Examination of Routine Use of Prenatal Weight Gain Charts as a Communication Tool for Providers

Objectives In 2009 the IOM revised prenatal weight gain guidelines. The primary purpose of this pilot study was to assess if provider education and use of prenatal weight gain charts to track weight gain and counsel patients was associated with better patient and provider knowledge and communication about the guidelines. Methods A prospective non-randomized study conducted in four OB practices (two control, two intervention). Data sources included provider surveys (n?=?16 intervention, 21 control), patient surveys (n?=?332), and medical records. Intervention clinics received provider education on the IOM guidelines and used patient education materials and prenatal weight gain charts to track weight gain and as a counseling tool. Comparison clinics received no education and did not use the charts or patient education information. Results More patients at intervention clinics (92.3%) reported that a provider gave them advice about weight gain, compared to patients from comparison clinics (66.4%) (p?<?0.001). Intervention patients were also more likely to report satisfaction discussions with their provider about weight gain (83.1 vs. 64.3%, p?=?0.007). Intervention clinic patients were more likely to have knowledge of the guidelines indicated by 72.3% reporting a target weight gain amount within the guidelines versus 50.4% of comparison patients (p?<?0.001). Conclusion Provider education and use of weight gain charts resulted in higher patient reported communication about weight gain from their provider, higher patient satisfaction with those discussions, and better knowledge of the appropriate target weight gain goals.     

Effects of educational intervention in waiting room on patient satisfaction

This study examines the effects of a low-cost educational intervention designed to occupy the waiting time in the clinic on patient satisfaction with the clinic visit. Patients waiting for appointments were randomly assigned to two groups: (1) educational intervention in the clinic waiting room (n = 160) and (2) usual clinic care (no structured education during the waiting time in the clinic; n = 160). There were significant negative correlations between satisfaction with the visit overall and the time patients waited in the clinic waiting room (r = -.17, p = .003) and their total wait time (r = -.16, p = .005). Patients who were taught while they waited in the clinics were more satisfied with their education than the control group (t = 4.26, df = 318, p < 0.001).     

Use of the Home Safety Self-Assessment Tool (HSSAT) within Community Health Education to Improve Home Safety

This exploratory research examined the benefits of a health education program utilizing the Home Safety Self-Assessment Tool (HSSAT) to increase perceived knowledge of home safety, recognition of unsafe activities, ability to safely perform activities, and develop home safety plans of 47 older adults. Focus groups in two senior centers explored social workers' perspectives on use of the HSSAT in community practice. Results for the health education program found significant differences between reported knowledge of home safety (p = .02), ability to recognize unsafe activities (p = .01), safely perform activities (p = .04), and develop a safety plan (p = .002). Social workers identified home safety as a major concern and the HSSAT a promising assessment tool. Research has implications for reducing environmental fall risks.     

Nutrition Knowledge and Food Choices of Elementary School Children

This research investigated the effect of a three-week school based nutrition education program on the nutrition knowledge and healthy food choices of 187 fifth graders who were randomly divided into a control ( n =97) or an experimental ( n =90) group. The control group received no nutrition education while the experimental group received 45 minutes of nutrition education, 4 days a week for 3 weeks. Nutrition knowledge scores and 3-day food records were collected at the beginning of the study and after 3 weeks. Food records were used to evaluate healthy food choices ( i.e. Dietary Guideline's recommended intake for macronutrients and the recommendations of the Food Guide Pyramid for each food group). In the experimental group there was a significantly greater increase in nutrition knowledge score ( p =0.001) and significant change in compliance in meeting the Dietary Guidelines ( p =0.0001) and the Food Guide Pyramid's recommendations ( p =0.0001). This study showed the effectiveness of a nutrition education program on nutrition knowledge scores and healthy food choices of fifth grade children.     

