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Mcintyre D, Chiang J, Thiagalingam A, Tong A, Chow CK. Engagement and fidelity of a cardiovascular disease prevention-focused digital health intervention in cardiology outpatient waiting rooms: a mixed-methods study. BMJ Qual Saf 2023; 32:655-664. [PMID: 35803709 DOI: 10.1136/bmjqs-2021-014664] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/20/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION We delivered a video-based, cardiovascular disease prevention focused intervention in cardiology waiting rooms that increased motivation to improve cardiovascular risk behaviours and satisfaction with clinic services. To better understand the potential generalisability and scalability of such waiting room interventions, this study evaluated the fidelity of intervention delivery and barriers and enablers to implementation. METHODS Mixed-methods process evaluation conducted among intervention participants in a randomised clinical trial. Data sources included (1) Participant screening logs, (2) Intervention delivery platform data and (3) Semi structured interviews performed with participants. Qualitative data were described using inductive thematic analysis. RESULTS The tablet-based intervention was delivered to 220 patients (112 (50.9%) male, mean age 54.2 (SD 15.4) years). Of 765 videos opened, 636 (83.1%) were watched to completion. Most videos opened were rated (738/765, 96.5%) and video ratings were predominantly positive (661/738, (89.6%) satisfied or highly satisfied). Younger and more educated participants were more likely to rate videos highly (relative risk (RR) 1.73 (95% CI 1.28 to 2.32) and RR 1.26 (95% CI 1.07 to 1.49)) but less likely to watch videos to completion (younger: RR 0.27 (95% CI 0.17 to 0.43), more educated: RR 0.90 (95% CI 0.85 to 0.96)). Of 39 invited, 21 (53.8%) participated in semistructured interviews. Thematic analysis of responses suggested reported behaviour change post intervention may be due to increased awareness of cardiovascular risk, reduced anxiety and intrinsic motivation from delivery within a cardiology waiting room. Lack of reinforcement and limited personalisation were barriers. CONCLUSION The current analysis demonstrates that engagement with a digitally delivered clinic waiting room educational intervention was high, providing explanation for its efficacy in improving motivation to change cardiovascular risk behaviours. The high fidelity of delivery demonstrates potential for scaling of such interventions across waiting rooms. Recall bias and low response rate may bias self-reported engagement measures. TRIAL REGISTRATION NUMBER ANZCTR12618001725257.
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Affiliation(s)
- Daniel Mcintyre
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
| | - Jason Chiang
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
| | - Aravinda Thiagalingam
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
- Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Clara Kayei Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
- Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
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McDonald CE, Voutier C, Govil D, D’Souza AN, Truong D, Abo S, Remedios LJ, Granger CL. Do health service waiting areas contribute to the health literacy of consumers? A scoping review. Health Promot Int 2023; 38:daad046. [PMID: 37440256 PMCID: PMC10340083 DOI: 10.1093/heapro/daad046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
Health service waiting areas commonly provide health information, resources and supports for consumers; however, the effect on health literacy and related outcomes remains unclear. This scoping review of the literature aimed to explore the use of waiting areas as a place to contribute to the health literacy and related outcomes of consumers attending health appointments. Articles were included if they focussed on health literacy or health literacy responsiveness (concept) in outpatient or primary care health service waiting areas (context) for adult consumers (population) and were published after 2010. Ten bibliographic databases, one full-text archive, dissertation repositories and web sources were searched. The search yielded 5095 records. After duplicate removal, 3942 title/abstract records were screened and 360 full-text records assessed. Data were charted into a standardized data extraction tool. A total of 116 unique articles (published empirical and grey literature) were included. Most articles were set in primary and community care (49%) waiting areas. A diverse range of health topics and resource types were available, but results demonstrated they were not always used by consumers. Outcomes measured in intervention studies were health knowledge, intentions and other psychological factors, self-reported and observed behaviours, clinical outcomes and health service utilization. Intervention studies overall demonstrated positive trends in health literacy-related outcomes, although the benefit declined after 3-6 months. Research on using waiting areas for health literacy purposes is increasing globally. Future research investigating the needs of consumers to inform optimal intervention design is needed.
