51
|
Ballonoff Suleiman A, Lin JS, Constantine NA. Readability of Educational Materials to Support Parent Sexual Communication With Their Children and Adolescents. JOURNAL OF HEALTH COMMUNICATION 2016; 21:534-543. [PMID: 27116292 DOI: 10.1080/10810730.2015.1103334] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Sexual communication is a principal means of transmitting sexual values, expectations, and knowledge from parents to their children and adolescents. Many parents seek information and guidance to support talking with their children about sex and sexuality. Parent education materials can deliver this guidance but must use appropriate readability levels to facilitate comprehension and motivation. This study appraised the readability of educational materials to support parent sexual communication with their children. Fifty brochures, pamphlets, and booklets were analyzed using the Flesch-Kincaid, Gunning Fog, and Simple Measure of Gobbledygook (SMOG) index methods. Mean readability grade-level scores were 8.3 (range = 4.5-12.8), 9.7 (range = 5.5-14.9), and 10.1 (range = 6.7-13.9), respectively. Informed by National Institutes of Health-recommended 6th to 7th grade levels and American Medical Association-recommended 5th to 6th grade levels, percentages falling at or below the 7.0 grade level were calculated as 38%, 12%, and 2% and those falling at or below the 6.0 grade level were calculated as 12%, 2%, and 0% based on the Flesch-Kincaid, Gunning Fog, and SMOG methods, respectively. These analyses indicate that the majority of educational materials available online to support parents' communication with their children about sex and sexuality do not meet the needs of many or most parents. Efforts to improve the accessibility of these materials are warranted.
Collapse
Affiliation(s)
- Ahna Ballonoff Suleiman
- a School of Public Health , University of California, Berkeley , Berkeley , California , USA
| | - Jessica S Lin
- b Center for Research on Adolescent Health and Development , Public Health Institute , Oakland , California , USA
| | - Norman A Constantine
- a School of Public Health , University of California, Berkeley , Berkeley , California , USA
- b Center for Research on Adolescent Health and Development , Public Health Institute , Oakland , California , USA
| |
Collapse
|
52
|
Yin HS, Gupta RS, Tomopoulos S, Mendelsohn AL, Egan M, van Schaick L, Wolf MS, Sanchez DC, Warren C, Encalada K, Dreyer BP. A Low-Literacy Asthma Action Plan to Improve Provider Asthma Counseling: A Randomized Study. Pediatrics 2016; 137:peds.2015-0468. [PMID: 26634774 DOI: 10.1542/peds.2015-0468] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The use of written asthma action plans (WAAPs) has been associated with reduced asthma-related morbidity, but there are concerns about their complexity. We developed a health literacy-informed, pictogram- and photograph-based WAAP and examined whether providers who used it, with no training, would have better asthma counseling quality compared with those who used a standard plan. METHODS Physicians at 2 academic centers randomized to use a low-literacy or standard action plan (American Academy of Allergy, Asthma and Immunology) to counsel the hypothetical parent of child with moderate persistent asthma (regimen: Flovent 110 μg 2 puffs twice daily, Singulair 5 mg daily, Albuterol 2 puffs every 4 hours as needed). Two blinded raters independently reviewed counseling transcriptions. PRIMARY OUTCOME MEASURES medication instructions presented with times of day (eg, morning and night vs number of times per day) and inhaler color; spacer use recommended; need for everyday medications, even when sick, addressed; and explicit symptoms used. RESULTS 119 providers were randomly assigned (61 low literacy, 58 standard). Providers who used the low-literacy plan were more likely to use times of day (eg, Flovent morning and night, 96.7% vs 51.7%, P < .001; odds ratio [OR] = 27.5; 95% confidence interval [CI], 6.1-123.4), recommend spacer use (eg, Albuterol, 83.6% vs 43.1%, P < .001; OR = 6.7; 95% CI, 2.9-15.8), address need for daily medications when sick (93.4% vs 34.5%, P < .001; OR = 27.1; 95% CI, 8.6-85.4), use explicit symptoms (eg, "ribs show when breathing," 54.1% vs 3.4%, P < .001; OR = 33.0; 95% CI, 7.4-147.5). Few mentioned inhaler color. Mean (SD) counseling time was similar (3.9 [2.5] vs 3.8 [2.6] minutes, P = .8). CONCLUSIONS Use of a low-literacy WAAP improves the quality of asthma counseling by helping providers target key issues by using recommended clear communication principles.
