Effects of video-based, online education on behavioral and knowledge outcomes in sunscreen use: A randomized controlled trial

Objectives

To compare online video and pamphlet education at improving patient comprehension and adherence to sunscreen use, and to assess patient satisfaction with the two educational approaches.

Methods

In a randomized controlled trial, 94 participants received either online, video-based education or pamphlet-based education that described the importance and proper use of sunscreen. Sun protective knowledge and sunscreen application behaviors were assessed at baseline and 12 weeks after group-specific intervention.

Results

Participants in both groups had similar levels of baseline sunscreen knowledge. Post-study analysis revealed significantly greater improvement in the knowledge scores from video group members compared to the pamphlet group (p = 0.003). More importantly, video group participants reported greater sunscreen adherence (p < 0.001). Finally, the video group rated their education vehicle more useful and appealing than the pamphlet group (p < 0.001), and video group participants referred to the video more frequently (p = 0.018).

Conclusion

Video-based learning is a more effective educational tool for teaching sun protective knowledge and encouraging sunscreen use than written materials.

Practice implications

More effective patient educational methods to encourage sun protection activities, such as regular sunscreen use, have the potential to increase awareness and foster positive, preventative health behaviors against skin cancers.     

Can wireless text messaging improve adherence to preventive activities? Results of a randomised controlled trial

Objective

To determine the effectiveness of cell phone wireless text messaging for improving adherence to a healthy behaviour.

Design

A randomised, unblinded, controlled trial was conducted with 102 subjects, 18 years or older, each having a cell phone and willing to take 1 vitamin C pill per day for 1 month for preventive reasons. Intervention group participants received text messaging reminders and were asked to acknowledge receiving their messages after taking the vitamins, whereas control group subjects had no text messaging activity.

Measurements

Self-reported adherence and the number of participant text messages acknowledging vitamins taken.

Results

Both groups reported an increased adherence after the trial: by 246% for the intervention group and by 131% for the control group. There was a non-significant difference between the two groups at endpoint: an average difference of 0.8 between the number of pills missed in the last week of the trial (2.5 out of 7 in the intervention and 3.3 out of 7 in the control group) with a power of 0.54. The study revealed a significant correlation (coefficient = −0.352, sig. = 0.01) between the average number of text messaging acknowledgements sent by the intervention group participants and the number of pills they reported missed during the last week of the trial.

Conclusion

This was a small randomised controlled trial with inconclusive but encouraging results. It suggests a new approach in addressing insufficient adherence in outpatient conditions and shows that the use of information technology tools for compliance warrants further research.     

Evaluating an intervention to increase cancer knowledge in racially diverse communities in South Carolina

Objective

To conduct a cancer education intervention with racially diverse communities in South Carolina.

Methods

The study was conducted at eight different sites in six counties in SC. The intervention included a 3-h general cancer knowledge and 30-min prostate cancer knowledge component. Pre- and post-intervention surveys were administered. Maximum scores were 31, 10 and 5 for the general cancer knowledge, prostate cancer knowledge and perceived self-efficacy in patient-physician interaction instruments, respectively. Analyses were completed using SPSS 16.0, SAS 9.1.3, and R v2.6.1.

Results

The study sample consisted of 164 predominantly African American participants. Most of the participants who reported age were 50+ years (62.5%). Among those who reported income, 46.1% had an annual household income <$40,000. The mean general cancer knowledge pre-test score was 26.2 (standard deviation (SD) 3.7) with a mean post-intervention increase of 2.15 points (p < 0.01). The mean pre-test prostate cancer knowledge score was 7.3 (SD 2.0) with a post-intervention increase of 0.48 points (p < 0.01). Perceived self-efficacy in patient-physician interaction scores had a ceiling effect.

Conclusion

General cancer knowledge and prostate cancer knowledge scores increased following the intervention.

Practice Implications

The intervention was successful in the short-term. It could be continued by community members.     

Development and pilot testing of an online screening decision aid for men with a family history of prostate cancer

Objective

This study aimed to develop and pilot test an online screening decision aid (DA) for men with a family history of prostate cancer.