Nutrition Knowledge and Food Choices of Elementary School Children

This research investigated the effect of a three-week school based nutrition education program on the nutrition knowledge and healthy food choices of 187 fifth graders who were randomly divided into a control ( n =97) or an experimental ( n =90) group. The control group received no nutrition education while the experimental group received 45 minutes of nutrition education, 4 days a week for 3 weeks. Nutrition knowledge scores and 3-day food records were collected at the beginning of the study and after 3 weeks. Food records were used to evaluate healthy food choices ( i.e. Dietary Guideline's recommended intake for macronutrients and the recommendations of the Food Guide Pyramid for each food group). In the experimental group there was a significantly greater increase in nutrition knowledge score ( p =0.001) and significant change in compliance in meeting the Dietary Guidelines ( p =0.0001) and the Food Guide Pyramid's recommendations ( p =0.0001). This study showed the effectiveness of a nutrition education program on nutrition knowledge scores and healthy food choices of fifth grade children.     

User satisfaction is influenced by the interval between a health care service and the assessment of the service

In order to improve the quality of patient care, questionnaires are often used to identify user’s experiences and evaluations, but only a few studies have examined whether measuring user satisfaction at different time points influences the assessment of health care. Several studies have shown equivalency between paper and electronic patient reported outcomes; however, none of these studies have considered the fact that electronic questionnaires are usually completed at the hospital, while paper questionnaires are typically completed at home weeks after the visit. In order to ensure that the comparison of results collected by the two different methods are not biased, the aim of this study was to determine if the interval between an outpatient visit and the assessment of the quality of care influences user satisfaction and to compare response rates between questionnaires completed at different times. In a follow-up study, parents from a paediatric outpatient clinic in Denmark were quasi-randomised to 1 of 3 groups: group 1 completed an electronic questionnaire on a touch screen computer in the outpatient clinic and a paper questionnaire 3–6 weeks after the visit; group 2 completed a paper questionnaire in the outpatient clinic and a paper questionnaire 3–6 weeks after the visit; and group 3 completed a paper questionnaire 3–6 weeks after the visit. A total of 1148 parents completed at least 1 questionnaire. User satisfaction was significantly lower when the assessment was made after a visit to the outpatient clinic compared to an assessment made at the clinic. The response rates of questionnaires completed at the clinic were significantly higher than the response rates of questionnaires completed after the visit. Both the timing of surveys and response rates need to be taken into consideration when planning user surveys. Outcomes from surveys conducted at different times are not readily comparable.     

Pregnant women's attitudes and knowledge in relation to access to serum-alpha-fetoprotein test

Serum-Alpha-Fetoprotein (se-AFP) screening is a controversial issue in Sweden. In some areas the test has never been offered, in others it is routinely offered to all pregnant women and there are areas where the se-AFP test has been offered but is no longer available but for very special indications. This pseudoexperimental situation was used to analyze the effects of different information environments on attitudes to and knowledge of testing procedures at the antenatal clinics, especially the se-AFP test, and anxiety of malformations. Consecutive series of pregnant women in these three areas filled in questionnaires at their first visit, in the 22nd to 24th, and the 32nd to 35th weeks of pregnancy, and after delivery. The attitudes to prenatal screening were most positive in the routine screening area and most negative in the area which previously but no longer offers the test. The level of knowledge was somewhat higher in the routine screening area at the first visit to the clinic and increased substantially, especially in the routine screening area.     

艾滋病行为干预模式在性病门诊中的应用研究

目的评估在性病门诊推广艾滋病性病干预模式在提高性病患者相关知识及安全套使用率方面的作用。方法由经过培训的接诊医生对所有入选的性病患者常规治疗的同时进行相关艾滋病性病知识的宣传教育和行为干预。采用问卷调查的方法,了解其干预前后艾滋病性病知识的知晓情况及安全套的使用情况。结果2003例性病患者参与了本项研究调查,调查发现艾滋病性病知识的知晓情况在不同的文化程度、年龄上有明显差异。对其中1000例性病患者开展宣传教育和行为干预工作,其艾滋病性病知识的知晓率显著提高,安全套的使用率从37.80%提高到63.00%,且在婚外性行为中的使用率高达89.34%。结论在性病门诊推广艾滋病性病干预模式显著提高了性病患者艾滋病性病知识的知晓率及安全套的使用率,对预防艾滋病性病有着重要的意义。     

经济欠发达地区农村产前保健项目中间结果评价

目的:对经济欠发达地区农村开展的产前保健项目的中间结果进行评价.方法:由县卫生局组织有关产前保健专家对乡镇卫生院产科医务人员进行业务培训;由县卫生局和乡镇领导协调卫生与计划生育部门开展农村社区产前保健的健康教育;由乡镇卫生院产科助产士负责开展产前检查.应用整群随机分组的设计及做干预前后测量的方法进行评价.评价的指标包括初次产前检查孕周、产前检查次数和产前检查率.结果:干预使孕妇初次产前检查的时间提前.干预提高了产前检查率.干预提高了高危妊娠妇女的产前检查次数.结论:卫生与计划生育部门合作开展产前保健是促进经济欠发过地区农村母婴保健工作可行与有效的途径.     