Collapse
Affiliation(s)
- H Shonna Yin
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York;
| | - Ruchi S Gupta
- Center for Community Health, and Smith Child Health Research Program, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and
| | - Suzy Tomopoulos
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
| | - Alan L Mendelsohn
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York
| | - Maureen Egan
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Linda van Schaick
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
| | - Michael S Wolf
- Health Literacy and Learning Program, Center for Communication in Healthcare, Division of General Internal Medicine, and Institute for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dayana C Sanchez
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
| | | | - Karen Encalada
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
| | - Benard P Dreyer
- Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
| |
Collapse
|
53
|
Eguienta S, Fayon M. [Prescription of asthma action plans in the Aquitaine region of France]. Rev Mal Respir 2015; 33:365-76. [PMID: 26545450 DOI: 10.1016/j.rmr.2015.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 10/08/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Although guidelines recommend the prescription of written asthma action plans (WAAP), their use remains limited. METHODS A prospective survey was performed from 2013 to 2014. We interviewed respiratory physicians, paediatric respiratory physicians and allergologists taking care of asthmatic patients and practicing in the Aquitaine region of France, using computerized questionnaires, regarding their everyday practice in the use of WAAP. RESULTS A total of 59/143 (41%) clinicians, with a mean age of 47 years, participated in the study. A total of 41/59 (69.5%) were using a WAAP (12 different models with very inhomogeneous contents, mostly targeting symptoms only). WAAP prescribers were younger than non-prescribers, were more often female, working mostly in the Gironde area, with mixed hospital and private-based activity, and were paediatric-respiratory physicians or respiratory physicians. The severity of asthma had little influence on WAAP prescriptions. CONCLUSION In the Aquitaine region, prescription of WAAPs remains inadequate and shows large disparities. WAAP users are mostly younger female specialists.
Collapse
Affiliation(s)
- S Eguienta
- Service de pneumologie pédiatrique, hôpital des Enfants, CHU de Bordeaux, 33000 Bordeaux, France; Centre d'investigation clinique (CIC 0005), hôpital des Enfants, CHU de Bordeaux, 33000 Bordeaux, France; Unité d'allergologie, service de médecine interne, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - M Fayon
- Service de pneumologie pédiatrique, hôpital des Enfants, CHU de Bordeaux, 33000 Bordeaux, France; Centre d'investigation clinique (CIC 0005), hôpital des Enfants, CHU de Bordeaux, 33000 Bordeaux, France
| |
Collapse
|
54
|
Wu DTY, Hanauer DA, Mei Q, Clark PM, An LC, Proulx J, Zeng QT, Vydiswaran VGV, Collins-Thompson K, Zheng K. Assessing the readability of ClinicalTrials.gov. J Am Med Inform Assoc 2015; 23:269-75. [PMID: 26269536 DOI: 10.1093/jamia/ocv062] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 05/04/2015] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE ClinicalTrials.gov serves critical functions of disseminating trial information to the public and helping the trials recruit participants. This study assessed the readability of trial descriptions at ClinicalTrials.gov using multiple quantitative measures. MATERIALS AND METHODS The analysis included all 165,988 trials registered at ClinicalTrials.gov as of April 30, 2014. To obtain benchmarks, the authors also analyzed 2 other medical corpora: (1) all 955 Health Topics articles from MedlinePlus and (2) a random sample of 100,000 clinician notes retrieved from an electronic health records system intended for conveying internal communication among medical professionals. The authors characterized each of the corpora using 4 surface metrics, and then applied 5 different scoring algorithms to assess their readability. The authors hypothesized that clinician notes would be most difficult to read, followed by trial descriptions and MedlinePlus Health Topics articles. RESULTS Trial descriptions have the longest average sentence length (26.1 words) across all corpora; 65% of their words used are not covered by a basic medical English dictionary. In comparison, average sentence length of MedlinePlus Health Topics articles is 61% shorter, vocabulary size is 95% smaller, and dictionary coverage is 46% higher. All 5 scoring algorithms consistently rated CliniclTrials.gov trial descriptions the most difficult corpus to read, even harder than clinician notes. On average, it requires 18 years of education to properly understand these trial descriptions according to the results generated by the readability assessment algorithms. DISCUSSION AND CONCLUSION Trial descriptions at CliniclTrials.gov are extremely difficult to read. Significant work is warranted to improve their readability in order to achieve CliniclTrials.gov's goal of facilitating information dissemination and subject recruitment.
