Web-based tailored nutrition education: results of a randomized controlled trial.

There is ample evidence that printed, computer-tailored nutrition education is a more effective tool for motivating people to change to healthier diets than general nutrition education. New technology is now providing more advanced ways of delivering tailored messages, e.g. via the World Wide Web (WWW). Before disseminating a tailored intervention via the web, it is important to investigate the potential of web-based tailored nutrition education. The present study investigated the immediate impact of web-based computer-tailored nutrition education on personal awareness and intentions related to intake of fat, fruit and vegetables. A randomized controlled trial, with a pre-test-post-test control group design was conducted. Significant differences in awareness and intention to change were found between the intervention and control group at post-test. The tailored intervention was appreciated better, was rated as more personally relevant, and had more subjective impact on opinion and intentions to change than the general nutrition information. Computer literacy had no effect on these ratings. The results indicate that interactive, web-based computer-tailored nutrition education can lead to changes in determinants of behavior. Future research should be aimed at longer-term (behavioral) effects and the practicability of distributing tailored interventions via the WWW.     

Health education for microcredit clients in Peru: a randomized controlled trial

Background  

Poverty, lack of female empowerment, and lack of education are major risk factors for childhood illness worldwide. Microcredit programs, by offering small loans to poor individuals, attempt to address the first two of these risk factors, poverty and gender disparity. They provide clients, usually women, with a means to invest in their businesses and support their families. This study investigates the health effects of also addressing the remaining risk factor, lack of knowledge about important health issues, through randomization of members of a microcredit organization to receive a health education module based on the World Health Organization's Integrated Management of Childhood Illness (IMCI) community intervention.     

Nutrition education intervention for dependent patients: protocol of a randomized controlled trial

ABSTRACT: BACKGROUND: Malnutrition in dependent patients has a high prevalence and can influence the prognosis associated with diverse pathologic processes, decrease quality of life, and increase morbidity-mortality and hospital admissions. The aim of the study is to assess the effect of an educational intervention for caregivers on the nutritional status of dependent patients at risk of malnutrition. METHODS: Intervention study with control group, randomly allocated, of 200 patients of the Home Care Program carried out in 8 Primary Care Centers (Spain). These patients are dependent and at risk of malnutrition, older than 65, and have caregivers. The socioeconomic and educational characteristics of the patient and the caregiver are recorded. On a schedule of 0-6-12 months, patients are evaluated as follows: Mini Nutritional Assessment (MNA), food intake, dentures, degree of dependency (Barthel test), cognitive state (Pfeiffer test), mood status (Yesavage test), and anthropometric and serum parameters of nutritional status: albumin, prealbumin, transferrin, haemoglobin, lymphocyte count, iron, and ferritin. Prior to the intervention, the educational procedure and the design of educational material are standardized among nurses. The nurses conduct an initial session for caregivers and then monitor the education impact at home every month (4 visits) up to 6 months. The North American Nursing Diagnosis Association (NANDA) methodology will be used. The investigators will study the effect of the intervention with caregivers on the patient's nutritional status using the MNA test, diet, anthropometry, and biochemical parameters. Bivariate normal test statistics and multivariate models will be created to adjust the effect of the intervention. The SPSS/PC program will be used for statistical analysis. DISCUSSION: The nutritional status of dependent patients has been little studied. This study allows us to know nutritional risk from different points of view: diet, anthropometry and biochemistry in dependent patients at nutritional risk and to assess the effect of a nutritional education intervention. The design with random allocation, inclusion of all patients, validated methods, caregivers' education and standardization between nurses allows us to obtain valuable information about nutritional status and prevention. Trial Registration number: Clinical Trial Registration-URL: www.clinicaltrials.gov. Unique identifier: NCT01360775.     

Medical self-care education for elders: a controlled trial to evaluate impact.