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Affiliation(s)
- Cassie E McDonald
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010, Australia
- Allied Health - Physiotherapy, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia
- Allied Health, Alfred Health, Melbourne, VIC 3004, Australia
| | - Catherine Voutier
- Health Sciences Library, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia
| | - Dhruv Govil
- Department of Business Intelligence and Reporting, Bass Coast Health, Wonthaggi, VIC 3995, Australia
| | - Aruska N D’Souza
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010, Australia
- Allied Health - Physiotherapy, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia
| | - Dominic Truong
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Shaza Abo
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010, Australia
- Allied Health - Physiotherapy, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia
| | - Louisa J Remedios
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010, Australia
- Department of Physiotherapy, Federation University, Churchill, VIC 3842, Australia
| | - Catherine L Granger
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010, Australia
- Allied Health - Physiotherapy, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia
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Shufflebarger EF, Walter LA, Gropen TI, Madsen TE, Harrigan MR, Lazar RM, Bice J, Baldwin CS, Lyerly MJ. Educational Intervention in the Emergency Department to Address Disparities in Stroke Knowledge. J Stroke Cerebrovasc Dis 2022; 31:106424. [PMID: 35334251 PMCID: PMC9086083 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/04/2022] [Accepted: 02/17/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES In the United States, Black individuals have higher stroke incidence and mortality when compared to white individuals and are also at risk of having lower stroke knowledge and awareness. With the need to implement focused interventions to decrease stroke disparities, the objective of this study is to evaluate the feasibility and efficacy of an emergency department-based educational intervention aimed at increasing stroke awareness and preparedness among a disproportionately high-risk group. MATERIALS AND METHODS Over a three-month timeframe, an emergency department-based, prospective educational intervention was implemented for Black patients in an urban, academic emergency department. All participants received stroke education in the forms of a video, written brochure and verbal counseling. Stroke knowledge was assessed pre-intervention, immediately post-intervention, and at one-month post-intervention. RESULTS One hundred eighty-five patients were approached for enrollment, of whom 100 participants completed the educational intervention as well as the pre- and immediate post- intervention knowledge assessments. Participants demonstrated increased stroke knowledge from baseline knowledge assessment (5.35 ± 1.97) at both immediate post-intervention (7.66 ± 2.42, p < .0001) and one-month post-intervention assessment (7.21 ± 2.21, p < .0001). CONCLUSIONS Emergency department-based stroke education can result in improved knowledge among this focused demographic. The emergency department represents a potential site for educational interventions to address disparities in stroke knowledge.
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Affiliation(s)
- Erin F Shufflebarger
- Department of Emergency Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA.
| | - Lauren A Walter
- Department of Emergency Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Toby I Gropen
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Tracy E Madsen
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Mark R Harrigan
- Department of Neurosurgery, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Ronald M Lazar
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Jamie Bice
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Cassidy S Baldwin
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Michael J Lyerly
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
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McIntyre D, Thiagalingam A, Klimis H, Von Huben A, Marschner S, Chow CK. Education on cardiac risk and CPR in cardiology clinic waiting rooms: a randomised clinical trial. Heart 2021; 107:1637-1643. [PMID: 34290036 DOI: 10.1136/heartjnl-2021-319290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/25/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Waiting time is inevitable during cardiovascular (CV) care. This study examines whether waiting room-based CV education could complement CV care. METHODS A 2:1 randomised clinical trial of patients in waiting rooms of hospital cardiology clinics. Intervention participants received a series of tablet-delivered CV educational videos and were randomised 1:1 to receive another video on cardiopulmonary resuscitation (CPR) or no extra video. Control received usual care. The primary outcome was the proportion of participants reporting high motivation to improve CV risk-modifying behaviours (physical activity, diet and blood pressure monitoring) post-clinic. SECONDARY OUTCOMES clinic satisfaction, CV lifestyle risk factors (RFs) and confidence to perform CPR. Assessors were blinded to treatment allocation. RESULTS Among 514 screened, 330 were randomised (n=220 intervention, n=110 control) between December 2018 and March 2020, mean age 53.8 (SD 15.2), 55.2% male. Post-clinic, more intervention participants reported high motivation to improve CV risk-modifying behaviours: 29.6% (64/216) versus 18.7% (20/107), relative risk (RR) 1.63 (95% CI 1.04 to 2.55). Intervention participants reported higher clinic satisfaction RR: 2.19 (95% CI 1.45 to 3.33). Participants that received the CPR video (n=110) reported greater confidence to perform CPR, RR 1.61 (95% CI 1.20 to 2.16). Overall, the proportion of participants reporting optimal CV RFs increased between baseline and 30-day follow-up (16.1% vs 24.8%, OR=2.44 (95% CI 1.38 to 4.49)), but there was no significant between-group difference at 30 days. CONCLUSION CV education delivery in the waiting room is a scalable concept and may be beneficial to CV care. Larger studies could explore its impact on clinical outcomes. TRIAL REGISTRATION NUMBER ANZCTR12618001725257.
