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PubMed1990

The diabetes physician and an assessment and treatment programme for male erectile impotence.

The feasibility has been investigated of a physician in a district general hospital implementing an assessment and treatment service for male erectile impotence. Over an 8-month period a questionnaire was given to 200 men attending a diabetes review clinic. There were 50 replies declaring a problem of impotence, 34 of whom expressed interest in discussing treatment. These men and 17 others who spontaneously mentioned an impotence problem were further assessed with a view to treatment. After a full assessment and discussion the following treatments were agreed and successfully implemented: no treatment 30 (59%), self-injection of papaverine 12 (24%), urology referral 4 (8%), psychosexual clinic referral 2 (4%), vacuum devices 2 (4%), adjustment of drug therapy 1 (2%). Only 18% of questionnaire respondents ultimately opted for active treatment compared with 88% of the spontaneous complaints. A successful impotence assessment and treatment service, including self-injection of vasoactive drugs, can be provided by a physician as part of the diabetes care service. Active treatment is gratefully accepted. The numbers involved are manageable if resources are concentrated on those spontaneously mentioning the problem. Our experience suggested self-injection of vasoactive drugs to be the most successful treatment option.

Adult↗
PubMedDate not supplied

Are information leaflets given to elderly people with diabetes easy to read?

This study examined 15 different leaflets routinely given to elderly patients in the diabetes unit of a teaching hospital. It used (1) a Fog Index to give a rough guide of readability, and (2) examined the size and style of print. Results were compared with those of information leaflets taken from the hospitals' acute elderly care unit, rehabilitation unit, physiotherapy department, day hospital and outpatients department. Seven out of a total 70 leaflets (10%) were as hard to read as the British Medical Journal. None of these came from the diabetes unit, which may be because the diabetes leaflets were prepared by educators with considerable experience in communicating with patients. However, the authors' awareness of the need to use simple language was greater than their awareness of the need to use legible type. Eleven of the 15 leaflets from the diabetes unit (73%) failed to meet guidelines suggested by the Royal National Institute for the Blind, a rate which differed little from the overall rate (77%). These findings suggest that those responsible for producing patient information should be more aware of the principles of effective written communication.

Aged↗
PubMed1998

Print material as a public health education tool.

Despite the widespread use of print materials in public health education, little is known about the costs and processes involved in developing these materials and their effectiveness in practice. We examined a sample of printed health education materials, using interviews and checklists. The most cost-effective processes for developing materials were not being used and the effectiveness of materials was rarely evaluated.

Cost-Benefit Analysis↗
PubMed2000

An analysis of resources for indigenous women in NSW about cervical screening.

OBJECTIVE: To examine resources about cervical screening made available to Indigenous women in NSW. METHOD: An Aboriginal woman, on behalf of another Aboriginal woman, telephoned 47 NSW based organisations in May 1998 for information about cervical screening. Received materials were analysed for format, content and readability and then submitted to a panel of Indigenous women for their feedback. RESULTS: Of those 34 organisations agreeing to send resources, only 20 (59%) did so. After removing duplicates, 12 cervical screening resources were available for review of which six were designed and printed in NSW and the other six originated outside NSW. Of the six resources developed in NSW, two (33%) were for Aboriginal women. Of the six resources originating from outside of NSW, another two (33%) also were for Aboriginal women. The Flesch readability scores for resources ranged from 58.6 to 87.27. Those developed in NSW had a significantly lower readability score than those from outside of NSW (p = 0.025). Despite lower education levels among the target group, there was no difference in the readability scores of resources designed for Indigenous women (p = 1). CONCLUSIONS: Most resources obtained by us were not tailored for Indigenous women. IMPLICATIONS: This study has set a base line for resources available for Indigenous women. Our method could be replicated in the future to evaluate and monitor improvement.

Adolescent↗
PubMed2000

A general practice-based recruitment strategy for colorectal cancer screening.

OBJECTIVE: To determine whether a screening recruitment strategy for first degree relatives of people with colorectal cancer is effective in enabling eligible relatives to request screening from their general practitioner (GP) and to assess acceptability to GPs and patients. METHODS: Thirty GPs, from 26 practices, and 303 of their patients aged over 50 who were first degree relatives of a person with colorectal cancer, participated in a randomised controlled trial of a GP-based recruitment strategy, in the Newcastle Area of New South Wales, Australia. RESULTS: The proportion of relatives requesting screening was statistically significantly higher in the intervention group than in the control group (18% compared to 4%, respectively; p = 0.01). CONCLUSIONS: Interest in the study by GPs was low, however for GPs who were involved, the recruitment strategy did prompt first degree relatives to discuss screening. The strategy may be even more effective when combined with other interventions such as a media campaign. The results may be generalizable to feasibility studies of general population screening for colorectal cancer in Australia. IMPLICATIONS: The results of this work are potentially informative to public health practice in Australia given the ensuing pilot programs of colorectal cancer screening.

