"User-testing" as a method for testing the fitness-for-purpose of written medicine information

Objective

Written medicine information is essential to support spoken information from pharmacists, but must be fit-for-purpose. This study applied “user testing” to the booklet supplied to UK patients taking anticoagulant medicines.

Methods

“User testing” uses mixed-methods, applied iteratively, to assess document performance - can people find and understand key points of information through a questionnaire and short semi-structured interview. The booklet was tested in 3 rounds of 10 people. After each round it was revised according to participants’ responses, and re-tested.

Results

The first round questionnaire identified problems with 6/18 information points (booklet purpose; other information; what affected daily doses; effect of ibuprofen; tablet colour; drinking alcohol); interviews raised further issues. The booklet was revised and, in the second testing round, one problem identified (changing doses of other medicines); the interviews raised fewer issues. After further re-wording and re-design, a third round showed all questions found and understood by at least 8/10 participants.

Conclusion

User testing assesses whether people can find and understand key information and can be applied using small numbers of participants. Application to medicine information can markedly improve performance.

Practice implications

Information producers should consider user testing to ensure documents are ‘fit for purpose’ in informing patients.     

A new computer-based counselling system for the promotion of physical activity in patients with chronic diseases—Results from a pilot study

Objective

To develop a computer-based counselling system (CBCS) for the improvement of attitudes towards physical activity in chronically ill patients and to pilot its efficacy and acceptance in primary care.

Methods

The system is tailored to patients’ disease and motivational stage. During a pilot study in five German general practices, patients answered questions before, directly and 6 weeks after using the CBCS. Outcome criteria were attitudes and self-efficacy. Qualitative interviews were performed to identify acceptance indicators.

Results

Seventy-nine patients participated (mean age: 64.5 years, 53% males; 38% without previous computer experience). Patients’ affective and cognitive attitudes changed significantly, self-efficacy showed only minor changes. Patients mentioned no difficulties in interacting with the CBCS. However, perception of the system's usefulness was inconsistent.

Conclusion

Computer-based counselling for physical activity related attitudes in patients with chronic diseases is feasible, but the circumstances of use with respect to the target group and its integration into the management process have to be clarified in future studies.

Practice implication

This study adds to the understanding of computer-based counselling in primary health care. Acceptance indicators identified in this study will be validated as part of a questionnaire on technology acceptability in a subsequent study.     

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.     

Author Index

Objective

To operationally define cancer literacy, understanding which aspects of cancer are important to be known by a layperson to be considered cancer literate.

Methods

A Delphi study in three consecutive rounds was conducted among a panel of Swiss cancer experts (oncologists, GPs, nurses from oncology wards, social workers, public health experts).

Results

The result of the Delphi process is a first operational definition of the concept of cancer literacy, a list of the aspects of cancer that, in the expert's view, laypeople should know to be considered cancer literate.

Conclusions

We have now an idea of what should be known about cancer. The study also provides us with some useful hints about what should be communicated about cancer, e.g. via public communication campaigns, school education, or media.

Practice implications

The operational definition of the concept can be used for the development and the validation of a measure of cancer literacy, not anymore limited to basic literacy and numeracy skills.     

Using the Extended Health Belief Model to understand siblings’ perceptions of risk for hereditary hemochromatosis

Objective

This research focuses on individuals’ reactions to news that a sibling has been diagnosed with hereditary hemochromatosis (HH). We used the Extended Health Belief Model (EHBM) to frame our analysis of siblings’ perceptions of risk for HH and decision of whether to obtain diagnostic testing.

Method

60 patient and 25 sibling interviews were transcribed and thematically analyzed for the six components of the EHBM.

Results

Patient and sibling reports of siblings’ perceptions were categorized into the six components of the EHBM: susceptibility, severity, benefits, barriers, cue to action, and self-efficacy.