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Affiliation(s)
- Daniel McIntyre
- Westmead Applied Research Centre, The University of Sydney, Westmead, New South Wales, Australia
| | - Aravinda Thiagalingam
- Westmead Applied Research Centre, The University of Sydney, Westmead, New South Wales, Australia.,Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Harry Klimis
- Westmead Applied Research Centre, The University of Sydney, Westmead, New South Wales, Australia
| | - Amy Von Huben
- Westmead Applied Research Centre, The University of Sydney, Westmead, New South Wales, Australia
| | - Simone Marschner
- Westmead Applied Research Centre, The University of Sydney, Westmead, New South Wales, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, The University of Sydney, Westmead, New South Wales, Australia.,Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
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Mcintyre D, Thiagalingam A, Chow C. While you're waiting, a waiting room-based, cardiovascular disease-focused educational program: protocol for a randomised controlled trial. BMJ Open 2020; 10:e036780. [PMID: 33082181 PMCID: PMC7577035 DOI: 10.1136/bmjopen-2020-036780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Patients with cardiovascular disease (CVD) frequently attend outpatient clinics and spend a significant amount of time in waiting rooms. Currently, this time is poorly used. This study aims to investigate whether providing CVD and cardiopulmonary resuscitation (CPR) education to waiting patients in a cardiology clinic of a large referral hospital improves motivation to change health behaviours, CPR knowledge, behaviours and clinic satisfaction post clinic, and whether there is any impact on reported CVD lifestyle behaviours or relevant CPR outcomes at 30 days. METHODS AND ANALYSIS Randomised controlled trial with parallel design to be conducted among 330 patients in the waiting room of a chest pain clinic in a tertiary referral hospital. Intervention (n=220) participants will receive a tablet-delivered series of educational videos catered to self-reported topics of interest (physical activity, blood pressure, diet, medications, smoking and general health) and level of health knowledge. Control (n=110) participants will receive usual care. In a substudy, intervention participants will be randomised 1:1 to receive an extra video on CPR or no extra video. The primary outcome will be the proportion of intervention and control participants who report high motivation to improve physical activity, diet and blood pressure monitoring at end of clinic. The primary outcome of the CPR study will be confidence to perform CPR post clinic. Secondary analysis will examine impact on clinic satisfaction, lifestyle behaviours, CPR knowledge and willingness to perform CPR post clinic and at 30-day follow-up. ETHICS AND DISSEMINATION Ethics approval has been received from the Western Sydney Local Health District Human Research Ethics Committee. All patients will provide informed consent via a tablet-based eConsent framework. Study results will be disseminated via the usual channels including peer-reviewed publications and presentations at national and international conferences. TRIAL REGISTRATION NUMBER ANZCTR12618001725257.