Tangible differences between adolescent-oriented and adult-oriented prenatal care.

Comprehensive prenatal care reduces many of the risks associated with adolescent childbearing. To learn why this intervention strategy is successful, we compared the care received by 123 poor, black, younger than 19-year-olds in an adolescent-oriented prenatal program to that received by 72 sociodemographically similar, black, 19-30-year-olds in a university hospital-based prenatal clinic. We found that adolescents entered care later (13.6 +/- 5.6 vs. 11.7 +/- 3.4 weeks; p less than 0.01) and were less likely to obtain an adequate quantity of care then were adults (45.5% vs. 61.1%; p = 0.04). However, teens were enrolled in the Women, Infant, and Children (WIC) food supplement program more rapidly than adults (within 7 +/- 6 vs. 10 +/- 6 weeks of the first prenatal visit; p = 0.002), were referred more often to community service agencies for help with nonobstetric, psychosocial, and financial problems (37.4% vs. 18.3%; p less than 0.0001), and were tested and treated more frequently for sexually transmitted diseases (p less than 0.0001). When the adolescents entered care they were smaller, had lower hematocrits, more social and behavioral problems, poorer diets, and more sexually transmitted diseases than did the adults. Later in gestation, however, hematocrits, diets, weight gain, and birth outcomes were similar in the two groups. The implications of these findings for health care providers and for further research are discussed.     

The effects of a prematurity prevention program on births to adolescents

This study evaluates the effectiveness of the North Carolina Prematurity Prevention Program in reducing lowbirthweight births among adolescents seeking prenatal care at the New Hanover Memorial Hospital obstetric clinic. Modeled on programs developed by Papiemik and Creasy, the program includes three components: staff education, patient identification, and patient education. Thirteen percent of the clinic population is 13–17 years old. The same prematurity prevention protocol is used for both adults and adolescents. Overall, 12% of the 847 women who delivered prior to the program had a lowbirthweight infant. Among the 748 women who delivered during the program, the number of low-birthweight infants declined to 9.5%. For mothers 13–17 years old, 14% of the preprogram group had a low-birthweight infant, as did 14% of those in the program. A logistic regression model, controlling for certain risk factors, suggests that the program was not effective in reducing lowbirthweight births among these adolescents (OR = 0.9; 95% CI = 0.2, 1.8).     

经济欠发达地区农村产前保健项目对产妇知信行的影响

为探索农村社区产前保健项目对产妇的孕产期健康与保健相关知识、态度和行为的影响 ,采取整群随机抽样的方法确定要调查的村 ,入户问卷调查干预组 41 1名、对照组 442名产妇。结果表明 ,干预组产妇掌握母婴健康保健知识较好、正确或恰当态度率较高、正确行为率较高。但两组产妇对首次产前检查孕周的正确回答率均在 50 %以下 ,对孕期无异常也要定期产前检查的正确态度率不理想 (干预组 61 %、对照组 45% )。说明产前保健项目在一定程度上改善了产妇的知信行 ,但改善的力度还不够大 ,项目有待进一步改进     

Nationwide satellite training for public health professionals: Web-based follow-up