We conducted a trial to evaluate the impact of medical self-care education on 330 elders whose average age was 71. The test group participated in a 13-session educational intervention with training in clinical medicine, life-style, and use of health services. The comparison group received a two-hour lecture-demonstration. Both groups were assessed pre-intervention, post-intervention, and one year after entry. The results indicate medical self-care instruction: produces substantial improvements, that were sustained for one year, in health knowledge, skills performance, and skills confidence; stimulates many attempts to improve life-style; and generates improvements in life quality. The program had little influence on utilization of medical care or health status.     

The impact of an intervention to change health workers' HIV/AIDS attitudes and knowledge in Nigeria: a controlled trial

The aim of the study was to improve health workers' skills and confidence in dealing with patients with HIV disease and increase attention to patients' human rights. A longitudinal controlled trial was carried out in which one Nigerian state served as the intervention site and the adjacent state served as the control site for an intervention and dissemination of training in clinical management, health education, and attitudinal change toward patients with HIV disease. The intervention group n=1072, control group n=480.Following initial questionnaire-defining focus groups, nurses, laboratory technologists and physicians in all base hospitals in the intervention state were trained by influential role models who attended the initial training. Data were collected in all sites pre-training and 1 y later. Hierarchical multiple regression analysis controlling for baseline data, and orthogonal factor analysis to define scales were used. Data showed significant positive changes after 1 y in the intervention group on perception of population risk assessment, attitudes and beliefs about people with HIV disease, less fear and more sympathy for and responsibility toward HIV patients, and an increase in self-perceived clinical skills. There was increased willingness to treat and teach colleagues about people with HIV. Clinician fear and discrimination were significantly reduced, and the climate of fear that was associated with HIV was replaced with a professional concern. There was increased understanding of appropriate psychosocial, clinical and human rights issues associated with HIV treatment and prevention. This intervention, targeting health workers in an entire state and using HIV/AIDS information, role modeling, diffusion of training and discussions of discrimination and human rights, significantly affected the perception of risk groups and behaviors, perceived skills in treatment and counseling, reduced fears and increased concern for people with HIV disease, and improved the climate of treatment and prevention of HIV disease compared with a control state.     

Effect of stepwise perinatal immunization education: A cluster-randomized controlled trial

BackgroundPerinatal immunization education is important for improving the immunization outcomes of infants; however, the content of educational materials used at each perinatal period has not been carefully evaluated. We hypothesized that stepwise education offered at different perinatal periods would improve infant immunization status and enhance maternal immunization knowledge.MethodsIn this cluster-randomized controlled trial, pregnant women were recruited from nine obstetric sites in Niigata, Japan. The intervention group received a stepwise, interactive education intervention (prenatally, postnatally, and 1 month after birth). The control group received a leaflet containing general information on immunization. Infant immunization status was evaluated at 6 months of age, and maternal immunization knowledge was evaluated by a written survey after each intervention.ResultsAmong 188 study participants, 151 (80.3%) replied to the final post-intervention survey. At 6 months of age, the percentage of children who completed three doses of inactivated polio, diphtheria, tetanus toxoid, and acellular pertussis (DTaP-IPV) vaccine was higher in the intervention group than in the control (p = 0.04); however, no differences between groups were observed for the Haemophilus influenzae type b (Hib) (p = 0.67) or 13-valent pneumococcal conjugate (PCV13) vaccines (p = 0.20). The duration to the completion of the third dose of the DTaP-IPV, Hib, and PCV13 vaccines was shorter in the intervention group than in the control (p = 0.03, p < 0.01, and p < 0.01, respectively). Furthermore, maternal knowledge scores exhibited significantly greater improvement in the intervention group over time compared with those of the control group (p = 0.02).ConclusionsStepwise perinatal immunization education improved immunization schedule adherence for required vaccines and improved maternal immunization knowledge.     

