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PubMed1992

The impact of mailing psychoeducational materials to women with abnormal mammograms.

A randomized trial was conducted to evaluate the impact of mailed psychoeducational materials on adherence to subsequent annual mammography among women with prior abnormal mammograms. The results showed a 13% increment in adherence among women who received this intervention. This effect was independent of all sociodemographic and medical variables examined. We conclude that mailed psychoeducational materials may be an effective mechanism to improve adherence among women with abnormal mammogram results.

Aged↗
PubMed1994

Educating patients with limited literacy skills: the effectiveness of printed and videotaped materials about colon cancer.

We investigated whether printed or videotaped information is more effective in enhancing colon cancer knowledge. Subjects (n = 1100) were randomized into three groups: to receive a booklet, view a videotape, or receive no intervention. Subjects receiving the intervention showed increased knowledge compared with control subjects (booklet = 23% and videotape = 26% vs no intervention = 3%). Findings suggest that personalized educational materials are effective in enhancing colon cancer knowledge.

Colonic Neoplasms↗
PubMed1997

'Call fast, Call 911': a direct mail campaign to reduce patient delay in acute myocardial infarction.

OBJECTIVES: A 10-month direct mail campaign was implemented to increase use of emergency medical services via 911 calls and to reduce prehospital delay for individuals experiencing acute myocardial infarction symptoms. METHODS: This prospective, randomized, controlled trial involved three intervention groups (receiving brochures with informational, emotional, or social messages) and a control group. RESULTS: Intervention effects were not observed except for individuals who had a history of acute myocardial infarction and who were discharged with a diagnosis of acute myocardial infarction; their 911 use was meaningfully higher in each intervention group than in the control group. CONCLUSIONS: The mailings affected only the individuals at greatest risk.

Adult↗
PubMed1997

A dietary intervention in primary care practice: the Eating Patterns Study.

OBJECTIVES: This study evaluated the effectiveness of a low-intensity dietary intervention in primary care practice in lowering dietary fat intake and raising dietary fiber intake. METHODS: A randomized controlled trial of 28 physician practices in six primary care clinics enrolled, by telephone, adult patients who had appointments for nonurgent nonacute visits. Of 3490 eligible patients contacted, 2111 completed baseline interview; 86.1% also completed a 12-month follow-up. Physicians gave intervention participants a self-help booklet and a brief motivational message. Changes in fat and fiber from baseline to 12-month follow-up were evaluated. RESULTS: Intervention and control groups both reported a decrease in fat intake and an increase in fiber intake. The differential change and 95% confidence interval (CI) for the percentage of energy obtained from fat was -1.2 (CI = -0.71, -1.7) (P = .0015), for grams fiber/1000 kcal 0.32 (CI = -0.066, 0.71) (P = .086), for fat score -0.044 (CI = -0.016, -0.072) (P = .010), and for fiber score 0.036 (CI = 0.011, 0.061) (P = .014), with greater reductions in fat and greater increase in fiber in the intervention group. CONCLUSIONS: This low-intensity intervention was effective in dietary behavior change.

Adult↗
PubMed1999

Prevention of relapse in women who quit smoking during pregnancy.

OBJECTIVES: This study is an evaluation of relapse prevention interventions for smokers who quit during pregnancy. METHODS: Pregnant smokers at 2 managed care organizations were randomized to receive a self-help booklet only, prepartum relapse prevention, or prepartum and postpartum relapse prevention. Follow-up surveys were conducted at 28 weeks of pregnancy and at 8 weeks, 6 months, and 12 months postpartum. RESULTS: The pre/post intervention delayed but did not prevent postpartum relapse to smoking. Prevalent abstinence was significantly greater for the pre/post intervention group than for the other groups at 8 weeks (booklet group, 30%; prepartum group, 35%; pre/post group, 39%; P = .02 [different superscripts denote differences at P < .05]) and at 6 months (booklet group, 26%, prepartum group, 24%; pre/post group, 33%; P = .04) postpartum. A nonsignificant reduction in relapse among the pre/post group contributed to differences in prevalent abstinence. There was no difference between the groups in prevalent abstinence at 12 months postpartum. CONCLUSIONS: Relapse prevention interventions may need to be increased in duration and potency to prevent post-partum relapse.

Adult↗
PubMed1995

Reading abilities of drug users in Anchorage, Alaska.

Evaluated the reading abilities of 122 male and fifty-nine female intravenous and other drug users in Anchorage, Alaska. Reading abilities were assessed through the Reading subtest of the Wide Range Achievement Test-Revised and the short Form of the Woodcock Reading Mastery Test-Revised. Results indicated that men and Black subjects reported the highest levels of schooling completed. However, no differences were revealed across gender and ethnicity in actual reading levels. Among all subjects, the average reading ability was between 8.5 and 8.7 grade level. These scores place the average subject reading at a level lower than approximately 76 percent of the general population. Implications are provided for development of educational materials accessible for this population.