INTRODUCTION: Few studies have rigorously evaluated the effectiveness of health-related continuing education using satellite distribution. This study assessed participants' professional characteristics and their changes in knowledge, attitudes, and actions taken after viewing a public health preparedness training course on mass vaccination broadcast nationally by satellite. METHODS: A three-part survey design was used to evaluate training effectiveness. Paper-based questionnaires were distributed at a stratified sample of downlink facilities to collect knowledge and attitude responses before and after the broadcast. Six weeks later, willing participants were invited by e-mail to complete a Web-based follow-up questionnaire to assess actions taken as a result of viewing the broadcast. Paired t-tests and McNemar's chi-square were used to compare changes in attitude from before to after the broadcast, after the broadcast to follow-up, and before the broadcast to follow-up. RESULTS: A total of 544 paper-based questionnaires were received from 59 of 70 sampled sites. The pre- and post assessments administered the day of the broadcast demonstrated statistically significant knowledge gain (p < .001) and an increased belief immediately following the broadcast that mass vaccination clinics are important to their organizations' public health activities (p < .001). Of the 291 respondents who completed the follow-up online questionnaire, 44% (n = 128) reported they implemented or planned some form of action after the broadcast. Reported actions were higher among public health workers most likely to be directly involved in preparedness and immunization activities. DISCUSSION: This evaluation assessed (1) participants' professional characteristics, (2) knowledge gain, (3) self-reported actions taken following the broadcast, (4) program satisfaction, and (5) suggested improvements for future satellite broadcast programs. The study's methodology of using a Web-based survey for follow-up is a relatively economical tool for assessing longer-term continuing education program objectives.     

Lack of knowledge in health professionals: a barrier to providing information to patients?

OBJECTIVE--To assess obstetricians' and midwives' knowledge of routine prenatal screening tests for fetal abnormality and factors associated with such knowledge. DESIGN--Questionnaire assessment of antenatal clinic staff. SETTING--Six hospitals within the United Kingdom (four district general hospitals in London, one district general hospital in Wales, and one teaching hospital in Wales), offering routine prenatal screening tests. SUBJECTS--29 obstetricians and 97 midwives were invited to participate, of whom 21 and 70 respectively responded to the questionnaire. MAIN MEASURES--Knowledge of prenatal tests, according to 19 item multiple choice questionnaire, reluctance to disclose uncertainty, and clinical experience. RESULTS--The overall response rate was 72% (91/126). In all, 43% of midwives and 14% of obstetricians obtained correct responses on fewer than half the items. Reluctance to disclose uncertainty to patients was associated in obstetricians with having less knowledge about prenatal testing (r = -0.50; p < 0.025, Pearson product moment correlation) and in midwives with more clinical experience (r = 0.43; p < 0.001). CONCLUSIONS--Lack of knowledge and greater clinical experience seem to be important barriers to providing patients with information about prenatal screening tests.     

Improving Rates of Early Entry Prenatal Care in an Underserved Population

Introduction Early prenatal care can improve pregnancy outcomes, reduce complications, and ensure a healthier pregnancy. Unfortunately, many pregnant women do not seek early care. This research provides a framework for improving prenatal care in a low income community-based obstetrics clinic. Methods A multi-disciplinary quality improvement initiative was implemented at a large federally qualified health clinic in Houston, Texas to improve the rate of early entry into prenatal care by identifying barriers through patient surveys, focus groups, stakeholder feedback, and improving processes to reduce these barriers. Results A significant increase in early prenatal care was achieved by redesigning operational and clinical processes to improve access to care, expand patient education and outreach, increase resources, extend hours of operation, and increase presumptive insurance eligibility. Three months post implementation, an increase of 44.5% (p?<?0.001) occurred in patients who had a prenatal visit in the first trimester. Patients with early prenatal care had better obstetrical and neonatal outcomes; however, the results were not statistically significant likely due to the small sample size. Discussion This quality improvement project provides various strategies and resources for other community-based clinics to consider when seeking improvement in their rates of early prenatal care.     

An office-based Internet patient education system: a pilot study

BACKGROUND: Patients' use of the Internet to find medical information is increasing, and physicians are exploring ways to incorporate the Internet into patient education programs and physician-patient encounters. We performed a pilot study of an Internet patient education system to obtain information on the usefulness of, feasibility of, and patient satisfaction with this type of information. METHODS: We developed a hypertext Web page directory to patient education sites on the Internet and made it available to patients in a community-based family practice residency clinic during their office visit. During a 1-month period, a medical student assisted patients with using the Internet, answered questions, interviewed patients, and collected data. Information was collected on sites visited, level of assistance required, amount of time spent "surfing" on-line versus intense reading on-line, quality of the experience, perceived usefulness of the educational materials, and patients' satisfaction with the materials. RESULTS: Fifty patients participated in the study. Forty-seven patients (94%) found the Internet information helpful. Most patients spent their time on-line intensely reading, and men spent significantly more time on-line (P = .007). Thirty-seven patients (77%) stated they would change a health behavior because of information they had read on the Internet; 45 (90%) were more satisfied with their visit than usual, and 46 (92%) would use the Internet center at the clinic again. CONCLUSIONS: Patients can obtain useful information from moderated Internet patient education systems and may plan to change health behaviors on the basis of that information. Internet patient information in the physician's office can improve patient satisfaction with clinic visits.     