Methods

Eligible men (with no previous prostate cancer diagnosis) were recruited through relatives attending a urology outpatient clinic. Men evaluated the DA in two stages. First, they appraised a paper-based version using a questionnaire (n = 22). Second, the same men were asked to reflect on an interactive web-based version via a semi-structured telephone interview (n = 20).

Results

Men evaluated both forms of the DA positively. Of the paper-based version, the majority of participants found the DA useful (91%), and that it contained enough information to make a screening decision (73%). All participants reported that the online DA was easy to use and navigate. Most participants reported that a website was their preferred mode of receiving prostate cancer screening information (70%).

Conclusion

The developed DA may represent the first online decision-making tool designed specifically for men with a family history prostate cancer that presents age and risk specific information to the user.

Practice implications

Comprehensive evaluations of the efficacy and impact of educational interventions such as this are crucial to improve services for individuals making informed screening decisions.     

Changing practitioner behavior and building capacity in tobacco cessation treatment: the TEACH project

Objective

To facilitate interprofessional knowledge transfer to practice by increasing treatment capacity of health care practitioners to deliver evidence-informed smoking cessation counseling.

Methods

TEACH (Training Enhancement in Applied Cessation Counseling and Health) combines diffusion of innovations with principles of adult learning to address the lack of system capacity to implement evidence-based smoking cessation treatments. Participants were professionals from 15 disciplines with commitment from their supervisor to implement the intervention. Pre- and post-training course evaluation surveys assessed the extent to which learning objectives were achieved and guided a continuous quality improvement process.

Results

Evaluation of 741 participants that attended the three-day Core Course from June 2007 to January 2009 revealed significant increases in pre- to post-training ratings of feasibility, importance, and confidence in using the intervention. In addition to attitudinal changes, practitioners made changes to practice behavior. At six months post-training, 55% of professionals were implementing the intervention and 91% engaged in knowledge transfer activities in their organizations/communities.

Conclusion

Findings suggest that TEACH impacted clinical practice and may serve as a model for knowledge translation initiatives in other health behavior domains.

Practice implications

These data demonstrate that it is feasible to operationalize interprofessional knowledge translation models to transfer research findings into practice.     

Tele-health: lessons and strategies from specialists in poison information

Objective

The use of the telephone for providing healthcare is growing. The aim of this exploratory study was to describe tele-health lessons and strategies as discussed by specialists who provide information and recommendations on poison control hotlines.

Methods

Three focus groups of 25 participants who work as specialists in poison information in poison control centers were conducted. Group discussions were analyzed using qualitative content analysis.

Results

Themes that emerged from the data on strategies for telephone communication include: taking control of the call, developing a therapeutic relationship, tailoring communication to fit each caller, preventing information overload, confirming caller understanding, and hands-on training for the development of telephone communication skills.

Conclusion

Specialists in poison information identified challenges specific to communicating with patients over the telephone and reported several types of strategies they used to manage them.

Practice implications

Telephone communication training may be needed to assist health care providers in improving their communication skills.     

Development and validation of the Medication-Related Consultation Framework (MRCF)

Objectives

To develop and test a framework for evaluating the consultation skills of practitioners undertaking medication-related consultations.

Methods

Key components of medication-related consultations were identified through a literature review and compiled to form an initial consultation skills framework. This was iteratively refined through consultation with experts (n = 21) to form the Medication-Related Consultation Framework (MRCF). Psychometric testing was undertaken by analyzing pharmacists’ (n = 10) assessment of fifteen pre-recorded simulated consultations.

Results

The MRCF consisted of 46 consultation behaviors, grouped into five sections. Performance was rated at individual behavior, framework section and global consultation levels. The MRCF discriminated between good, satisfactory and poor consultations at the global rating level (p < 0.01) with good test-retest reliability (rho = 0.59-0.95) and moderate inter-assessor reliability (Kendall's W = 0.67). There was also good internal consistency for the five sections (Cronbach's alphas = 0.58-0.97).

Conclusions

The MRCF demonstrated good psychometric properties at the global and section rating levels. Some inconsistencies in assessors’ ratings of individual consultation behaviors were indentified, which may represent a future training need.