Multidisciplinary patient education in groups increases knowledge on osteoporosis: a randomized controlled trial

INTRODUCTION: Specific pharmacological treatment reduces the incidence of fractures significantly in patients with osteoporosis. Unfortunately, compliance with such therapy is low in clinical practice and is inversely related to educational level. We hypothesized that patients' knowledge of osteoporosis may be increased by a group-based multidisciplinary education programme. METHODS: Three hundred patients, aged 45-81 years, recently diagnosed with osteoporosis and started on specific treatment, were randomized to either the "school' or "control' group. Teaching was performed by nurses, physiotherapists, dieticians, and doctors, and designed to increase the patient's empowerment. The patient's knowledge of osteoporosis was tested at study entry and at 3 months using a validated questionnaire. RESULTS: At study entry, no differences in age or score (22 (18-24) (median (25-75 percentiles)) vs. 22 (18-24)) were seen between the school and control groups. The change in knowledge during the study, however, differed significantly between the two groups (p<0.001). In the school group, the increase in knowledge score correlated inversely with the level of education; that is, the lower the education level, the higher the gain in knowledge during the course (Rho=-0.25, p<0.01). CONCLUSIONS: A group-based multidisciplinary education programme significantly increases patients' knowledge of the disease.     

Multimedia versus written information for nocturnal enuresis education: a cluster randomized controlled trial

OBJECTIVE: This study evaluated the impact of child-focused information provision using a multimedia software package 'All About Nocturnal Enuresis' and written leaflets containing the same information for bedwetting children. DESIGN: A stratified cluster randomized controlled trial with data on 270 children collected longitudinally. SETTING: Fifteen school nurse-led community enuresis clinics in Leicestershire, UK. MAIN OUTCOME MEASURES: The outcome measures were becoming and remaining dry and time to dry, non-attendance and dropout rates. The psychological measures completed by children were the impact of bedwetting and Coopersmith self-esteem scales. Parents completed the maternal tolerance scale. RESULTS: No significant intervention effect was found for any of the outcome measures recorded during treatment, at discharge or six-months post discharge. CONCLUSIONS: Multimedia educational programs and written leaflets are widely used to enable children to learn more about their health-related conditions. However, our result suggests that multimedia is no more effective than traditional materials at effecting health-related behavioural change.     

Immunization education for internal medicine residents: A cluster-randomized controlled trial

PurposeThe aims of this study are to evaluate the impact of a novel immunization curriculum based on the Preferred Cognitive Styles and Decision Making Model (PCSDM) on internal medicine (IM) resident continuity clinic patient panel immunization rates, as well as resident immunization knowledge, attitudes, and practices (KAP).MethodsA cluster-randomized controlled trial was performed among 143 IM residents at Mayo Clinic to evaluate the PCSDM curriculum plus fact-based immunization curriculum (intervention) compared to fact-based immunization curriculum alone (control) on the outcomes of resident continuity clinic patient panel immunization rates for influenza, pneumococcal, tetanus, pertussis, and zoster vaccines. Pre-study and post-study immunization KAP surveys were administered to IM residents.ResultsNinety-nine residents participated in the study. Eighty-two residents completed pre-study and post-study surveys. Influenza and pertussis immunization rates improved for both intervention and control groups. There was no significant difference in immunization rate improvement between the groups. Influenza immunization rates improved significantly by 33.4% and 32.3% in the intervention and control groups, respectively. The odds of receiving influenza immunization at the end of the study relative to pre-study for the entire study cohort was 4.6 (p < 0.0001). The odds of having received pertussis immunization at the end of the study relative to pre-study for the entire study cohort was 1.2 (p = 0.0002). Both groups had significant improvements in immunization knowledge. The intervention group had significant improvements in multiple domains that assessed confidence in counseling patients on immunizations.ConclusionsFact-based immunization education was useful in improving IM resident immunization rates for influenza and pertussis. The PCSDM immunization curriculum did not lead to increases in immunization rates compared with the fact-based curriculum, but it did significantly increase resident confidence in communicating with patients about vaccines.     

