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PubMed2000

A rapid appraisal method for the selection and pre-testing of environmental health leaflets.

This paper presents a rapid appraisal method for the selection and pre-testing of printed leaflets on environmental health issues. The method combines a staff questionnaire, a readability test and a target population survey and is designed to aid leaflet selection in a way which is practically feasible yet retaining an acceptable level of face validity. A multiple, embedded case study was used to field-test the method and the feedback from this is discussed. The results suggest that the method has the potential to replace ad hoc arrangements by the gatekeepers and make the selection of leaflets more a matter of structured decision-making involving representatives of all the stake-holders.

Environmental Health↗
PubMed2005

Development of a linguistically and culturally appropriate booklet for Latino cancer survivors: lessons learned.

In response to the need for linguistically and culturally appropriate cancer survivorship materials for Latinos, the Office of Education and Special Initiatives and the Office of Cancer Survivorship at the National Cancer Institute (NCI) set out to test, adapt, and refine a Spanish translation of an English-language booklet for adult cancer survivors titled Facing Forward: Life After Cancer Treatment (Siga adelante: la vida después del tratamiento del cáncer). The authors used a process called "transcreation," which involves translating existing English-language materials into Spanish and then adapting them for Latino audiences. The Spanish version of the booklet was reviewed by nine Spanish-speaking reviewers who were cancer survivors. The multistage transcreation process reinforced the importance of conducting formative research as well as adjusting the methodology to address the needs of changing demographics.

Adult↗
PubMed2006

Lessons learned from developing a tailored print intervention: a guide for practitioners and researchers new to tailoring.

Although some "how-to" guides have been written on tailored messaging, we found no reports on lessons learned from the process of developing a tailored intervention. Such lessons may be useful for practitioners and researchers who are new to tailored intervention development. The authors describe lessons gleaned from the process of developing a repeat mammography tailored print intervention. Lessons learned include the following: Selection of determinants appropriate for tailoring should be based on a theoretic framework and refined through assessment of the target population; researchers should anticipate threats to fidelity of intervention delivery because of incomplete or illogical survey data; fingerprinting enables assessment of intervention dose and how it relates to effectiveness of the tailored intervention; and a systematic process for conducting a systems test is needed to check for inconsistencies and errors before final tailored letter production. These lessons are discussed in the context of challenges and possible solutions for tailored health communication.

Female↗
PubMed2005

Development of an educational booklet for children of adult liver transplant recipients.

Educating family members of transplant recipients has long been recognized as an important factor in preparation for organ transplantation. This preparation may help the family come to terms with potential complications, the possibility of extended hospitalization, and the psychological changes that their loved ones might experience. Although education of a spouse or essential others may take place, children of an organ recipient may be unintentionally overlooked in the teaching process. This article describes how an educational booklet for children of adults undergoing liver transplantaion was developed and introduced into a liver transplant unit.

Adolescent↗
PubMed2005

Preoperative visiting: landmarks of the journey.

Our fifteen bed, five day recovery unit accepts adult and paediatric patients and serves seven theatres dedicated to eye and ENT surgery. The aim of this article is to provide an insight into the practicalities involved in introducing a preoperative visiting programme and associated leaflet. These initiatives aim to give continuity of care, reduce stress and anxiety, and promote patients' coping strategies, by increasing the patients' knowledge and understanding of their perioperative journey (Malin & Teasdale 1991).

Adult↗
PubMed2006

Preparing a patient information leaflet.

As a student of operating department practice, I was asked to produce a patient information leaflet that helped to prepare patients for a surgical procedure. In addition, I had to write a paper highlighting the issues involved in effectively communicating with vulnerable patients. The relevance of communication and information giving is vital in all aspects of healthcare but even more so in theatre where the patient must be informed to give consent.

Cholecystectomy, Laparoscopic↗
PubMed2004

How readable are orthodontic patient information leaflets?

