Gastrointestinal topics.
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Gastrointestinal Diseases↗
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Effects of a media campaign on back beliefs is sustained 3 years after its cessation.
STUDY DESIGN: Quasi-experimental, nonrandomized, nonequivalent, parallel group-controlled study involving before and after telephone surveys of the general population. OBJECTIVE: To measure the magnitude of any sustained change in population beliefs about back pain 3 years after cessation of a population-based intervention designed to alter beliefs about back pain. SUMMARY OF BACKGROUND DATA: A media campaign, which ran between September 1997 and December 1999 in Victoria, Australia, provided simple evidence-based advice about back pain. Following the campaign, there were significant improvements in both community and physicians' beliefs about back pain, as well as a decline in number of workers' compensation back claims. METHODS: The campaign's impact on population beliefs about back pain and fear-avoidance beliefs was measured using telephone surveys. Demographically identical population groups in Victoria and the adjacent control state, New South Wales, were surveyed at 4 times: before, during, immediately after, and 3 years after the media campaign in Victoria (surveys 1-4, respectively). Back beliefs were measured using the Back Beliefs Questionnaire (BBQ) (possible score 9-45, for which a higher score indicates a more positive belief about low back trouble). Fear-avoidance beliefs were measured using the Fear-Avoidance Beliefs Questionnaire consisting of 2 subscales for physical activity and work activity (possible scores 0-24 and 0-36, respectively), for which a lower score indicates fewer fear-avoidance beliefs. RESULTS: A total of 6230 individuals in the general population completed the surveys. Large statistically significant improvements in population beliefs about back pain were still observed in Victoria 3 years after cessation of the campaign (mean scores on the BBQ were 26.5, 28.4, 29.7, and 28.8 for surveys 1-4, respectively). No changes were observed in New South Wales (mean scores on the BBQ were 26.3, 26.2, 26.3, and 26.1 for surveys 1-4, respectively). Of those individuals who reported back pain during the previous year, fear-avoidance beliefs about physical activity in Victoria were also significantly better than at baseline (mean scores on the Fear-Avoidance Beliefs Questionnaire for physical activity were 14.0, 12.5, 11.6, and 12.3 for surveys 1-4, respectively). CONCLUSIONS: Significant sustained improvements in population beliefs about back pain were observed 3 years after cessation of a media campaign of provision of positive messages about back pain. This result provides further evidence that a primary preventive strategy of altering population beliefs about back pain may be a highly effective way for reducing back-related disability.
Adolescent↗
Climacteric symptoms among indigenous Australian women and a model for the use of culturally relevant art in health promotion.
OBJECTIVE: To evaluate climacteric symptoms among rural and remote, indigenous Australian women and to develop culturally relevant women's health midlife educational material. DESIGN: A cross-sectional pilot survey based on structured interviews of women older than 18 years of age who were available for interview and willing to participate. The study was conducted in the Kimberley region of Western Australia and southwestern Victoria between February and June 1999. Health issues central to the local community were identified by the structured survey. Development of culturally relevant information involved collaboration between indigenous women and indigenous artists, health workers, educators, and ourselves. Traditional health themes in art form were then linked with specific health issues to be addressed. Health messages were translated by Aboriginal women and health workers into both traditional language and vernacular, to target all women. RESULTS: Fifty-five women completed the survey. Thirty-eight were premenopausal, 4 were perimenopausal, and 13 were postmenopausal. The 4 perimenopausal women and 9 of the 13 postmenopausal women had climacteric symptoms, but none had been prescribed systemic or local hormonal therapy. Rates of obesity, diabetes mellitus, and hypertension were high. Midlife women's health booklets were produced in collaboration with Aboriginal elders and artists to communicate preventive health information in a visual context familiar to Aboriginal people of the Kimberley and surrounding communities. CONCLUSIONS: In contrast to the case in other non-Caucasian populations, climacteric symptoms seem to be common among Australian indigenous women and are apparently untreated. Aboriginal art and language has been employed in the development of culturally appropriate health promotion literature for Aboriginal communities in the Kimberley region of Western Australia. This process of collaboration provides a useful model for addressing women's health issues in other culturally diverse populations.
Adult↗
The effect of education and counseling services on compliance to therapy of women taking hormone therapy for the first time.