HIV/AIDS education in further education: a survey

This paper summarizes a report prepared for the Health Education Authority on the nature and extent of HIV/AIDS education in further education (FE) for the 16-19 age range. The results are based on a questionnaire survey of all the FE and tertiary colleges in England which was carried out by the authors in 1990. The main conclusion is that, although most colleges claim to be making some provision for HIV/AIDS education, such provision varies considerably, tends to be voluntary and, moreover, reaches very few students. Some factors do seem to enhance HIV/AIDS education, such as the appointment of a coordinator and the provision of in-service training, but many FE staff seem to question whether it is their role to provide education of such a non-specialist nature.     

The effect of an early education program on adult health: the Carolina Abecedarian Project randomized controlled trial

Objectives. We explored whether a successful randomized controlled trial of early education, the Carolina Abecedarian Project (ABC), which enrolled infants from 1972 to 1977 at the Frank Porter Graham Child Development Institute in Chapel Hill, North Carolina, improved health outcomes and behaviors by 21 years of age.Methods. ABC randomized 111 infants to receive an intensive early education program or nutritional supplements and parental counseling alone; participants have been followed to the present day. We examined the effect of ABC on health outcomes and behavioral risk factors when participants were aged 21 years, and then explored the mediators of this relationship.Results. Relative to the control group, the ABC treatment group was previously found to have improved cognition and educational attainment. We found that the intervention also improved heath (P = .05) and health behaviors (P = .03) when participants were aged 21 years. These improvements in behaviors were not mediated by IQ, math and reading scores at 15 years of age, educational attainment, or health insurance.Conclusions. Effective early education programs may improve health and reduce risky health behaviors in adulthood.Enhancements to schooling have the potential to improve a wide range of socioeconomic outcomes, including cognitive development, educational attainment, and occupational status, which may, in turn, increase health and longevity.^1–8 The considerable disadvantages faced by children from low-income families can be mitigated by high-quality early education programs that provide cognitive enrichment.^9–14 Such programs may therefore serve as an effective and efficient way to simultaneously improve population health and reduce health disparities.¹⁵The adult health benefits of early childhood education have only been studied in a randomized controlled trial once before.¹⁶ That study, the Perry Preschool Program (PPP), found that a moderately intensive parental and prekindergarten program reduced risky health behaviors in former participants (relative to the control group) by 40 years of age.The Carolina Abecedarian Project (ABC), a small, intensive program designed to enhance cognition and language development starting in infancy, afforded another opportunity to explore this relationship through young adulthood, with randomized data.¹⁷ ABC produced large improvements among treated children (relative to control participants) in IQ by 3 years of age, higher reading and math achievement by 15 years of age, lower rates of teen pregnancy and depression, and greater likelihood of college enrollment at 21 years of age.^18,19 We investigated whether ABC also improved adult behavioral risk factors and health.     

Spaced education improves the retention of clinical knowledge by medical students: a randomised controlled trial

Purpose Medical knowledge learned by trainees is often quickly forgotten. How can the educational process be tailored to shift learning into longer‐term memory? We investigated whether ‘spaced education’, consisting of weekly e‐mailed case scenarios and clinical questions, could improve the retention of students' learning. Methods During the 2004–5 surgery clerkships, 3rd‐year students completed a mandatory 1‐week clinical rotation in urology and validated web‐based teaching programme on 4 core urology topics. Spaced educational e‐mails were constructed on all 4 topics based on a validated urology curriculum. Each consisted of a short clinically relevant question or clinical case scenario in multiple‐choice question format, followed by the answer, teaching point summary and explanations of the answers. Students were randomised to receive weekly e‐mailed case scenarios in only 2 of the 4 urology topics upon completion of their urology rotation. Students completed a validated 28‐item test (Cronbach's α = 0.76) on all 4 topics prior to and after the rotation and at the end of the academic year. Results A total of 95 of 133 students (71%) completed the end‐of‐year test. There were no significant differences in baseline characteristics between randomised cohorts. Spaced education significantly improved composite end‐of‐year test scores (P < 0.001, paired t‐test). The impact of the spaced educational e‐mails was largest for those students who completed their urology education 6–8 and 9–11 months previously (Cohen's effect sizes of 1.01 and 0.73, respectively). Conclusion Spaced education consisting of clinical scenarios and questions distributed weekly via e‐mail can significantly improve students' retention of medical knowledge.     