Collapse
Affiliation(s)
- Danny T Y Wu
- School of Information, University of Michigan, Ann Arbor, MI, USA
| | - David A Hanauer
- School of Information, University of Michigan, Ann Arbor, MI, USA Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Qiaozhu Mei
- School of Information, University of Michigan, Ann Arbor, MI, USA Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI, USA
| | - Patricia M Clark
- School of Nursing, University of Michigan, Ann Arbor, MI, USA Center for Health Communication Research, University of Michigan, Ann Arbor, MI, USA
| | - Lawrence C An
- Center for Health Communication Research, University of Michigan, Ann Arbor, MI, USA Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Joshua Proulx
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Qing T Zeng
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | | | - Kevyn Collins-Thompson
- School of Information, University of Michigan, Ann Arbor, MI, USA Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI, USA
| | - Kai Zheng
- School of Information, University of Michigan, Ann Arbor, MI, USA School of Public Health Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
55
|
Federman AD, Martynenko M, O'Conor R, Kannry J, Karp A, Lurio J, Hoy-Rosas J, Lopez R, Obiapi R, Young E, Wolf MS, Wisnivesky JP. Rationale and design of a comparative effectiveness trial of home- and clinic-based self-management support coaching for older adults with asthma. Contemp Clin Trials 2015; 44:103-111. [PMID: 26238181 DOI: 10.1016/j.cct.2015.07.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/23/2015] [Accepted: 07/25/2015] [Indexed: 01/01/2023]
Abstract
Older adults with asthma face numerous barriers to effective self-management and asthma control, and experience worse outcomes than younger asthmatics. Yet, there have been no controlled trials of interventions specifically designed to improve their care and outcomes. Through a multi-stakeholder collaboration (patients, academia, community-based organizations, a state department of health, and an advocacy organization) we developed a multi-component asthma self-management support intervention to address the myriad psychosocial, functional, health status, and cognitive barriers to effective asthma self-management in adults ages 60 and older. We are recruiting 425 New Yorkers in Manhattan and the Bronx for a pragmatic randomized controlled trial with 3 arms: the intervention delivered in primary care settings or in their home, or usual care. In the intervention, care coaches use a novel screening tool to identify the specific barriers to asthma control and self-management they experience. Once identified, the coach and patient choose from a menu of actions to address it. The intervention emphasizes efficiency, flexibility, shared decision making and goal setting, communication strategies appropriate for individuals with limited cognition and literacy skills, and ongoing reinforcement and support. Additionally, we introduced asthma-specific enhancements to the electronic health records of all participating clinical practices, including an asthma severity assessment, clinical decision support, and a patient-tailored asthma action plan. Patients will be followed for 12months and interviewed at baseline, 3, 6, and 12months and data on emergency department visits and hospitalizations will be obtained through the New York State Statewide Planning and Research Cooperative System.