OBJECTIVE: To assess the readability of published orthodontic patient information leaflets (PILs) and their eligibility for the Plain English Campaign's Crystal Mark. DESIGN: A retrospective, observational study. SETTING: PILs available from professional organizations and commercial companies. MATERIALS AND METHODS: Twenty-six orthodontic PILs were assessed. The entire text of each leaflet was reproduced in Microsoft Word, 2000. Readability statistics were obtained via the 'Tools' menu. The design elements of each leaflet were assessed. The leaflets were sent to the Plain English Campaign for assessment of their eligibility for the Crystal Mark. OUTCOME MEASURES: Leaflet and sentence length, passive percentage, Flesch Reading Ease score, Flesch Kincaid Grade Level, design percentage and eligibility for the Plain English Campaign's Crystal Mark. RESULTS: Overall, nearly half of the leaflets (42.3%) were rated as 'fairly difficult' or 'difficult' to read. However, the BOS PILs were significantly better than the AAO leaflets in all but one outcome with the BOS leaflets being rated as 'standard' or 'fairly easy' to read, meaning that 70-80% of the UK population would be able to understand them. None of the PILs were eligible for the Plain English Campaign's Crystal Mark. CONCLUSIONS: The orthodontic PILs assessed were difficult to read and none were eligible for the Plain English Campaign's Crystal Mark. However, the BOS leaflets were much easier to read and better designed than those produced by the AAO making them a useful tool to improve patients' understanding of different treatment options and allowing them to be used in the informed consent process.

Comprehension↗
PubMed1997

Evaluation of a self-management plan for chronic obstructive pulmonary disease.

We hypothesized that the use of an Action Plan might assist self-management for patients with chronic obstructive pulmonary disease (COPD). A pilot process and randomized, controlled study were undertaken to evaluate an Action Plan that provided advice on management of usual care and exacerbations, together with a booklet on self-management. Fifty six subjects with COPD recruited through general practitioners (GPs) completed the 6 month study, 27 in the control group and 29 in the intervention group. The control group received usual care from their GP, and the intervention group received a booklet and Action Plan from their practice nurse plus a supply of prednisone and antibiotic from their GP. The two groups were demographically similar with a mean age of 68 yrs. The resources were well received by GPs, practice nurses and intervention group subjects. After 6 months, there were no differences in quality of life scores or pulmonary function. There were significant changes in self-management behaviour in the intervention group compared to controls. In response to deteriorating symptoms, 34 versus 7% (p=0.014) initiated prednisone treatment and 44 versus 7% (p=0.002) initiated antibiotics. Subjects in the intervention group readily adopted self-management skills but did not show any difference in quality of life or lung function parameters. A larger, prospective, controlled, clinical trial of this approach is warranted.

Aged↗
PubMed2006

A cross-sectional evidence-based review of pharmaceutical promotional marketing brochures and their underlying studies: is what they tell us important and true?

BACKGROUND: A major marketing technique used by pharmaceutical companies is direct-to-physician marketing. This form of marketing frequently employs promotional marketing brochures, based on clinical research, which may influence how a physician prescribes medicines. This study's objective was to investigate whether or not the information in promotional brochures presented to physicians by pharmaceutical representatives is accurate, consistent, and valid with respect to the actual studies upon which the promotional brochures are based. METHODS: Physicians in five clinics were asked to consecutively collect pharmaceutical promotional brochures and to send them all to a centralized location. The brochures for any class of medication were collected on a continuous basis until 20 distinct promotional brochures were received by a central location. Once the brochure was received, the corresponding original study was obtained. Two blinded reviewers performed an evidence-based review of the article, comparing data that was printed on the brochure to what was found in the original study. RESULTS: Among the 20 studies, 75% of the studies were found to be valid, 80% were funded by the pharmaceutical company, 60% of the studies and the corresponding brochures presented patient-oriented outcomes, and 40% were compared to another treatment regimen. Of the 19 brochures that presented the data as graphs, 4 brochures presented a relative risk reduction while only 1 brochure presented an absolute risk reduction. 15% of the promotional marketing brochures presented data that was different from what was in the original published study. CONCLUSION: Given the present findings, physicians should be cautious about drawing conclusions regarding a medication based on the marketing brochures provided by pharmaceutical companies.

Advertising↗
PubMed2005

Evidence-based patient choice: a prostate cancer decision aid in plain language.