Practice implications

The MRCF provides healthcare professionals with a patient-centered consultation structure, serving to identify medication-related needs and potentially support adherence. It also allows the quality of a practitioner's consultation to be evaluated.     

Association of age, health literacy, and medication management strategies with cardiovascular medication adherence

Objective

To examine patients’ use of medication management strategies (e.g., reminders, pill boxes), and to determine how their use influences the relationship between patient characteristics and medication adherence.

Methods

Retrospective and cross-sectional study of 434 patients with coronary heart disease, examining both refill adherence and self-reported adherence.

Results

The most common strategy for managing refills was seeing a near empty pill bottle (89.9%), and for managing daily medications, it was associating medications with daily events (80.4%). Age < 65 (OR = 1.7), as well as marginal (OR = 2.0) or inadequate health literacy (OR = 1.9), was independently associated with low refill adherence. Patients <65 also had lower self-reported adherence (OR = 1.8). Adjustment for use of medication management strategies did not substantially change these relationships. Reliance on reminders from friends or family to take medications, or waiting to refill a medicine only when the bottle was near empty, each were associated with 3-fold greater odds of non-adherence.

Conclusion

Age <65 and marginal or inadequate health literacy were independently associated with medication non-adherence. Use of medication management strategies did not explain these relationships.

Practice implications

The strategies which patients report using to assist with managing medication refills and daily medication use may be ineffective.     

Hypersomnia in inter-episode bipolar disorder: does it have prognostic significance?

Background

Hypersomnia in inter-episode bipolar disorder has been minimally researched. The current study sought to document the prevalence of hypersomnia in a sample of inter-episode patients with bipolar disorder and to examine the relationship between hypersomnia and future bipolar depressive symptoms.

Methods

A total of 56 individuals with bipolar disorder (51 type I + 5 type II) who were currently inter-episode, along with 55 non-psychiatric controls, completed a baseline assessment, including semi-structured interviews for psychiatric diagnoses, sleep disorders, and a battery of indices that included assessment of hypersomnia. Approximately 6 months later, participants were recontacted by telephone and mood was re-evaluated.

Results

Three of six indices suggested that approximately 25% of participants with bipolar disorder endorsed symptoms of hypersomnia in the inter-episode period. Within the bipolar group, hypersomnia in the inter-episode period was associated with future depressive symptoms. This finding was independent of baseline depressive symptoms and medication use.

Limitations

Small sample size and concurrent psychopharmacology in the bipolar sample.

Discussion

Though no gold standard measure for hypersomnia currently exists, this research takes a step towards identifying a clinically and empirically useful hypersomnia assessment. This study demonstrates that hypersomnia in the inter-episode period of bipolar disorder relates to future depressive symptoms, and adds to the growing body of evidence on the importance of inter-episode symptoms predicting bipolar relapse.     

Neural network analysis of employment history as a risk factor for prostate cancer

Background

Prostate cancer is the most common non-cutaneous malignancy in men. Its etiology likely involves environmental exposures and demographic factors.

Objective

Investigate the potential relationship between occupation history and prostate cancer risk in a population-based, case-control study (n=1365).

Methods

The variables: race, age group, smoking status, income, marital status, education and the first 15 years of employment history were examined by sequential odds ratio analysis then compared to a neural network consensus model.

Results

Both the sequential odds ratio method and the neural network consensus model identified a similar hypothetical case of greatest risk: a Black, married man, older than 60 years, with at best a high school diploma who made between $25,000-$65,000. The work history determined by odds ratio analysis consisted of 10 years in the chemical industry with 3 yrs in the processing plant. Neural network analysis showed a similar work history with 8 years in the chemical industry and 2 years in the processing plant.

Discussion

Neural network outcomes are similar to sequential odds ratio calculations. This work supported previous studies by finding well known demographic risk factors for prostate cancer including certain processing jobs and chemical related jobs.     

Patient education in groups increases knowledge of osteoporosis and adherence to treatment: A two-year randomized controlled trial

Objective

Non-adherence to pharmacological treatment in osteoporosis is a well-recognized problem. We hypothesized that a group-based educational programme would increase patients’ knowledge and level of adherence with medical treatment.