OBJECTIVE: The purpose of this experimental research was to examine the effect of hormone therapy (HT)-related education and counseling on compliance. DESIGN: The 119 women in both the experimental and the control group were being seen in a referral maternity and women's health teaching hospital's menopause outpatient clinic. Similarity between experimental and control groups was ensured using one-to-one pairing. The data were collected using a questionnaire and a follow-up form. The experimental group was given group education and an educational booklet on the first day they began therapy and counseling in the third and sixth months of therapy. The control group was not given counseling or education. Chi-square was used in data evaluation. RESULTS: There was no difference between the groups at the third month for those who were continuing HT (P > 0.05), but at the sixth month a significant difference was found (P < 0.05). The primary reason for stopping HT at the third month in the experimental group was fear of cancer and in the control group it was the side effects of HT. At 6 months, the primary reason for stopping HT in the experimental group was, again, fear of cancer but in the control group it was the woman's desire not to continue. There was no significant difference in the groups at either 3 or 6 months in experiencing benefits or side effects from HT (P > 0.05). CONCLUSION: Education and counseling services given by nurses or other health care personnel have an effect on long-term compliance with HT.
Adult↗
Media warnings about environmental pollution facilitate the acquisition of symptoms in response to chemical substances.
OBJECTIVE: Previous studies showed that somatic symptoms can be acquired in response to chemical substances using an associative learning paradigm, but only when the substance was foul smelling and not when it smelled pleasant. In this study, we investigated whether warnings about environmental pollution would facilitate acquiring symptoms, regardless of the pleasantness of the smell. METHOD: One group received prior information framing the study in the context of the rapidly increasing chemical pollution of our environment. Another group received no prior information. Conditional odor stimuli (CS) were diluted ammonia (foul-smelling) and niaouli (neutral-positive smelling); the unconditional stimulus (UCS) was 10% CO2-enriched air. Each subject breathed one odor mixed with CO2 and a control odor mixed with air in 80-sec breathing trials. The type of odor mixed with CO2 was counterbalanced across participants. Next, the same breathing trials were administered without CO2. Breathing behavior was measured during each trial; subjective symptoms were assessed after each trial. RESULTS: Only participants who had been given warnings about environmental pollution reported more symptoms to the odor that had previously been associated with CO2, compared with the control odor. This was so for both the foul- and the pleasant-smelling odor. Symptom learning did not occur in the group that did not receive warnings. The elevated symptom level could not be accounted for by altered respiratory behavior, nor by experimental demand effects. CONCLUSIONS: Raising environmental awareness through warnings about chemical pollution facilitates learning of subjective health symptoms in response to chemical substances.
Administration, Inhalation↗
Evaluation of booklet-based self-management of symptoms in Ménière disease: a randomized controlled trial.
OBJECTIVE: This study examined the effectiveness of booklet-based education in vestibular rehabilitation (VR) and symptom control (SC) techniques to manage vertigo and dizziness in Ménière disease. METHODS: Participants (n = 360) were randomized to a waiting list control group or to receive either a VR or an SC self-management booklet. VR involved provoking dizziness in a controlled manner by making repeated head movements in order to promote neurological and psychological habituation. SC involved using applied relaxation, challenging negative beliefs, and lifestyle modification to reduce amplification of dizziness by anxiety. Subjective improvement in health, enablement (ability to understand and cope with symptoms), and adherence were measured at 3 and 6 months. Symptoms, handicap, anxiety and depression, and negative beliefs about symptoms were assessed pretreatment and at 3 and 6 months. RESULTS: At 6-month follow-up, 45 (37.5%) of the VR group and 47 (39.2%) of the SC group reported improvement compared with 19 (15.8%) controls; the relative probability of improvement compared with controls was 2.37 (95% confidence interval [CI], 1.48-3.80) for VR and 2.47 (95% CI, 1.55-3.95) for SC. Both intervention groups reported greater enablement than controls (p < .001, d > 0.70). At 3 months, the VR group had reduced symptoms, anxiety, handicap, and negative beliefs about dizziness; the SC group had reduced handicap; but the control group showed no improvement. Reported adherence levels were low and strongly related to outcome. CONCLUSIONS: Self-management booklets offer an inexpensive and easily disseminated means of helping people with Ménière disease to cope with dizziness symptoms.
Culture↗
An educational program to improve quality of life for individuals with acoustic neuroma.
Nursing management of the patient with an acoustic neuroma begins during the preoperative period and continues into the rehabilitative phase following hospital discharge. This article describes the process of developing and implementing an acoustic neuroma educational program. Program content was determined by a survey which identified the type of information acoustic neuroma patients wanted before and after surgery. The survey also described the problems patients encountered once home. Included in the program is a preoperative informational video, a discharge booklet, a multidisciplinary rehabilitation group for outpatients and educational sessions for nurses from the hospital and community.
Adaptation, Psychological↗
Development of printed teaching materials for neuroscience patients.
Neuroscience nurses are challenged by the current climate of cost containment and the nursing shortage to continue to provide quality patient education. One strategy for meeting this challenge is to follow the process outlined in this overview for the development and use of printed materials.
Humans↗
Neurology patient education materials: do our educational aids fit our patients' needs?