Ethnicity,insurance type,and follow-up in a pediatric weight management program

OBJECTIVE: To assess the characteristics of children and adolescents who drop out of a clinical weight management program. RESEARCH METHODS AND PROCEDURES: A retrospective survey of children and adolescents attending a pediatric weight management program [n = 518; mean +/- SEM: age 10.4 +/- 0.2 years, BMI z-score 4.9 +/- 0.1, 62% female, 41% African American and 57% white] was undertaken. Characteristics of children (age, relative weight, gender, and ethnicity) who dropped out of the program were compared with characteristics of those who continued beyond the initial assessment as a function of type of insurance. RESULTS: The children who dropped out of the program after the initial assessment differed by ethnicity from those who continued in the program: 63% of white children returned for more than one visit, whereas only 35% of the African-American children continued in the program. Indemnity insurance coverage was associated with more clinic visits, as compared with managed care insurance. The association between insurance type and clinic visit number was of borderline significance (p = 0.06), when ethnic group was added to this analysis. DISCUSSION: Ethnicity is associated with attendance in a Pediatric Weight Management Program. Given the epidemic of obesity in children and adolescents, issues related to program compliance must be assessed to improve overall outcome. This is especially important given the high rate of obesity among African Americans and the low rate of ongoing attendance observed among African Americans in the Weight Management Program.     

Ego-Dystonic Pregnancy and Prenatal Consumption of Alcohol Among First-Time Mothers

This study examines predictors of drinking during pregnancy among first-time mothers, in order to distinguish those in need of targeted screening and intervention. Data from the prenatal panel of the Parenting for the First Time study were used in hierarchical linear regressions to determine likelihood of prenatal alcohol consumption among a sample of 645 women. African-American women and those of race/ethnicities other than White were less likely to drink, regardless of age or level of education. Among all women, being in school was associated with abstention (P = 0.05). Among teens, endorsing a perception of feeling "pushed around" was a significant indicator of prenatal alcohol consumption (P = 0.05), as was not having plans for infant feeding shortly before delivery (P = 0.05). Among adults with some level of college education, having a first prenatal visit after the fourth month of pregnancy was a significant predictor of drinking (P = 0.01). This study indicates that women who evidence behaviors or attitudes indicating an ego-dystonic pregnancy (one that is psychologically or emotionally uncomfortable), may be more likely to self-medicate and cope via avoidance through drinking. These behaviors and attitudes may be indicators of the need for targeted screening and intervention, as well as indicators of underlying problems to be targeted in treatment. Further, among all women for whom continued education is a possibility, retaining the ability to attend school during the pregnancy can be protective.     

南京市流动人口艾滋病健康教育效果评价

目的提高流动人口艾滋病相关知识水平,增强自我保护能力,减少感染性病艾滋病的风险,控制南京市流动人口性病艾滋病的蔓延。方法对南京市流动人口聚集地的流动人口开展一系列的艾滋病健康教育活动,干预前后分别作问卷调查,评估健康教育效果。结果除“接受未筛选的血液及血制品可传播艾滋病病毒”外,其余有关艾滋病传播途径及预防知识正确知晓率干预后较干预前有明显提高（P〈0.05）。对艾滋病的认识及态度在干预前后差异有统计学分析意义（P〈0.05）,特别是“愿意与艾滋病病毒感染者交往”的比例由干预前的43.2%（504/1168）上升到干预后的69.7%（798/1145）。求医行为以去公立医院看医生为主,干预前75.3%（879/1168）,干预后上升到93.3%（1068/1145）,差异有统计学意义。结论通过健康教育有效提高了居地流动人口艾滋病相关知识的正确知晓率,减少了对艾滋病的恐惧和歧视。