Methods

A total of 300 patients (32 men aged 65 ± 9 years and 268 women aged 63 ± 8 years), recently diagnosed with osteoporosis, were randomised to either an osteoporosis school programme (four classes of 8-12 participants over four weeks) or a control group. Teaching was multidisciplinary, based on patients’ experiences and background and designed to encourage empowerment. Patients’ knowledge about osteoporosis and adherence to treatment was assessed with self-completed questionnaires at baseline and after 3, 12, and 24 months.

Results

There were no significant differences at baseline between the two groups with respect to knowledge score or level of adherence. At two years’ follow-up, the improvement in knowledge score was 2 [0-4] points (median [25-75 percentiles]) in the school group and 0 [−2 to 2] in controls (p < 0.001) and self-reported adherence to pharmacological therapy was significantly higher in the school group (92%) compared to the control group (80%), p < 0.001.

Conclusion

The programme increased knowledge about osteoporosis and increased self-reported adherence to pharmacological treatment over a period of two years.     

The identification of unipolar mania subtype based on anxiety comorbidity

Background

Unipolar mania is a controversial topic. Clinical research has focused on establishing specific characteristics that allow it to be distinguished from bipolar disorder (BD).

Methods

Experienced and carefully trained clinicians evaluated a clinical sample of 298 patients with bipolar disorder using structured instruments to analyze the clinical and socio-demographics differences between people with manic episodes over the course of a 15-year illness compared with participants with histories of manic and depressive episodes.

Results

According to adopted criteria, 16 (5.6%) participants presented unipolar mania (UM) and 282 participants presented manic and depressive (MD) phases. UM patients reported significantly more hospitalizations and medications, as well as more frequent psychosis at the first episode in the UM group than compared to the MD group. The UM group showed worse overall functioning, although differences in mood status between groups were not identified. Comorbid anxiety disorders and anxiety symptoms occurred significantly less frequently in the UM group.

Limitations

Because of the cross-sectional design, determining causal relationships was not possible. Furthermore, the retrospective nature of the UM diagnosis could not exclude a future depressive episode.

Conclusions

The presence of anxiety disorders can differentiate patients with unipolar mania from those with bipolar mania.     

The effect of conflicting medication information and physician support on medication adherence for chronically ill patients

Objective

This article explores the effect of conflicting information, defined as contradictory information about medication topics from different sources, on medication adherence in a sample of chronically ill patients. We specifically investigate whether conflicting information and physician support directly affect medication adherence or whether the effect is mediated by adherence self-efficacy and outcome expectations for medications.

Methods

Vasculitis patients (n = 228) completed two on-line questionnaires which contained measures of conflicting information, adherence self-efficacy, outcome expectations, physician support, and medication adherence. We conducted a mediation analysis using a bootstrapping approach to generate point estimates and 95% confidence intervals to test the significance of each mediated effect.

Results

A majority of patients (51.3%) received conflicting medication information. Conflicting information had a direct negative effect on medication adherence, which was not mediated by self-efficacy or outcome expectations. Alternatively, self-efficacy mediated the positive effect of physician support on medication adherence.

Conclusion

Patients who encounter conflicting medication information are less adherent to their medications. The presence of a supportive physician may counteract the negative effect of conflicting medication information.

Practice implications

Physicians should initiate conversations about conflicting medication information with their patients. Consensus-based guidelines that address medication discrepancies may also reduce the availability of conflicting information.     

Beyond reading alone: The relationship between aural literacy and asthma management

Objectives

To examine the relationship between literacy and asthma management with a focus on the oral exchange.

Methods

Study participants, all of whom reported asthma, were drawn from the New England Family Study (NEFS), an examination of links between education and health. NEFS data included reading, oral (speaking), and aural (listening) literacy measures. An additional survey was conducted with this group of study participants related to asthma issues, particularly asthma management. Data analysis focused on bivariate and multivariable logistic regression.

Results

In bivariate logistic regression models exploring aural literacy, there was a statistically significant association between those participants with lower aural literacy skills and less successful asthma management (OR: 4.37, 95%CI: 1.11, 17.32). In multivariable logistic regression analyses, controlling for gender, income, and race in separate models (one-at-a-time), there remained a statistically significant association between those participants with lower aural literacy skills and less successful asthma management.