The purpose of this study was to assess the suitability of various neurology patient education brochures, as well as neurology information on the World Wide Web, to determine whether they were appropriate for patients with low literacy. A convenience sample of 520 patients in university-based public and private neurology clinics participated. In this cross-sectional study, the patients' reading levels were assessed by using the Rapid Estimate of Adult Literacy in Medicine. Forty-three patient education materials were assessed for reading level by using the Fog Index and for suitability characteristics (including content, type and relevance of graphics, layout, type size and fonts, and motivating qualities) by using the Suitability Assessment of Materials. The mean education level of patients was 12th grade; however, the mean reading level was 7th-8th grade. Of the assessed materials, 91% were written at a 9th-grade level or above, even though only 58% of patients read at a 9th-grade level. Only 14% of the materials were considered to have superior suitability, whereas 58% were adequate, and 28% were determined not suitable. Thus, the available neurology patient education aids are not matched to the patient population or to the average U.S. reading levels. Ideally, information needs to be written at a 9th-grade level or below. Instructional graphics, simpler words, patient interaction, and cultural sensitivity improve material suitability.
Adolescent↗
MDA and AAEM informational brochures: can patients read them?
The purpose of this study was to assess patient literacy and the readability of patient education brochures from the American Academy of Electrodiagnostic Medicine and Muscular Dystrophy Association. Materials with the appropriate readability and suitability are more likely to provide instruction patients will understand. The readability of the brochure was assessed with Grammatik (Fry, 1977), the literacy of the participants with the Rapid Estimate of Adult Literacy (REALM) in Medicine test, and the suitability of the brochure was tested with the Suitability Assessment of Materials measure (Doak, Doak, & Root, 1993). The average REALM score for participation in this study correlated with a reading level of 7th-8th grade. All six brochures were found to be too difficult for many patients. Readability levels in four of the brochures were at 11th- or 12th-grade levels, one at 9th grade, and one at 10th grade. Materials with readability levels for 9th grade or higher should be rewritten to be understandable by most Americans, or supplemental instruction should be given. Readability and suitability assessments should be made to determine whether educational materials are appropriate for patients.
Adult↗
An evidence-based patient information leaflet about otitis media with effusion.
Leaflets are a useful resource for information provision. Many otolaryngology patients have poor reading skills, and may have difficulty understanding medical jargon. The aim of this project was to produce a patient information leaflet on otitis media with effusion whose content is based on the best available research evidence, and which is presented in a clear format with simple language. Patients were involved at the planning stage, and in testing the final draft. The leaflet was preferred by the majority compared to existing information material and was felt to be more informative and easier to understand. The leaflet has been given the Crystal Mark for clarity of language by the Plain English Campaign. This study shows that existing guidelines can be used to improve the quality of written information provision.
Attitude↗
Evaluating risk communication about fish consumption advisories: efficacy of a brochure versus a classroom lesson in Spanish and English.
Presentation format can influence the way target audiences understand risk-related information. Brochures or fish fact sheets are the methods traditionally used by state agencies to inform the public about fish consumption advisories and the risks from consuming fish. This study examines the efficacy of presenting information about the risks from consuming contaminated fish and shellfish in two different formats: a brochure and classroom presentation. The two instruments were developed and tested in Spanish and English, reflecting the local ethnic composition in the Newark Bay Complex. The instruments were tested on women of child-bearing age at the Women, Infants, and Children Center in Elizabeth, New Jersey. Detailed diagrams were used in both presentations, including contaminated fish species, fish preparation methods, and food chain bioaccumulation and transmission to the fetus. There were few language-related differences in the efficacy of the classroom lesson, and the main ideas were understood by both groups. Where there were significant differences in understanding about the risks from consuming fish or crabs from the contaminated waters of Newark Bay, in all cases the women exposed to the classroom lesson had a better understanding than those who read the brochure. Ninety-six percent of the women who heard the lesson understood that it was unsafe to eat fish from the port, compared to 72% of those reading the brochure. Both formats succeeded in imparting information to most women about the area under advisories, the fish species under advisories, and transmission of toxins to the fetus. Information on fish preparation was recalled less clearly, partly because women were asked to relate methods to reduce the risk from consuming fish from 11 presented, and most recalled only two or three of the list. The advantages and disadvantages of conducting short classes to women of child-bearing age are discussed.
Adult↗
An oral cancer information leaflet for smokers in primary care: results from two randomised controlled trials.