BACKGROUND: Decision aids (DA) to assist patients in evaluating treatment options and sharing in decision making have proliferated in recent years. Most require high literacy and do not use plain language principles. We describe one of the first attempts to design a decision aid using principles from reading research and document design. The plain language DA prototype addressed treatment decisions for localized prostate cancer. Evaluation assessed impact on knowledge, decisions, and discussions with doctors in men newly diagnosed with prostate cancer. METHODS: Document development steps included preparing an evidence-based DA in standard medical parlance, iteratively translating it to emphasize shared decision making and plain language in three formats (booklet, Internet, and audio-tape). Scientific review of medical content was integrated with expert health literacy review of document structure and design. Formative evaluation methods included focus groups (n = 4) and survey of a new sample of men newly diagnosed with prostate cancer (n = 60), compared with historical controls (n = 184). RESULTS: A transparent description of the development process and design elements is reported. Formative evaluation among newly diagnosed prostate cancer patients found the DA to be clear and useful in reaching a decision. Newly diagnosed patients reported more discussions with doctors about treatment options, and showed increases in knowledge of side effects of radiation therapy. CONCLUSION: The plain language DA presenting medical evidence in text and numerical formats appears acceptable and useful in decision-making about localized prostate cancer treatment. Further testing should evaluate the impact of all three media on decisions made and quality of life in the survivorship period, especially among very low literacy men.

Choice Behavior↗
PubMed2006

Development and testing of innovative patient resources for the management of coronary heart disease (CHD): a descriptive study.

BACKGROUND: Although heart disease is a major cause of morbidity and mortality the majority of patients do not access existing rehabilitation programs and patient resources are not designed to facilitate patient choice and decision-making. The objective of this study was to develop and test a series of risk factor modules and corresponding patient information leaflets for secondary prevention of CHD. METHODS: In phase one, a series of risk factor modules and management options were developed following analysis of literature and interviews with health professionals. In phase two, module information leaflets were developed using published guidelines and interviews of people with CHD. In phase three, the leaflets were tested for quality (DISCERN), readability (Flesch) and suitability (SAM) and were compared to the existing cardiac rehabilitation (CR) information leaflet. Finally, the patients assessed the leaflets for content and relevance. RESULTS: Four key risk factors identified were cholesterol, blood pressure, smoking and physical inactivity. Choice management options were selected for each risk factor and included medical consultation, intensive health professional led program, home program and self direction. Patient information needs were then identified and leaflets were developed. DISCERN quality scores were high for cholesterol (62/80), blood pressure (59/80), smoking (62/80) and physical activity (62/80), all scoring 4/5 for overall rating. The mean Flesch readability score was 75, representing "fairly easy to read", all leaflets scored in the superior category for suitability and were reported to be easy to understand, useful and motivating by persons with CHD risk factors. The developed leaflets scored higher on each assessment than the existing CR leaflets. CONCLUSION: Using a progressive three phase approach, a series of risk factor modules and information leaflets were successfully developed and tested. The leaflets will contribute to shared-decision making and empowerment for persons with CHD.

Adult↗
PubMed2007

Development of a series of patient information leaflets for constipation using a range of cognitive interview techniques: LIFELAX.

BACKGROUND: The aim of the LIFELAX randomised controlled trial (diet and lifestyle vs. laxatives in the management of chronic constipation) is to develop and evaluate a cost effective intervention to promote diet and lifestyle in the treatment and management of chronic constipation for older people in Primary Care. Constipation affects the quality of life in around 20% of older people in the community. In the 65 years plus population, a significant proportion of men and women both living in institutions (81% and 75% respectively) and free living (30% and 37% respectively) use laxatives. Approximately 42 million pounds is spent each year on prescribed laxatives in England in addition to laxatives purchased over the counter. Although bowel problems are often multifactorial, diet and lifestyle have an extremely important role in their management. This paper describes one aspect of the main study, the development and piloting of the Patient information leaflets (PILs). METHODS: Following review of the literature and interviews with practitioners and patients, 8 PILs were designed on: constipation, activity, bowel health, fruit and vegetables, fibre, fluid, alternative therapies and laxatives. To check the patient's understanding of terms used in the PILS and the clarity and accessibility of the information understanding, cognitive interviews (CI) were used with nine patients (selected from 3 GP surgeries), aged > or = 55 years, who had received > or = 3 prescriptions of laxatives over 12 months. Interviews were recorded and transcribed. RESULTS: Changes made following the CI process included the lay-out, words used (e.g. 'exercise' was changed to 'activity', 'gut motility' changed to 'bowel movement') and descriptions and examples were adapted to be more appropriate for the target population. CONCLUSION: Pilot testing with CIs resulted in improvements in the PILs, which emphasises the need to pilot PILs with the target population before use. The techniques employed are relatively inexpensive and could be routinely used when preparing literature for research or clinical use including those intended for use with healthcare professionals and patients.