Conclusion

In the case of HH, siblings’ perceptions of HH are varied and include a range of motivators and barriers that may impact family-based detection. Family-based detection can often play an important part of effective public health strategies to address inherited risk of disease. Further research should examine the EHBM with other genetic conditions.

Practice implications

This analysis using the EHBM suggests areas of importance for message development for both medical personnel and HH patients to promote diagnostic testing of at-risk siblings.     

The psychophysiology of medical communication. Linking two worlds of research

Objective

Medical communication is goal oriented behavior. As such, it can be modeled as a chain of decisions, resulting from cognitive and emotional processes each potentially associated with psychophysiological reactions. Psychophysiological may be helpful to detect small changes in affect or arousal in the course of a consultation that would be difficult to detect by other evaluations of the process, like self-reports.The question is how psychophysiological communication research should be modeled for unraveling in more detail the cognitive, emotional and interpersonal processes which underlie physician and patient behavior.

Methods

In the world of medical communication research the six-function model of medical communication reveals a number of fundamental perceptual, cognitive and emotional processes which may evoke psychophysiological responses. The world of psychophysiological research encompasses domains of perception, mental imagery, anticipation and action which all have close connections with fundamental tasks in communication.

Conclusion

This paper discusses ten methodological issues in linking continuous psychophysiological data to verbal and nonverbal events in a medical consultation observed with the Verona coding system.

Practice implications

When linking the two worlds of research, the methodological challenges discussed need to be solved to obtain a valid and reliable application of psychophysiological measures in medical communication research.     

Counselling in infertility: individual, couple and group interventions

Objective

Infertility is considered a biopsychosocial crisis and infertility counselling is recommended as an integral part of a multidisciplinary approach. This article will outline the theoretical background and describe common interventions used in infertility counselling for individuals, couples and in a group setting.

Methods

This article summarizes the proceedings of the first campus workshop of the Special interest group of Psychology and Counselling of the European Society for Human Reproduction and Embryology (ESHRE).

Results

Infertility counselling offers the opportunity to explore, discover and clarify ways of living more satisfyingly and resourcefully when fertility impairments have been diagnosed. The Heidelberg Fertility Consultation Service is presented as a framework for individual and couples counselling and highlights important issues in counselling patients. For group work a number of steps to set up a group within an infertility framework are discussed.

Conclusion

In recent years, infertility counselling has become a specialist form of counselling requiring professional expertise and qualification. Key issues and common interventions are presented to raise awareness for the specific counselling needs of individuals and couples experiencing infertility and undergoing medical treatment.

Practice implications

Mental health professionals new to the field of reproductive technologies as well as those in other areas of mental health counselling clients with fertility disorders can benefit from the topics addressed.     

Sensory feedback prosthesis reduces phantom limb pain: proof of a principle

Background

Constrained functionality and phantom limb pain (PLP) are major concerns for forearm amputees. Neuroscientific investigations of PLP suggest that behaviorally relevant stimulation of the stump can decrease PLP. Furthermore the prosthesis user could use feedback information of the prosthesis hand for optimizing prosthesis motor control when handling soft and fragile objects. Somatosensory feedback information from a prosthetic hand may therefore help to improve prosthesis functionality and reduce phantom limb pain.

Objectives

We wanted to find out whether a two weeks training on a hand prosthesis that provides somatosensory feedback may help to improve prosthesis functionality and reduce phantom limb pain.

Methods

Eight forearm amputees with phantom limb pain were trained for two weeks to use a hand prosthesis with somatosensory feedback on grip strength.

Results

The current study demonstrates a significant increase of functionality of the prosthesis in everyday tasks. Furthermore, the study shows that usage of a prosthesis that provides somatosensory feedback on the grip strength is effective to reduce phantom limb pain.

Conclusions

A prosthesis with a feedback function appears to be a promising therapeutic tool to reduce phantom limb pain and to increase functionality in everyday tasks. Future studies should further investigate the scope of application of that principle.     