Aged↗
PubMed2003

Home bowel cancer tests and informed choice--is current information sufficient?

OBJECTIVES: To evaluate the type of information that is available to purchasers of home-based bowel cancer test kits. METHODS: Manufacturers, pharmacies and independent testing programs were contacted to obtain faecal occult blood test (FOBT) kits. State cancer organisations were contacted for information on bowel cancer screening. Information on bowel cancer, the FOBT kit, the testing process and potential benefits and harms of the screening process were assessed using guidelines provided by the UK General Medical Council (GMC). RESULTS: FOBT kits and cancer organisation information provided adequate information on the purpose of screening, the screening process itself and potential benefits, but provided no information concerning uncertainties of screening or potential harms. CONCLUSIONS: On the basis of both the UK GMC criteria and patient desires for information, the information available at present falls short of being considered adequate for an informed decision to purchase a home-based FOBT. IMPLICATIONS: We must ensure adequate and balanced information is available to redress the present information asymmetry to facilitate informed participation in a potentially valuable public health initiative.

Australia↗
PubMed1990

Night waking in infants: effects of providing advice and support for parents.

A randomized controlled study was conducted with three groups of mothers with night waking infants less than 18 mths. Groups received a specially written advice booklet and support visits, the booklet only or no intervention. A fourth group of non-night waking infants acted as a comparison group. Mothers' estimates of waking frequency and infant sleep diaries and maternal well being measures were used to assess change. No significant differences in terms of outcome measures were found between three waking groups. Mothers of night wakers showed higher levels of distress than those in the sleeping group. Parents of wakers were positive about both the support they had received and the booklet.

Community Health Nursing↗
PubMed1998

Women's knowledge and attitudes, and the acceptability of voluntary antenatal HIV testing.

OBJECTIVE: To assess pregnant women's knowledge of, and attitudes towards, antenatal HIV testing, and its acceptability to them. SETTING: Antenatal clinic at Guy's Hospital, London, six community antenatal clinics and a midwifery group practice. POPULATION: Eight hundred and forty-three women attending the antenatal clinics. METHOD: The women received a leaflet explaining HIV testing, and completed a questionnaire before and after their booking appointment. This included an assessment of their knowledge of, and attitudes towards HIV testing, and its acceptability. RESULTS: Seven hundred and eighty-nine women (94%) completed questionnaires. Fifty-one percent (n = 405) were Caucasian, 25% (n = 195) African, 11% (n = 86) West Indian and 13% (n = 100) were from other ethnic groups. Fifty-eight percent received the HIV information leaflet, of whom 86% had read it. Knowledge relating to HIV was good, the median knowledge score being 6 out of a possible 8, but it was less in non-Caucasian women and those with lower educational qualifications. Knowledge was not related to uptake of testing. Thirty-five percent of women accepted the offer of an HIV test, rates being higher in hospital clinics (41%) than in the midwifery group practice (10%) and the community clinics (30%). Women more likely to accept the offer of an HIV test were non-Caucasian (P = 0.0443), those who had thought about the HIV test before this pregnancy (P = 0.0298) and those seeing one particular midwife (P = 0.0003). Most women (67%) thought that all pregnant women should be offered the HIV test and then make their own decision. Overall, 64% women did not change their original pre-discussion decision on testing for HIV. Thirty-six percent of women changed their decision from 'yes' to 'no' or 'don't know' after seeing the midwife. Women attending the community clinics (P = 0.003) and those who had been tested before (P = 0.0451) were more likely to change their decision. CONCLUSION: This study, in a multiethnic population, has shown that knowledge regarding HIV is good but does not increase the uptake of testing. Women prefer to be offered the HIV test and make their own choice regarding whether to accept it.

Africa↗
PubMed1999

Is the provision of information leaflets before colposcopy beneficial? A prospective randomised study.

OBJECTIVE: To assess the usefulness of a leaflet distributed to women before colposcopy designed to reduce their anxiety and psychosexual morbidity by providing information. DESIGN: Prospective randomised study. SETTING: Colposcopy clinic of a large district general hospital. SAMPLE: Two hundred consecutive women undergoing colposcopy for the first time for a cervical cytological abnormality of severity no greater than moderate dyskaryosis. METHODS: Women were randomised into one of two groups (leaflet or control). Those in the leaflet group were sent an information leaflet prior to attending the clinic. In the colposcopy clinic all the women completed a State/Trait Anxiety Inventory (StAI/TrAI) and a modified psychosexual questionnaire before undergoing colposcopy. This was repeated at the six-month follow up visit. Women in the leaflet group also completed a further questionnaire on the leaflet. MAIN OUTCOME MEASURES: Differences of anxiety and psychosexual scores between leaflet and control groups. RESULTS: The leaflet was well received. There were no statistical differences in StAI and TrAI scores between the study group and the control group at either visit, although in the whole study population StAI and TrAI scores were reduced at the second visit. The leaflet group had significantly more psychosexual problems but by the second visit, the scores had improved and the two groups were similar. When the mean differences in anxiety and psychosexual scores at the initial and second visits were compared between the groups, the reduction in negative sexual feelings and deterioration of TrAI scores experienced by the leaflet group was significant. CONCLUSIONS: This study suggests that the provision of sending an information leaflet prior to colposcopy is not beneficial in isolation. Other approaches need to be considered.