Effectiveness of a theory-based postpartum sexual health education program on women's contraceptive use: a randomized controlled trial

Background

The aim of this study was to evaluate the effectiveness of a refined theory-based Interactive Postpartum Sexual Health Education Program to enhance postpartum women's effective contraceptive behavior.

Study Design

Participants (N=250) were randomized to three groups. Experimental Group A received our intervention program via strategies that matched participants' learning preparedness, as determined by the transtheoretical model. Experimental Group B received only a pamphlet. The control group received routine education. Only Group A received health education. Data were collected at baseline, 3 days, 2 months and 3 months postpartum.

Results

Women who received theory-based postpartum sexual health education program had significantly greater contraceptive self-efficacy and were more likely to choose more effective contraceptive methods at 2 months postpartum than women in the routine teaching and interactive pamphlet-only groups.

Conclusion

Our theory-based Interactive Postpartum Sexual Health Education Program enhanced postpartum women's contraceptive self-efficacy and effective contraceptive behavior.     

Response to rubella immunisation education in health authority family planning clinics: a controlled clinical trial

The response of women attending family planning clinics run by the Area Health Authority providing health education on protection against rubella (cases), was compared with those attending clinics with no specific educational provision (controls). The effectiveness of the intervention was determined by studying the number of women approaching their General Practitioner in the ensuing four months for serological testing to determine their immune-status. Of 174 cases and 170 controls registered with a General Practitioner, follow-up information was obtained on 164 (94%) cases and 155 (91%) controls. General Practitioners' records revealed pre-existing knowledge of serologically confirmed immunity or previous rubella immunisation in only 35 (21%) cases and 29 (19%) controls. In response to health education, 12 (7%) cases approached their GP on the subject compared with 3 (2%) controls - a small but significant difference (P less than 0.05) which was confined to women aged 25-29 years. This suggests that such a programme would fail to make a significant contribution to the prevention of congenital rubella.     

青少年预防艾滋病健康教育的教学方法探讨

随着经济的发展生活方式的改变,青少年性发育的提前是全球性趋势,加之社会开放程度不断提高,青少年性心理性观念也发生明显变化,青少年正处在艾滋病快速流行的社会背景当中,容易受不良因素的影响而成为艾滋病的受害者。青少年是国家的未来,开展符合青少年特点的艾滋病健康教     

A controlled trial of health education in the physician's office

Screening of 6,144 patients in a general practice clinic to assist physician case-finding uncovered 983 (16%) who were uncontrolled hypertensives. Following physician recommendation, 115 patients volunteered for a controlled trial to test the effectiveness of supplementary strategies to the pharmaceutical management of high blood pressure. A study of nonparticipants indicated that about 7% of the practice population was eligible for cardiovascular health education. One group received a health education program, a second was allocated to self-monitor their blood pressure for 6 months, a third group was allocated to both strategies, and the final group, acting as a control, continued to receive their usual care. Physician monitoring of patients continued for the duration of the study and blood pressures decreased in all patients. The study's most important outcome was the joint reduction of blood pressure and medication strength. These were assessed by a "blind" clinician before and after the interventions according to criteria set out in the "stepped-care" approach to management of high blood pressure. People allocated to a health education program conducted in the doctor's common room did twice as well on this measure as those who were not so educated. Daily self-monitoring of blood pressure for 6 months proved to be too much for the majority of those so instructed. It is concluded that the general practice setting remains an important place for health education to prevent cardiac disease and suggestions are made for incorporating this into everyday practice.