Patients’ reaction to the disclosure of rare dreaded adverse events

Background

Physicians must frequently inform their patients of the risks of rare, but serious, adverse events (AEs).

Objective

To examine how patients react to the disclosure of rare AEs.

Methods

Outpatients viewed a video of a physician describing a medication associated with a rare AE. Subjects then rated their worry, perceived chance of developing the AE, and willingness to take the medication.

Results

Non-White men were more likely to perceive a greater chance of developing the AE compared to White men [Adjusted odds ratio (95% CI) = 3.37 (1.09-10.45)]; White women were more likely to be worried [2.00 (0.95-4.24)] and to perceive a greater chance of developing the [6.22 (2.50-15.50)], perceive a greater chance of developing the AE [6.27 (2.43-16.15)], and be less willing to take the medication [0.23 (0.09-0.59)], compared to White men.

Conclusions

Gender and ethnicity influence how patients react to disclosure of rare, but serious, AEs.

Practice implications

An improved understanding of patients’ risk perceptions is required to inform the development of best practices to improve risk communication.     

The medication experience: preliminary evidence of its value for patient education and counseling on chronic medications

Objective

To describe medication therapy management (MTM) pharmacists’ encounters with patients’ medication experiences, to examine the utility of the medication experience in practice, and to explore the value of the medication experience in patient education and counseling on medications.

Methods

A focus group of 10 MTM pharmacists, and 1 pharmacist's 9-month practice diary were analyzed to reveal patients’ medication experiences and the utility and value of the medication experience in practice.

Results

MTM pharmacists commonly encountered patients’ medication experiences in their practices. The medication experience was often at the root of drug therapy problems (DTPs) the practitioners identified. The pharmacists identified several examples of drug therapy problems with an associated medication experience at the root. The medication experience was a meaningful construct to guide patient education and counseling on new chronic medications to ultimately prevent DTPs, and valuable for tailoring patient education and counseling on medications to resolve DTPs.

Conclusion

Our study provides preliminary evidence of the value of the medication experience for patient education and counseling on chronic medications in practice.

Practice implications

The medication experience is a valuable tool for practitioners to understand patients’ needs, identify and resolve DTPs, and tailor patient education and counseling for chronic medications.     

“I need to lead my own life in any case”—A study of patients in dialysis with or without a partner

Objective

To elicit psychological and psychosocial problems existing in patients in dialysis and their partners, its being felt that the diversity involved has important implications for how service in dialysis units is delivered to patients and their partners.

Methods

The results of a series of interviews of 39 patients in dialysis and 21 partners of theirs, each interview individual, concerning their ways of thinking and their feelings and the behaviour, were analyzed in qualitative and content-oriented terms.

Results

Five basic themes could be identified: importance of treatment being individualized, dependency on an apparatus, consequences of the disease and its treatment, hopes for the future, and thoughts concerning life and death. Diversities relating to age, civil status, cultural and gender matters were disclosed.

Conclusion

The interview approach illustrated the importance of extended professional and individualized support in handling psychological and psychosocial disparities and needs in order to make treatment regimes more acceptable to the persons involved.

Practice implications

Suggestions are made concerning efforts to improve the care of patients receiving dialysis, and the importance of working with the patients and those closest to them in multidisciplinary teams.     

Understanding information and education gaps among people with type 1 diabetes: A qualitative investigation

Objective

Many patients with type 1 diabetes struggle to self-manage this chronic disease, often because they have a poor knowledge and understanding of the condition. However, little attention has been paid to examining the reasons for this poor knowledge/understanding. To inform future educational interventions, we explored patients’ accounts of the education and information they had received since diagnosis, and the reasons behind gaps in their diabetes knowledge.

Methods

Semi-structured interviews were conducted with 30 type 1 diabetes patients enrolled on a structured education programme in the UK. Data were analysed using an inductive, thematic approach.