Adult↗
PubMed2001

Anxiety levels in women attending colposcopy clinics for treatment for cervical intraepithelial neoplasia: a randomised trial of written and video information.

OBJECTIVE: To assess the effectiveness of video information in reducing the level of anxiety in women attending Colposcopy clinics. DESIGN: An observational study followed by a randomised trial. SETTING: Colposcopy Clinic, Royal Free Hospital, London. PARTICIPANTS: Between April and December 1999, all new referrals to the clinic with a cervical smear showing moderate or severe dyskaryosis. MAIN OUTCOME MEASURE: The level of anxiety measured by the Spielberger State Anxiety Inventory. CONCLUSION: Women attending colposcopy clinics for either diagnosis or treatment, experience a high level of anxiety. The highest levels occur in women attending a one-stop see and treat clinic. The introduction of visual information in the form of an explanatory video prior to attendance significantly reduced anxiety.

Anxiety↗
PubMed2005

A simple way to increase service use: triggers of women's uptake of postpartum services.

OBJECTIVE: To examine the socio-demographic and service-related determinants of utilisation of postpartum services. DESIGN: Data were used from a single-blind, randomised controlled trial aimed at changing women's knowledge, attitude and behaviour regarding certain postpartum health issues by providing written information via a specially prepared booklet. SETTING: Four private hospitals, two in Beirut and two in the Bekaa region, were selected. All were privately owned and one in Beirut was a teaching hospital. SAMPLE: All women delivering a live birth in the designated hospitals during a three- to four-month period were recruited into the study. Of the 503 eligible women, 450 agreed to complete the initial questionnaire and 378 completed the postpartum interviews. METHODS: Eight trained female interviewers collected the baseline data. On discharge, interviewers handed each woman a sealed and numbered envelope containing the intervention booklet or the placebo leaflets. Interviewers were blind about the allocation group of women. Interviewers conducted follow up assessment at women's residence 6-20 weeks after delivery. MAIN OUTCOME MEASURES: Any postpartum visit with or without a preset appointment. RESULTS: Multivariable analysis with adjusted ORs show that women given an appointment for their postpartum visit were more likely to having had that visit (OR = 6.8, 95% CI 6.2-7.4). In the absence of such an appointment, university education (OR = 3.6, 95% CI 2.6-4.7), information on maternal health (OR = 4.9, 95% CI 4.0-5.8) and the intervention booklet (OR = 2.9, 95% CI 2.0-3.9) were important determinants of a postpartum visit. CONCLUSION: Giving women appointments for postpartum visits, or written or verbal information on maternal health can increase their use of health services.

Adult↗
PubMed2006

A randomised controlled trial of a decision-aid leaflet to facilitate women's choice between pregnancy termination methods.

OBJECTIVE: To evaluate the effectiveness of a decision aid to help women choose between surgical and medical methods of pregnancy termination. DESIGN: A randomised controlled trial comparing a decision-aid leaflet about termination methods with a control leaflet about contraception. SETTING: An NHS regional centre for pregnancy termination. SAMPLE: All women less than 9 weeks of gestation referred for termination of pregnancy over 7 months in 2002. METHODS: Participants were given an envelope containing either the decision-aid or the control leaflet prior to choosing between medical and surgical termination methods and completed two questionnaires, one immediately after this consultation and another after the termination procedure. MAIN OUTCOME MEASURES: Choice of termination method; measures of effective decision making including risk perception, attitudes and knowledge of both the medical and surgical methods; decisional conflict; anxiety and usefulness of the leaflet. RESULTS: Three hundred and twenty-eight women participated. There was no difference in the method chosen between the groups (60/162 women in the decision-aided group chose a medical method versus 54/164 women in the control group (OR 1.2; 95% CI 0.76-1.9). Women in the decision-aided group had higher knowledge and lower risk-perception scores about both methods, more positive attitudes about the medical method, lower decisional conflict, more stable evaluations of the decision information over time and higher perceived usefulness of information ratings. Anxiety was high but unrelated to leaflet type. CONCLUSIONS: Women made more informed decisions when provided with an evidence-based decision-aid leaflet preceding a routine consultation about choices of termination method.

Abortion, Induced↗