could be explained by worsened disease activity in the education group. There was no significant change in the QuICC scores (p = 0.61). Education group patients who had not received prior educational material had improved mean IBDQ scores of +0.24 +/- 0.47 compared with education patients who had received educational material prior to this study, with a score change of -0.25 +/- 0.46 (p = 0.09). CONCLUSIONS: The addition of educational booklets to IBD patients in a tertiary center does not improve, and may worsen, short-term HRQOL. Education of newly diagnosed or less informed patients should be studied further.

Adult↗
PubMed2002

Randomized controlled trial comparing the efficacy of a video and information leaflet versus information leaflet alone on patient knowledge about surveillance and cancer risk in ulcerative colitis.

BACKGROUND AND AIMS: Knowledge of colorectal cancer risk in patients with ulcerative colitis is inadequate. The authors aimed to improve knowledge in a sample of patients and determine whether this was best achieved by a simple information leaflet or by watching a video reading a leaflet. MATERIALS AND METHODS: Patients (n = 124) were recruited into a randomized controlled trial conducted from the gastroenterology outpatient departments of two Leicester hospitals. Participants completed a questionnaire prior to receiving the leaflet or viewing the video, immediately afterward, and 1 month later. RESULTS: One hundred fifteen questionnaires were returned (response rate = 93%). Both videos and leaflets increased knowledge with mean percentage improvements in scores of 71% (95% CI = 40.2-100) and 49% (95% CI = 32.1-66), respectively. However, the difference between the two interventions was not statistically significant (Difference = 22%, 95% CI = -56.3-13.2, p = 0.2). After 1 month, knowledge levels decreased in both groups to 55% (95% CI = 33.2-75.8; video plus leaflet) and 36% (95% CI = 23.7-48.6; leaflet alone). CONCLUSIONS: Leaflets and videos have an important role in reinforcing information provided by clinicians. However, there appears to be no immediate or prolonged advantage of a video over and above that of a simple information leaflet. The cost implications of producing a video, such as extra staff time, need to be weighed against the minor benefit that this medium has to offer.

Adult↗
PubMedDate not supplied

Evaluation of innovative research-based fact sheets.

Research-based fact sheets are simple, clear, and concise one-page reviews of a topic (e.g., culture and ethnicity, homelessness) with tips to improve culturally competent care. Using research helps nurses achieve promotion, advance careers, and enhance patient care. The background, literature, purpose, methods, and evaluation of fact sheets are reported. In a survey, 142 nurses reported that the fact sheets about general topics (end of life, depression, heart failure, smoking cessation, ethnicity, homelessness, hypertension, conflict management, medication safety, and pressure ulcers) were 99% excellent in efficiency, usefulness in practice, effectiveness, and importance in improving practice. Nurses (93.5%) said they improved the professional's knowledge. Fact sheets 8 and 9 (i.e., schizophrenia and advance directives) were rated as excellent by 88-97% of nurses. Nurses use fact sheets with an average of seven patients to improve education, assessment, intervention, and follow-up care.

Evidence-Based Medicine↗
PubMedDate not supplied

Strengthening patient-provider relationships.

In support of the Veterans Health Administration commitment to the promotion of shared decision-making between providers and patients, this study investigated the relationship between the provision of a patient appointment guidebook, designed to promote and support patient participation in the health care visit, and patient perceptions of primary care visit effectiveness. This study compared perceptions among 277 randomly selected patients randomly assigned to one of two groups. Patients assigned to an intervention group received a patient appointment guidebook along with the standard appointment reminder letter prior to the scheduled routine visit. Patients assigned to a control group received only the standard appointment reminder letter. Patient perceptions were assessed with a follow-up questionnaire designed to measure patient agreement with six statements pertaining to primary care visit effectiveness. No significant differences were noted in the proportion of patients in the two groups that agreed with any of the six statements pertaining to primary care visit effectiveness. Significant differences were noted, however, in the proportion of patients in the groups who received preventive health care interventions of influenza vaccination, pneumococcal vaccination, and gender-specific cancer screening. Approximately 37% of the patients in the intervention group provided positive comments about the patient appointment guidebook, while only 7% provided negative comments. Although statistically inconclusive, the narrative comments indicate that a patient appointment guidebook may assist veterans in preparing for primary care appointments. The lack of significant difference between the two groups on the measures of primary care visit effectiveness may be due, in part, to positive perceptions among the sample in general, as reflected by high levels of agreement and predominantly positive comments for both control and intervention groups.

Appointments and Schedules↗
PubMedDate not supplied

Development, implementation, and evaluation of a continence education package in acute and subacute care settings.

OBJECTIVE: The objective of the study was to trial and evaluate the effect that a discharge Continence Education Package (CEP) had on patients' continence awareness and management preferences. DESIGN: An exploratory descriptive design was used. SETTINGS AND SUBJECTS: A total of 631 participants were included in the study: 352 females (55.8%) and 279 males (44.2%) from 4 rural and regional settings in Victoria, Australia. INSTRUMENTS AND METHODS: A specifically designed questionnaire was used to assess participants' knowledge of incontinence and its management and also to investigate their treatment preferences and intentions if they experienced this type of problem. Data were collected at 2 time periods. Specifically, patients were interviewed before discharge from acute and subacute settings identified as Time 1 (T1). Then the participants were given the CEP and asked to complete a similar questionnaire. RESULTS: The findings revealed that fewer than 25% of participants had received information on continence before the study being conducted, yet the majority had indicated that they had experienced continence symptoms. The majority of participants found the CEP easy to understand (98.2%) and helpful (95.3%). Most participants said it provided them with information about types of actions to take and/or treatment options for incontinence problems. It also raised their awareness of the signs and symptoms associated with incontinence and provided them with a useful self-administered gauge with which to assess their continence status. CONCLUSIONS: These findings suggest that the CEP may be a useful educational tool for use in the general population.

Adult↗
PubMedDate not supplied

Does a continence educational brochure promote health-seeking behavior?

OBJECTIVE: This study reviewed whether participants who were given a continence education package, which included a Continence Educational Brochure (CEB), and who indicated that they were bothered by incontinence symptoms changed health-seeking behaviors about their incontinence problem because of being given the brochure. METHOD: This study used a descriptive and exploratory design. Participants were given the CEB and asked to read the information. They were also asked to complete a continence questionnaire and mail this back to the research team. Participants who indicated that they were bothered by a continence problem and consented to being interviewed were telephoned 2 to 3 months later. They were asked questions to determine their actions and progress in relation to managing their continence problem and whether the CEB had influenced their behavior. SETTING AND SUBJECT: A total of 631 participants (352 females, 55.8%; 279 males, 44.2%) from 4 rural and regional settings in Victoria, Australia, participated. Of this sample, 111 participants (78 females, 70.3%; 33 males, 29.7%) who reported that they were bothered by a continence problem were interviewed 3 months after being given the CEB. RESULTS: Two thirds of the total sample of participants (n=111) sought help for their continence problem. Approximately 70.3% (n=78) continued to have a continence problem. Of this group, 84.6% were still bothered by the continence problem and 65.4% had taken action to treat their incontinence. Forty-nine participants (44.1%) indicated that they had discussed the issue of bladder or bowel problems with someone directly because of this study or the information contained in the brochure. More than 94% of participants who remembered the CEB indicated that they believed the brochure would be helpful if given to other people. CONCLUSIONS: These findings suggest that the CEB prompted individuals to discuss their continence problem and in fewer cases to seek professional help. Given these findings, distribution of a continence education package is advocated as a continence health promotion strategy.

Fecal Incontinence↗