OBJECTIVES: To investigate whether primary care patients who claim to smoke tobacco gain greater benefit of a patient information leaflet (PIL) on oral cancer than nonsmokers. METHODS: Two studies were conducted. Study 1 examined the research question initially, and Study 2 acted as a replication and inclusion of additional secondary outcome measures. The leaflet was designed and tested in an earlier study. Knowledge of oral cancer was assessed by a previously validated 36-dichotomous-item scale. A single-item question ascertained self-reported smoking status (kappa = 0.94). Study 1 participants were drawn from 14 practices (6 medical, 8 dental). A randomised control group design was adopted. The experimental group received the leaflet on attendance to the practice and then completed the questionnaire. The control group received the questionnaire only. Complete data were collected from 739 respondents. The design of Study 2 was identical; 786 new respondents from 16 practices (7 medical, 9 dental) were collected. RESULTS: Both studies confirmed that smokers knew less about oral cancer than nonsmokers (P < 0.05) when access to the leaflet had been denied. On receipt of the leaflet, there was no distinction in oral cancer knowledge between the smoking status categories of respondents. Evidence of reassurance about screening from leaflet exposure was supported by the second study. CONCLUSION: This programmed research has demonstrated an effect of a brief PIL to offset the decrement in oral cancer knowledge observed in primary care patients who use tobacco in comparison to their nonsmoking counterparts. The leaflet reduced anxiety about oral health screening in smokers.
Adult↗
Readability and content of postoperative tonsillectomy instructions given to patients in Scotland.
All NHS hospitals in Scotland where tonsillectomies were being performed routinely were contacted. Thirty-two wards were identified. A copy of each ward's postoperative tonsillectomy discharge information sheet was obtained, if available. Twenty-six information sheets were obtained. Of these, 13 were for adults, 11 for children and 2 for both adults and children. The information sheets were assessed for readability using two readability formulae. Content was also assessed. The average reading grade/age required to understand these information sheets was above those recommended by patient-education experts. Postoperative safety instructions were similar and overall of a good standard, but variations did arise in what information was included. None of the units had adopted the British Association of Otolaryngologists - Head and Neck Surgeons (BAO-HNS) tonsillectomy postoperative advice sheet. This advice sheet is evidence based and meets recommended readability criteria.
Adult↗
An intervention study to increase colorectal cancer knowledge and screening among community elders.
This study evaluates the effectiveness of a culturally relevant intervention, delivered over 12 months on knowledge of colorectal cancer and participation in fecal occult blood testing. An experimental, repeated measures design was used. Free fecal occult blood testing was offered to the participants. Fifteen senior centers were randomly selected and assigned to the Cultural and Self-Empowerment Group, the Modified Cultural Group, or the Traditional Group. Their mean age was 73.83 years, and their average educational level was 8.8 years. The majority was African American, female, and reported annual incomes < or = 10,000 dollars. Data were collected at baseline, at 6 months, and at 12 months. Participants in the Cultural and Self-Empowerment Group had a significantly greater increase in their knowledge of colorectal cancer over time. Group membership and knowledge of colorectal cancer were significant predictors of participation in colorectal cancer screening. Participants in the Cultural and Self-Empowerment Group and those with greater knowledge of colorectal cancer were more likely to participate in fecal occult blood testing at the end of the 12-month period. Similar strategies may be implemented in community settings and health care agencies to inform elders about colorectal cancer.
Black or African American↗
How to profit from sensible drinking.
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Alcohol Drinking↗
Pre-operative information and patient-controlled analgesia: much ado about nothing.
We examined whether pre-operative information benefited patients receiving patient-controlled analgesia (PCA) after major surgery. We investigated whether patients felt better informed about PCA and also whether pre-operative information altered the use of PCA, the adequacy of pain relief, worries about addiction and safety, and knowledge of side-effects. We investigated the effectiveness of information provided in two ways, namely by a patient-determined leaflet or an interview by a trained nurse from the pain team, compared with routine pre-operative information. We studied 225 patients, 75 in each group. Patients in the leaflet group were better informed about PCA, became familiar with using PCA more quickly and were less confused about PCA than the control group. However, there were no effects on pain relief, worries about addiction and safety, and knowledge of side effects. The pre-operative interview resulted in no benefits. Our findings indicate that the detailed provision of pre-operative information failed to improve patients' experiences of PCA.
Adolescent↗
Information leaflets in the dermatology out-patient waiting area.
Patients' attitudes to the supply and quality of information provided about their condition were examined by questionnaire before (n = 852) and after exposure to an information leaflet campaign (n = 560) in the dermatology out-patient waiting area. A high expectation of this service was demonstrated, particularly from patients under 60 years of age with chronic diseases. A variety of information sources, other than doctors, were identified which could be improved (video-systems, specialist nurses, leaflets, posters). The campaign significantly increased the percentage of patients who derived information from the leaflet source (5.6-18.8%, P < 0.001) and it reduced a demand for leaflets (16.4-9.1%, P < 0.001). However, the campaign did not alter patients' perceived need to spend more time with a dermatologist. In order to achieve a greater impact on patient satisfaction, a combination of information sources in the out-patient department should be targeted at young adults with chronic diseases.
Dermatology↗