Collapse
Affiliation(s)
- Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Melissa Martynenko
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Rachel O'Conor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Joseph Kannry
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Adam Karp
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Joseph Lurio
- Institute for Family Health, New York, NY, United States
| | | | - Ray Lopez
- Little Sisters of the Assumption Family Health Service, New York, NY, United States
| | - Rosemary Obiapi
- St. Luke's Hospital, Mount Sinai Healthcare System, New York, NY, United States
| | - Edwin Young
- Union Settlement, New York, NY, United States
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | | |
Collapse
|
56
|
Towards tailored and targeted adherence assessment to optimise asthma management. NPJ Prim Care Respir Med 2015; 25:15046. [PMID: 26181850 PMCID: PMC4588030 DOI: 10.1038/npjpcrm.2015.46] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 05/31/2015] [Accepted: 06/01/2015] [Indexed: 01/28/2023] Open
Abstract
In this paper, we aim to emphasise the need for a more comprehensive and tailored approach to manage the broad nature of non-adherence, to personalise current asthma management. Although currently several methods are available to measure the extent of asthma patients' adherence, the vast majority do not incorporate confirmation of the actual inhalation, dose and inhalation technique. Moreover, most current measures lack detailed information on the individual consequences of non-adherence and on when and how to take action if non-adherence is identified. Notably, one has to realise there are several forms of non-adherence (erratic non-adherence, intelligent non-adherence and unwitting non-adherence), each requiring a different approach. To improve asthma management, more accurate methods are needed that integrate measures of non-adherence, asthma disease control and patient preferences. Integrating information from the latest inhaler devices and patient-reported outcomes using mobile monitoring- and feedback systems ('mHealth') is considered a promising strategy, but requires careful implementation. Key issues to be considered before large-scale implementation include patient preferences, large heterogeneity in patient and disease characteristics, economic consequences, and long-term persistence with new digital technologies.
Collapse
|
57
|
Marques SS, Lin JS, Starling MS, Daquiz AG, Goldfarb ES, Garcia KCR, Constantine NA. Sexuality Education Websites for Adolescents: A Framework-Based Content Analysis. JOURNAL OF HEALTH COMMUNICATION 2015; 20:1310-1319. [PMID: 26147453 DOI: 10.1080/10810730.2015.1018621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The web has unique potential for adolescents seeking comprehensive sexual health information. As such, it is important to understand the nature, scope, and readability of the content and messaging provided by sexuality educational websites. We conducted a content analysis of 14 sexuality education websites for adolescents, based on the 7 essential components (sexual and reproductive health and HIV, relationships, sexual rights and sexual citizenship, pleasure, violence, diversity, and gender) of the International Planned Parenthood Framework for Comprehensive Sexuality Education. A majority of content across all sites focused on sexual and reproductive health and HIV, particularly pregnancy and STI prevention, and other information about STIs and HIV. No other topic comprised more than 10% of content coverage across a majority of sites. The authors found little discussion of gender issues, sexual rights, sexual diversity, or sexual violence. Most sites provided brief references to sexual pleasure, generally moderated with cautionary words. Language used implied a heterosexual female audience. Reading levels for most sites were above the 9th-grade level, with several at the college level. These findings have implications for enhancing online sexuality education and broadening the coverage of essential topics.