Adolescent↗
PubMed2003

Evaluation of new multimedia formats for cancer communications.

BACKGROUND: Providing quality, current cancer information to cancer patients and their families is a key function of the National Cancer Institute (NCI) Web site. This information is now provided in predominantly-text format, but could be provided in formats using multimedia, including animation and sound. Since users have many choices about where to get their information, it is important to provide the information in a format that is helpful and that they prefer. OBJECTIVE: To pilot and evaluate multimedia strategies for future cancer-information program formats for lay users, the National Cancer Institute created new multimedia versions of existing text programs. We sought to evaluate user performance and preference on these 3 new formats and on the 2 existing text formats. METHODS: The National Cancer Institute's "What You Need to Know About Lung Cancer" program was the test vehicle. There were 5 testing sessions, 1 dedicated to each format. Each session lasted about 1 hour, with 9 participants per session and 45 users overall. Users were exposed to the assigned cancer program from beginning to end in 1 of 5 formats: text paperback booklet, paperback booklet formatted in HTML on the Web, spoken audio alone, spoken audio synchronized with a text Web page, and Flash multimedia (animation, spoken audio, and text). Immediately thereafter, the features and design of the 4 alternative formats were demonstrated in detail. A multiple-choice pre-test and post-test quiz on the cancer content was used to assess user learning (performance) before and after experiencing the assigned program. The quiz was administered using an Authorware software interface writing to an Access database. Users were asked to rank from 1 to 5 their preference for the 5 program formats, and provide structured and open-ended comments about usability of the 5 formats. RESULTS: Significant improvement in scores from pre-test to post-test was seen for the total study population. Average scores for users in each of the 5 format groups improved significantly. Increments in improvement, however, were not statistically different between any of the format groups. Significant improvements in quiz scores were seen irrespective of age group or education level. Of the users, 71.1% ranked the Flash program first among the 5 formats, and 84.4% rated Flash as their first or second choice. Audio was the least-preferred format, ranking fifth among 46.7% of users and first among none. Flash was ranked first among users regardless of education level, age group, or format group to which the user was assigned. CONCLUSIONS: Under the pilot study conditions, users overwhelmingly preferred the Flash format to the other 4 formats. Learning occurred equally in all formats. Use of multimedia should be considered as communication strategies are developed for updating cancer content and attracting new users.

Adult↗
PubMedDate not supplied

Knowledge and behavior of tourists to Manu National Park, Peru, in relation to Leishmaniasis.

BACKGROUND: Tourists have been infected with Leishmania braziliensis and the lack of appropriate travel information on the disease has been documented. The aim of this study was to describe the knowledge and behavior of tourists booked on a trip to Manu National Park in Peru in relation to leishmaniasis and its prevention. METHODS: The clients of two tour operators in Cusco, Peru, represented the experimental and control group. The experimental group completed a questionnaire after the tour briefing the night before the trip and received the information leaflet. A second questionnaire was completed just before returning from the park. The clients in the control group did not receive the leaflet. RESULTS: Three hundred and seventy-three questionnaire pairs were collected (173 experimental, 200 control). Only 24 (6%) of all participants claimed to have heard of leishmaniasis. Of the 92.5% of tourists who read the leaflet, 156 (97.5%) found it informative, although 50 (32.5%) wanted more information. It was suggested that the leaflet should be distributed by tour operators (56.9%), general practitioners/family doctors (49%), and travel agents (47.1%). There was no significant difference in the use of preventive measures between the groups. One-third of the experimental group claimed to have paid more attention to protection due to the information given in the leaflet. CONCLUSIONS: There is generally a lack of knowledge on leishmaniasis with a great feeling of need for more and detailed information. Correct and complete information on leishmaniasis should be included in the health advice for travelers to endemic areas.

Adult↗
PubMed1996

How have patients reacted to the implications of the DCCT?

OBJECTIVES: To assess the reactions of people with insulin-treated diabetes (ITD) to the results of the Diabetes Control and Complications Trial (DCCT). RESEARCH DESIGN AND METHODS: A leaflet documenting the purpose and results of the DCCT was circulated to all 771 patients ages 15-60 years with ITD attending our clinic. Patients were invited to complete and return a questionnaire on their responses. RESULTS: Of 550 respondents, 330 felt encouraged to improve glycemic control. Female respondents (P = 0.003) and younger age-groups (15-25 years, P = 0.001) were most likely to want to improve control. Patients with long duration of diabetes (> 20 years, P = 0.00001), hypoglycemia unawareness (P = 0.0001), or previous severe hypoglycemia (P = 0.001) were less likely to want to improve their control. Fear of hypoglycemia concerned all age-groups, whereas female respondents were most likely to be worried about the potential for weight gain (P = 0.00006). CONCLUSIONS: Knowledge of the results of the DCCT encourages significant numbers of patients to want to improve glycemic control. Fear of hypoglycemia and, in women, weight gain may prove significant impediments to the clinical implementation of the results of the DCCT.