Conclusion

Lower aural literacy skills seem to complicate asthma management capabilities.

Practice implications

Greater attention to the oral exchange, in particular the listening skills highlighted by aural literacy, as well as other related literacy skills may help us develop strategies for clear communication related to asthma management.     

Maximizing your Patient Education Skills (MPES): A multi-site evaluation of an innovative patient education skills training course for oncology health care professionals

Objective

To evaluate the acceptability and relevance of the Maximizing your Patient Education Skills (MPES) course and to determine whether it significantly improved knowledge regarding patient education (PE) theory, self-assessed PE competencies, and PE skills using case based vignettes.

Methods

1-Group, multi-site, pre-post-intervention. Participants completed a pre-assessment (T1), participated in the 4-h MPES course, and then a 3-month post-assessment (T2). A focus group was conducted with sub-set of participants.

Results

98 (75%) of participants completed both time points. Participants were highly satisfied with MPES and found it to be relevant. Results showed that MPES had a significant impact on all of our outcome measures.

Conclusion

Findings from this study show that oncology HCPs knowledge of patient education theory, self-assessed competencies and skills can improve after participating in a brief problem-focused and interactive workshop.

Practice implications

Given the evidence that well-planned education and support can contribute to a number of positive health outcomes and the evidence that HCPs may lack the skills to teach and support patients and their families effectively, these results suggest that MPES course may be of value to oncology professionals. Efforts to further develop this course include exploring alternative funding models and using different learning platforms.     

Helminthic infection and the risk of neurologic disease progression in HTLV-1

Background

Infection with the human T-cell lymphotropic virus, type 1 (HTLV-1) has been associated with an increased Th1 response. Interestingly, a higher prevalence of helminthic coinfection has been observed among infected individuals, and subsequent modulation of the immune response typically associated with helminths may influence clinical outcomes among HTLV-1 coinfected individuals.

Objective

This study was conducted to elucidate the association between helminthic coinfection and the development of clinically characterized neurologic disease that occurs in HTLV-1 infection.

Study design

In a cohort analysis, incidence of HTLV-associated myelopathy/tropical spastic paraparesis (HAM/TSP) was recorded. Incidence of clinical outcomes and disease-free survival of several neurologic outcomes associated with HTLV-1 were estimated using the Kaplan-Meier method with log-rank tests. The relationships between helminthic infection and risk of HTLV-1 neurologic outcomes were assessed by Cox proportional hazard modeling.

Results

Seventy-four coinfected and 79 non-coinfected patients were followed, with 92 helminthic infections observed in the coinfected group. One patient per group developed HAM/TSP and the risk of progression to neurologic disease outcomes did not differ among those with and without helminthic coinfection (p > 0.45). A significant difference was noted in the prevalence of neurologic disease outcomes among all patients at the conclusion of the study (p < 0.01).

Conclusions

These data suggest that treated helminthic infection does not affect risk of development of neurologic disease in HTLV-1 infection, and reinforce that treatment of helminths does not adversely affect patients with HTLV-1. Importantly, among all patients, an overall progression of neurologic disease was observed.     

Correlating reading comprehension and health numeracy among adults with low literacy

Objective

Using the Test of Functional Health Literacy for Adults (TOFHLA), a pilot study was conducted to assess whether reading comprehension and numeracy scores sufficiently correlate in health contexts among adults with low literacy skills.

Methods

The TOFHLA was administered to 144 adults with low literacy enrolled in a health literacy program prior to the start of coursework. Raw scores for reading and numeracy were calculated. Weighted numeracy scores were calculated and compared to raw reading comprehension scores.

Results

Among 143 participants, 20% (n = 28) had a higher numeracy score than reading comprehension score, while an additional 20% scored lower in numeracy than in reading comprehension.

Conclusion

This study found that reading comprehension and numeracy skill in the context of understanding health information do not necessarily correlate for specific disadvantaged groups. This finding calls attention to the need to further examine numeracy as a construct which is conceptually separate from reading comprehension, and highlights the importance of including a numerate component in health literacy evaluations.

Practice implications

The results of this study have important implications for medical decision-makers, health educators, and health promoters working with traditional methods of assessing health literacy.