Results

Patients’ accounts illustrated a number of knowledge deficits which were influenced by various lifecourse events. Reasons for deficits included: diagnosis at a young age and assumption of decision-making responsibility by parents; lack of engagement with information when feeling well; transitions in care; inconsistency in information provision; and, lack of awareness that knowledge was poor or incomplete.

Conclusion

Patients’ knowledge deficits can arise for different reasons, at different points in the lifecourse, and may change over time.

Practice implications

The delivery of individualised education should take account of the origins of patients’ knowledge gaps and be provided on a regular and on-going basis.     

Attitudes of physical therapy students toward patient-centered care, before and after a course in psychosocial aspects of care

Objective

Patient-centered care is vital in developing the therapeutic relationship. Attitude may be an important measure of student potential for giving patient-centered care. The purpose of this study was to assess attitudes toward patient-centered care in doctor of physical therapy students before and after completion of a course that addresses communication skills and psychosocial aspects of care.

Methods

In 2009, forty-nine students in the Doctor of Physical Therapy educational program at Duke University took a required course which included recommended elements for teaching patient-centered care. Students completed the Patient-Practitioner Orientation Scale (PPOS) and the Tasks of Medicine Scale (TOMS) twice prior to the course and once at course completion. Demographic data were gathered and students responded to open-ended questions at final survey administration.

Results

There were statistically significant differences in student attitudes toward patient-centered care after the educational experience on the PPOS and the TOMS, which were supported by students’ written responses.

Conclusion

Changes in attitudes toward patient-centered care are possible with educational intervention.

Practice implications

The results of this study may help to inform educators of medical professionals about the education of practitioners to develop patient-centered attitudes.     

Moving beyond the language barrier: The communication strategies used by international medical graduates in intercultural medical encounters

Objective

To understand the communication strategies international medical graduates use in medical interactions to overcome language and cultural barriers.

Methods

In-depth interviews were conducted with 12 international physicians completing their residency training in internal medicine in a large hospital in Midwestern Ohio. The interview explored (a) barriers participants encountered while communicating with their patients regarding language, affect, and culture, and (b) communication convergence strategies used to make the interaction meaningful.

Results

International physicians use multiple convergence strategies when interacting with their patients to account for the intercultural and intergroup differences, including repeating information, changing speaking styles, and using non-verbal communication.

Practice implications

Understanding barriers to communication faced by international physicians and recognizing accommodation strategies they employ in the interaction could help in training of future international doctors who come to the U.S. to practice medicine. Early intervention could reduce the time international physicians spend navigating through the system and trying to learn by experimenting with different strategies which will allow these physicians to devote more time to patient care. We recommend developing a training manual that is instructive of the socio-cultural practices of the region where international physician will start practicing medicine.     

Microbiological investigation of endoscopes at Brest Hospital over a period from 2007 to 2009

Objectives

The aim of this study is to evaluate the quality of disinfection of endoscopes at Brest hospital over a period from 2007 to 2009.

Patients and methods

Retrospective study of microbiological investigations of endoscopes done at Brest hospital from 2007 to 2009. The interpretation of the microbiological investigations is based on the recommendations of the Comité technique national des infections nosocomiales et infections liées aux soins (CTINILS) of 2007.

Results

Most of the controls realized over the period deal with gastroenterological endoscopes (63.4 %) and bronchial endoscopes (21.8 %). Most of the controls (66.8 %) are conformed to the target level. Only 26.7 % of the controls get the level of action. Globally, the rate of level of action significantly increases (p = 0.004) from 2007 (21.2 %) to 2009 (35.6 %). This increase is relatively important in gastroenterology endoscopy (46.8 % in 2009 versus 24.1 % in 2007) whereas the rate decreases in bronchial endoscopy (14.8 % in 2009 versus 25.9 % in 2007). In gastroenterological endoscopy, rates vary with the type of endoscopes and the context of controls, but there is no significant difference between manual disinfection and automated disinfection. The most frequent germ found in gastroenterological and bronchial endoscopies is Pseudomonas aeruginosa.