Collapse
Affiliation(s)
- Sara S Marques
- a Center for Research on Adolescent Health and Development , Public Health Institute , Oakland , California , USA
| | - Jessica S Lin
- a Center for Research on Adolescent Health and Development , Public Health Institute , Oakland , California , USA
| | - M Summer Starling
- a Center for Research on Adolescent Health and Development , Public Health Institute , Oakland , California , USA
| | - Aubrey G Daquiz
- a Center for Research on Adolescent Health and Development , Public Health Institute , Oakland , California , USA
| | - Eva S Goldfarb
- b Department of Health and Nutrition Sciences , Montclair State University , Montclair , New Jersey , USA
| | - Kimberly C R Garcia
- a Center for Research on Adolescent Health and Development , Public Health Institute , Oakland , California , USA
| | - Norman A Constantine
- a Center for Research on Adolescent Health and Development , Public Health Institute , Oakland , California , USA
- c School of Public Health , University of California, Berkeley , Berkeley , California , USA
| |
Collapse
|
58
|
Carolan-Olah M, Steele C, Krenzin G. Development and initial testing of a GDM information website for multi-ethnic women with GDM. BMC Pregnancy Childbirth 2015; 15:145. [PMID: 26142482 PMCID: PMC4491240 DOI: 10.1186/s12884-015-0578-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 05/28/2015] [Indexed: 11/10/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) affects approximately 5–15 % of pregnant women in Australia. Highest rates are seen among women who are obese, from specific ethnic backgrounds and low socio-economic circumstance. These features also impact on uptake of self-management recommendations. GDM that is not well managed can give rise to serious pregnancy complications. The aim of this project was to develop and test an intervention to improve knowledge of GDM and GDM self-management principles. Methods A web-based intervention, consisting of resources aimed at a low level of literacy, was developed and tested among multi-ethnic women at a metropolitan hospital in Melbourne Australia. A basic one-group pre-test/post-test design was used to explore the impact of the intervention on knowledge, in 3 domains: (1) Knowledge of GDM; (2) food values, and;(3) GDM self-management principles. Questionnaire data was analysed using Statistical Package for the Social Sciences (SPSS), version 21.0. Fisher’s exact test was used to test for an improvement in each knowledge scale. Results Twenty-one women with GDM, from multi-ethnic backgrounds, participated in the testing of the intervention. Results indicated that the intervention was effective at improving knowledge scores and this effect was greatest in the first domain, knowledge of GDM. Although some improvement of knowledge scores occurred in the other two domains, food values and self-management principles, these improvements were less than expected. This finding may relate to a number of misunderstandings in the interpretation of the web resource and survey questions. These issues will need to be resolved prior to proceeding to a clinical trial. Conclusion Initial results from this study look promising and suggest that with some improvements, the intervention could prove a useful adjunct support for women with GDM from multi-ethnic and low socio-economic backgrounds. Conducting a randomised controlled trial is feasible in the future and will provide a useful means of examining efficacy of the intervention.
Collapse
Affiliation(s)
- Mary Carolan-Olah
- Nursing and Midwifery, College of Health and Biomedicine, Victoria University, St Alban's Campus, PO Box 14228, Melbourne, 8001, Australia.
| | - Cheryl Steele
- Western Health, Diabetes Education Service, Western Hospital, Gordon St., Footscray, VIC, 3011, Australia.
| | - Gillian Krenzin
- Western Health, Diabetes Education Service, Western Hospital, Gordon St., Footscray, VIC, 3011, Australia.
| |
Collapse
|
59
|
Abstract
The inner city has long been recognized as an area of high asthma morbidity and mortality. A wide range of factors interact to create this environment. These factors include well-recognized asthma risk factors that are not specific to the inner city, the structure and delivery of health care, the location and function of the urban environment, and social inequities. In this article, these facets are reviewed, and successful and unsuccessful interventions are discussed, to understand what is needed to solve this problem.
Collapse
Affiliation(s)
- Peter J Gergen
- Allergy, Asthma, Airway Biology Branch (AAABB), MD, USA.
| | - Alkis Togias
- Allergy, Asthma, Airway Biology Branch (AAABB), MD, USA
| |
Collapse
|
60
|
Riera A, Ocasio A, Tiyyagura G, Krumeich L, Ragins K, Thomas A, Trevino S, Vaca FE. Latino caregiver experiences with asthma health communication. QUALITATIVE HEALTH RESEARCH 2015; 25:16-26. [PMID: 25185159 DOI: 10.1177/1049732314549474] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In this article, we analyze qualitative data from a purposeful sample of limited English proficiency (LEP) asthma health caregivers. We used ethnically concordant, semistructured, in-depth Spanish-language interviews and a follow-up focus group to explore issues related to communication during pediatric asthma encounters in medical settings. Inductive coding of Spanish transcripts by a bilingual research team was performed until thematic saturation was reached. Several key findings emerged. LEP caregivers encountered significant asthma burdens related to emotional stress, observed physical changes, and communication barriers. Language-discordant communication and the use of ad hoc interpreters were common. This finding is complex, and was influenced by perceptions of interpreter availability, delays in care, feelings of mistrust toward others, and individual emotional responses. Language-concordant education and suitable action plans were valued and desired. We discuss a revealing depiction of the LEP caregiver experience with asthma health communication and recommend areas for further inquiry.