Adolescent↗
PubMed1999

Improvements in diabetic care as measured by HbA1c after a physician education project.

OBJECTIVE: To measure the quality of diabetic care as indicated by HbA1c testing frequency and HbA1c values and to demonstrate improvement in care after an appropriate quality improvement intervention. RESEARCH DESIGN AND METHODS: The quality improvement project used computerized claims and laboratory data relating to HbA1c testing among the private practices of nine physicians caring for diabetic Medicare patients. Nine indicators evaluated three main areas: HbA1c testing frequency, HbA1c values, and frequency of office visits. A quality improvement intervention consisting of a physician component and a patient component was implemented. RESULTS: There were 835 patients and 4,367 visits studied. After the intervention, statistically significant improvements in HbA1c testing frequency and values were noted. Rates of seized opportunities for testing HbA1c improved from 17.7 to 33.9% (P < 0.0001). The percentage of patients with a current HbA1c value improved from 31.3 to 47.6% (P < 0.0001). The median HbA1c values fell from 8.5 to 7.8% (P < 0.006). Patients achieving good or fair control (HbA1c < or = 8%) improved from 43.8 to 56.9% (P = 0.007). The median time between physician visits fell from 70 days to 60 days (P < 0.0001). CONCLUSIONS: The study revealed that HbA1c testing was underused but that after a quality improvement initiative, a significant increase in testing use could be achieved. The quality improvement initiative also resulted in significant improvements in glycemic control. The techniques and interventions used in this study could be used to intervene in larger populations and practice settings to improve medical care for diabetic patients.

Aged↗
PubMed2003

Motivational brochures increase the number of medicare-eligible persons with diabetes making therapeutic footwear claims.

OBJECTIVE: This study tests the hypothesis that Medicare beneficiaries at high risk of foot complications who are mailed a motivational brochure describing the Medicare diabetes-related therapeutic footwear benefit will increase their therapeutic footwear-related Medicare claims. RESEARCH DESIGN AND METHODS: In this quasi-experimental study, a motivational brochure was mailed in the summer of 1997 to 5,872 Medicare beneficiaries in Washington, Alaska, and Idaho who were identified as being at high risk for foot-related claims on the basis of their prior Medicare claims history. Beneficiaries were identified through footwear claims made in these states-and also in three comparison states (Oregon, Montana, and Wyoming)-during the 18 months before and after the mailing. Linear regression was used to compare the number of persons making claims in the intervention states with the comparison states before, at the time of, and after the mailing. RESULTS: Before the intervention, the number of persons making claims was increasing in the non-intervention states and decreasing in the intervention states. During the first month after the intervention mailing, the number of persons making claims remained nearly the same in non-intervention states, but increased 13 persons per month in intervention states (95% CI 3.5-11 persons/month). After the intervention, the number of persons making claims continued to increase similarly in both intervention and non-intervention states. CONCLUSIONS: Mailed motivational brochures were associated with an increase in the number of persons making therapeutic footwear claims. Randomized trials should confirm these findings.

Aged↗
PubMed1995

Readability and comprehensibility of the "exercise lite" brochure.

Studies suggest that exercise literature tends to be very difficult to read and the writing not matched to the reading ability of the audience for which it was intended. Two studies aimed at describing the readability and comprehensibility of the recently developed U.S. Centers for Disease Control and American College of Sports Medicine "Exercise Lite" brochure were conducted. In Study 1, the brochure's readability was assessed using four different formulas. This study showed that the brochure was written at a level equivalent to that of a scientific journal article. In Study 2, 56 participants (two-thirds of whom were college graduates) were tested to assess whether they could comprehend the brochure's message. Results showed that, without supplemental instruction, the Exercise Lite brochure was incomprehensible for 69.6% (n = 39) of the subjects.

Adult↗
PubMed1995

Development and evaluation of stage-matched written materials about lifestyle and structured physical activity.

Two sets of written materials about physical activity were developed, one promoting lifestyle exercise and the other promoting structured exercise. Both sets integrated the Transtheoretical Model of behavior-change concepts. Materials were evaluated by 8 women and 6 men (M age = 63.1 yr.) using a stratified (by gender) randomized group design. Participants evaluated the materials on 8 factors of a standardized instrument. Cronbach alpha was .97. No significant differences were found between the two sets of materials on the 8 factors evaluated. Effect size differences ranged from .16 to .84 (M = .46).

Adult↗
PubMed1977

Drug information source credibility among junior and senior high school youths.

Analysis was made of data gathered in a winter 1974/75 survey of 7th through 12the grade youngsters attending public schools in New York State to learn the credibility of various sources of information on drugs. The results showed important relationships to hold between the youth's involvement with substances and their belief in the media and nonmedia information sources that were probed.

Adolescent↗