Conclusion

Our results show that it is very difficult to insure a perfect disinfection of endoscopes. Difficulties met are certainly related with the complexity of the endoscopes and of the techniques of disinfection. Infections of patients are very infrequent in endoscopy, which takes the question of the pertinence of the threshold used for microbiological investigations.     

Diabetes education in mainland China- a systematic review of the literature

Objective

In this review, we assess and summarize evidence and gaps in the literature regarding diabetes education in mainland China.

Methods

Using China/Chinese, diabetes and education as key words, articles were obtained from the National Science and Technology Library (NSTL), Chongqing Weipu and Qinghua Tongfang databases. Articles included in this review were further selected based on pre-determined criteria, including studying duration, outcome measurements, and inclusion of control groups.

Results

Based on the 34 articles, we found that studies often took place in inpatient and outpatient department. Popular methods used were class teaching, or one-on-one teaching, and knowledge and glycemic control were mostly selected as the outcome measurements. Beneficial effects of diabetes education on knowledge, and glycemic control were demonstrated in studies during a relatively short follow-up (3-6 months). Limitations to the studies selected were that the effects of interventions on behavior change, BMI, blood pressure, lipids, and medical costs were not clearly addressed, and long-term outcomes and adherence to diabetes education was unknown.

Conclusions

Diabetes education had positive impact on glycemic control in mainland China in short duration.

Practice implications

Future studies should use more creative ways of education, and the long-term impact of diabetes education should be evaluated.     

Non-adherence to medication and doctor-patient relationship: Evidence from a European survey

Objective

Studies on the determinants of non-adherence to medication have put emphasis in understanding the role of the doctor-patient relationship in individuals’ decision to follow recommendations. Yet, evidence on general perceptions that individuals hold about doctors and their impact on their decision to non-adhere is lacking. This paper aims to explore the issue using data from the European Social Survey (ESS).

Methods

The ESS was conducted in 2004/2005 and included 45,700 participants from 24 countries in Europe. A Heckman probit model with sample selection was used for the analysis.

Results

The results show that perceptions about doctors constitute the model that better explains non-adherence to prescribed medication.

Conclusion and practice implications

Our findings confirm that general beliefs individuals have about the doctor-patient relationship impact significantly on their decision to non-adhere to prescribed medication. Key points were shown to be involvement in the decision making process, treating patients as equals and avoiding leaving unresolved issues when prescribing.     

Factor structure and dimensionality of the two depression scales in STAR*D using level 1 datasets

Background

The factor structure and dimensionality of the HAM-D₁₇ and the IDS-C₃₀ are as yet uncertain, because psychometric analyses of these scales have been performed without a clear separation between factor structure profile and dimensionality (total scores being a sufficient statistic).

Methods

The first treatment step (Level 1) in the STAR*D study provided a dataset of 4041 outpatients with DSM-IV nonpsychotic major depression. The HAM-D₁₇ and IDS-C₃₀ were evaluated by principal component analysis (PCA) without rotation. Mokken analysis tested the unidimensionality of the IDS-C₆, which corresponds to the unidimensional HAM-D_6.

Results

For both the HAM-D₁₇ and IDS-C₃₀, PCA identified a bi-directional factor contrasting the depressive symptoms versus the neurovegetative symptoms. The HAM-D₆ and the corresponding IDS-C₆ symptoms all emerged in the depression factor. Both the HAM-D₆ and IDS-C₆ were found to be unidimensional scales, i.e., their total scores are each a sufficient statistic for the measurement of depressive states.

Limitations

STAR*D used only one medication in Level 1.

Conclusions

The unidimensional HAM-D₆ and IDS-C₆ should be used when evaluating the pure clinical effect of antidepressive treatment, whereas the multidimensional HAM-D₁₇ and IDS-C₃₀ should be considered when selecting antidepressant treatment.