Collapse
Affiliation(s)
| | - Agueda Ocasio
- Junta for Progressive Action, New Haven, Connecticut, USA
| | | | | | - Kyle Ragins
- Yale University, New Haven, Connecticut, USA
| | - Anita Thomas
- University of Washington, Seattle, Washington, USA
| | - Sandra Trevino
- Junta for Progressive Action, New Haven, Connecticut, USA
| | | |
Collapse
|
61
|
MacGillivray ME, Flavin MP. Canadian paediatric asthma action plans and their correlation with current consensus guidelines. Paediatr Child Health 2014; 19:362-6. [PMID: 25332675 DOI: 10.1093/pch/19.7.362] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND While written action plans are standard in the treatment and management of asthma, significant variability exists in the content and format among plans. This variability results in inconsistent educational messages that lend themselves to patient confusion and suboptimal health outcomes. OBJECTIVES To assess the content of Canadian paediatric written action plans for consistency in format, layout, zone-defining symptoms, suggested treatment options and adherence to current Canadian asthma care guidelines. METHODS Written action plans were sought from Canadian paediatric hospitals, major teaching hospitals associated with academic centres and three national organizations, for a total of 17 plans. An analysis was performed to assess the similarities and differences among plans. RESULTS Of all the Canadian paediatric written action plans, 76% were found to consist of three zones and 82% incorporated a traffic light-style design. The plans were divided between symptom-based (59%) and combined symptom- and peak-flow rate approaches (41%). Nominal concordance with the 2012 Canadian Thoracic Society guidelines existed with respect to inhaled corticosteroid and oral corticosteroid therapy. Considerable variability existed among the symptom descriptors that defined each zone. Greater consistency existed among treatment strategies, although the suggested treatment was often difficult to ascertain from the plan templates. CONCLUSION Canadian written action plans would be improved by nationally clarifying the symptom descriptors for each zone, adding asthma trigger information to the plans, increasing the emphasis of the common cold as a potential harbinger of worsening asthma symptoms and further incorporating national guideline recommendations.
Collapse
|
62
|
Riera A, Ocasio A, Goncalves P, Krumeich L, Katz KH, Trevino S, Vaca FE. Findings from a community-based asthma education fair for Latino caregivers. J Asthma 2014; 52:71-80. [PMID: 25019349 DOI: 10.3109/02770903.2014.944982] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess limited English proficiency (LEP) asthma caregiver quality of life (QoL), skills retention and healthcare utilization after an asthma education fair (AEF). METHODS A language concordant AEF was conducted at a Latino community center. LEP caregivers of children 1-12 years old and an established asthma diagnosis participated in three skill stations: (a) medication recognition and administration, (b) peak flow use (if child ≥ 5 years) and (c) action plan dissemination. Spacers, peak flow meters and individualized action plans were distributed. A validated, pediatric asthma caregiver quality of life questionnaire (PACQLQ-Spanish version) was administered. Baseline data was compared to follow-up interview data at three and six months after the AEF. Mean PACQLQ scores were analyzed with Wilcoxon signed-rank test and nominal paired data with McNemar's test. RESULTS We analyzed data from 18 caregivers able to speak English well (22%), not well (28%) or not at all (50%). After three months, improved caregiver QoL was experienced (51 vs. 72, p<0.01). No differences were observed in medication recognition, spacer and peak flow use or peak flow interpretation. After six months, mean school days missed due to asthma decreased (4.1 vs. 0.4, p<0.01). Mean clinic visits, emergency department visits and hospitalizations remained unchanged. CONCLUSIONS Implementation of a community-based AEF with action plan administration can be beneficial for LEP caregivers and their children. QoL improvements to emotional wellbeing and activity limitations were observed, and lower rates of school absenteeism were reported. Caregiver ability to accurately identify medications was not enhanced.