Aged↗
PubMedDate not supplied

Research briefs reading grade level and readability of printed cancer education materials.

PURPOSE/OBJECTIVES: To analyze cancer brochures to estimate their reading level and assess their readability. DESIGN: Quantitative. SAMPLE: 10 cancer brochures published by various cancer organizations. METHODS: SMOG was used to estimate reading grade level of the brochures; the Readability Assessment Instrument (RAIN) was used to analyze the brochures in terms of 14 variables that affect comprehension. Interrater reliability was computed for reading grade level and readability level. MAIN RESEARCH VARIABLES: Reading grade level and readability. FINDINGS: Reading grade level of the brochures ranged from 9-15. The RAIN analysis showed that the number of variables incorporated across the 10 brochures ranged from 12-14, and the number of variables reaching readability criteria ranged from 6-8. CONCLUSIONS: Cancer education materials are written at levels that may be too high for the average reader. These materials also may be difficult to understand because of the way they are written. Materials need to be written so that they match the reading levels of patients with cancer and the general public and incorporate more of the variables that affect comprehension so that readers can understand them easily. IMPLICATIONS FOR NURSING: Nurses use written education materials to inform patients about their cancer diagnoses. They can conduct a comprehensive analysis of cancer brochures using SMOG and RAIN and then, if needed, use this information to revise the brochures so that they can be understood easily. If possible, patients who are going to be using the materials should be involved in the revision process.

Comprehension↗
PubMed2004

Professional and patient perspectives on nutritional needs of patients with cancer.

PURPOSE/OBJECTIVES: To identify and compare perceptions of RNs, registered dietitians (RDs), and patients regarding the best format and key nutrition information components that should be provided to patients during cancer treatment. DESIGN: Cross-sectional study using an opinion-based questionnaire. SETTING: Outpatient cancer centers. SAMPLE: 506 RNs and 367 RDs, as well as 653 patients undergoing cancer treatment. METHODS: Two similar self-administered questionnaires were developed, one for patients and one for healthcare professionals. Face and content validity were assessed by a panel of experts. Data were analyzed using descriptive statistics, chi-square statistic, and a Spearman Correlation Coefficient to compare responses. MAIN RESEARCH VARIABLES: Patient nutrition concerns as well as format and content of printed educational materials. FINDINGS: Significant differences existed among groups regarding the most common nutrition concerns, the perception of importance of information frequently provided to patients with cancer, and rank order of importance for eight items typically provided to patients. The dietary information format preferred by all groups was an all-inclusive booklet; RNs (75%) were more likely than RDs (43%) or patients (50%) to prefer this format. Data also revealed that almost half of the patients (47%) received no dietary counseling, including 18% who experienced significant weight loss. CONCLUSIONS: RNs and RDs who provide nutrition education to patients with cancer should consider the need to develop and use a variety of printed materials to meet individual needs. Because major concerns of patients and healthcare professionals were related to patients ability to consume adequate amounts of food, this should be the primary focus of any nutrition education materials. IMPLICATIONS FOR NURSING: These findings provide information that can be applied to the development of informational materials and counseling practices.

Adult↗
PubMed1991

Lithium maintenance: 1. A standard education programme for patients.

A videotape lecture and written hand-out containing factual information about lithium were given to 30 attenders at a lithium clinic. A further 30 patients acted as a control group and were not given the programme until later in the study. The educational programme resulted in substantial and significant increases in patient knowledge about lithium, such that knowledge increased from a baseline comparable with that of social workers to a level similar to that of community psychiatric nurses. Patients' attitudes to lithium also became more favourable after education.

Attitude to Health↗