Collapse
Affiliation(s)
- Antonio Riera
- Pediatric Emergency Medicine, Yale University School of Medicine , New Haven, CT , USA
| | | | | | | | | | | | | |
Collapse
|
63
|
Marshall T, van Asperen P, Selvadurai H, Robinson P. Don't write off paediatric asthma action plans just yet. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2014; 22:144-5. [PMID: 23708113 PMCID: PMC6442798 DOI: 10.4104/pcrj.2013.00049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tracey Marshall
- Clinical Nurse Consultant Asthma Education, Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Westmead NSW, Australia
- Clinical Nurse Consultant, Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Locked Bag 4001, Westmead NSW 2145, Australia Tel: +61 (02) 9845 2293 Fax: +61 (02) 9845 2111 E-mail:
| | - Peter van Asperen
- Senior Staff Respiratory Physician, Department of Respiratory Medicine, The Children's Hospital at Westmead; Macintosh Professor of Paediatric Respiratory Medicine, Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Sydney NSW, Australia
| | - Hiran Selvadurai
- Department Head, Department of Respiratory Medicine, The Children's Hospital at Westmead; Clinical Associate Professor, Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Australia
| | - Paul Robinson
- Staff Respiratory Physician, Department of Respiratory Medicine, The Children's Hospital at Westmead; Clinical Lecturer, Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Australia
| |
Collapse
|
64
|
Riera A, Navas-Nazario A, Shabanova V, Vaca FE. The impact of limited English proficiency on asthma action plan use. J Asthma 2013; 51:178-84. [PMID: 24147607 DOI: 10.3109/02770903.2013.858266] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The goal of this study was to compare rates of asthma action plan use by limited English proficiency (LEP) caregivers to English proficient (EP) caregivers. METHODS A cross-sectional bilingual survey was distributed at an urban, academic, pediatric emergency department (PED). Surveys were completed by adult caregivers of children with asthma who sought PED care for asthma related chief complaints. LEP was defined as caregiver ability to speak English less than "very well". Data were analyzed using Fisher's exact test and odds ratios (OR). RESULTS One hundred seven surveys were completed and analyzed. Fifty-one surveys (48%) were completed by LEP caregivers and 56 (52%) by EP caregivers. A 25% difference (p = .01) in action plan use rates between LEP caregivers (39%) and EP caregivers (64%) was observed. EP alone was associated with action plan use (OR 2.8 [95% CI 1.3-6.1]). Variables not associated with plan use included mother acting as caregiver (OR 2.1 [95% CI 0.7-7.0]), age of child >7 years (OR 1.0 [95% CI 0.5-2.4]), caregiver education ≥ associate degree (OR 1.4 [95% CI 0.6-3.0]), private insurance (OR 0.7 [95% CI 0.3-1.8]), White race (OR 0.7 [95% CI 0.2-2.2]), Latino ethnicity (OR 0.5 [95% CI 0.2-1.3]) and a federally qualified health center (OR 0.8 [95% CI 0.3-2.0]). The main caregiver reasons for plan use were feeling that a plan works/gets results, helps with symptom management and appreciation towards physician attentiveness when a plan is prescribed. The main caregiver reasons for non plan use were they were not informed/given an action plan or perceived the child's asthma as mild/well controlled. CONCLUSION Compared with EP caregivers, those with LEP experience disparate rates of asthma action plan use.
Collapse
Affiliation(s)
- Antonio Riera
- Depatment of Pediatric Emergency Medicine, Yale University , New Haven, CT , USA
| | | | | | | |
Collapse
|