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Affiliation(s)
- Daniel Mcintyre
- Westmead Applied Research Centre, University of Sydney, Westmead, New South Wales, Australia
| | - Aravinda Thiagalingam
- Westmead Applied Research Centre, University of Sydney, Westmead, New South Wales, Australia
- Cardiology Department, Westmead Hospital, Westmead, New South Wales, Australia
| | - Clara Chow
- Westmead Applied Research Centre, University of Sydney, Westmead, New South Wales, Australia
- Cardiology Department, Westmead Hospital, Westmead, New South Wales, Australia
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Redding LE, Cole SD. Posters Have Limited Utility in Conveying a Message of Antimicrobial Stewardship to Pet Owners. Front Vet Sci 2019; 6:421. [PMID: 31824973 PMCID: PMC6883349 DOI: 10.3389/fvets.2019.00421] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 11/08/2019] [Indexed: 01/02/2023] Open
Abstract
Pet owners frequently administer antimicrobials to their pets and therefore have an important role to play in promoting antimicrobial stewardship in veterinary medicine. However, best methods of educating pet owners about antimicrobial stewardship have yet to be defined. While visual materials such as brochures and posters are often used in health promotion campaigns, their effectiveness in veterinary medicine is unknown. The objective of this study was to determine whether pet owners noticed and retained the message of a poster with an antimicrobial stewardship message placed in veterinary clinic exam rooms. A total of 111 pet owners from five veterinary clinics (three general practices, two low-cost clinics) in the greater Philadelphia area participated in the study. Participants completed a survey asking whether they noticed the poster and if they could paraphrase its message. In a follow-up survey, an antibiotic knowledge score was calculated from answers to questions assessing their knowledge of the poster message. Baseline knowledge was assessed by asking participants to define antibiotic resistance. At the end of the study, veterinarians at participating clinics were interviewed about their experiences with the poster. Only 51 (46.4%) participants noticed the poster, and only 11 (9.9%) could partially or completely reproduce its message. No demographic or clinic-level factors were significantly associated with noticing the poster or recalling its message. Antibiotic knowledge scores were highly correlated (ρ = 0.87, p < 0.001) with baseline knowledge and not affected by viewing the poster (p = 0.955). Veterinarians expressed skepticism that the poster was effective in conveying a message of judicious antibiotic use to clients and noted no difference in the frequency with which they discussed antibiotic resistance or felt pressured to prescribe antibiotics by their clients. Posters alone will likely have limited impact in conveying a message of judicious antibiotic use to pet owners. However, they might be useful as part of an active, multi-modal education strategy, especially if complemented by veterinarian actions.
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Affiliation(s)
- Laurel E Redding
- School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, United States
| | - Stephen D Cole
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Akhlaghi MS, Zahedi MJ, Ahmadnia S. Effects of Health Messages on Knowledge, Satisfaction, and Anxiety of Patients’ Companions Referring to Tehran Heart Center. JOURNAL OF EDUCATION AND COMMUNITY HEALTH 2018. [DOI: 10.21859/jech.5.3.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Winston K, Grendarova P, Rabi D. Video-based patient decision aids: A scoping review. PATIENT EDUCATION AND COUNSELING 2018; 101:558-578. [PMID: 29102063 DOI: 10.1016/j.pec.2017.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 10/06/2017] [Accepted: 10/16/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study reviews the published literature on the use of video-based decision aids (DA) for patients. The authors describe the areas of medicine in which video-based patient DA have been evaluated, the medical decisions targeted, their reported impact, in which countries studies are being conducted, and publication trends. METHOD The literature review was conducted systematically using Medline, Embase, CINAHL, PsychInfo, and Pubmed databases from inception to 2016. References of identified studies were reviewed, and hand-searches of relevant journals were conducted. RESULTS 488 studies were included and organized based on predefined study characteristics. The most common decisions addressed were cancer screening, risk reduction, advance care planning, and adherence to provider recommendations. Most studies had sample sizes of fewer than 300, and most were performed in the United States. Outcomes were generally reported as positive. This field of study was relatively unknown before 1990s but the number of studies published annually continues to increase. CONCLUSION Videos are largely positive interventions but there are significant remaining knowledge gaps including generalizability across populations. PRACTICE IMPLICATIONS Clinicians should consider incorporating video-based DA in their patient interactions. Future research should focus on less studied areas and the mechanisms underlying effective patient decision aids.
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Affiliation(s)
- Karin Winston
- Alberta Children's Hospital, 2800 Shaganappi Trail NW, Calgary, Alberta, T3B 6A8, Canada.
| | - Petra Grendarova
- University of Calgary, Division of Radiation Oncology, Calgary, Canada
| | - Doreen Rabi
- University of Calgary, Department of Medicine, Calgary, Canada
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Rath L, Vijiaratnam N, Skibina O. Assessing understanding of individual risk and symptoms of progressive multifocal leukoencephalopathy in patients prescribed natalizumab for multiple sclerosis. Intern Med J 2017; 47:194-199. [DOI: 10.1111/imj.13318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/05/2016] [Accepted: 10/09/2016] [Indexed: 01/09/2023]
Affiliation(s)
- Louise Rath
- Neurology Department; Alfred Health; Melbourne Victoria Australia
| | | | - Olga Skibina
- Neurology Department; Alfred Health; Melbourne Victoria Australia
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DeMeester RH, Lopez FY, Moore JE, Cook SC, Chin MH. A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients. J Gen Intern Med 2016; 31:651-62. [PMID: 26988980 PMCID: PMC4870417 DOI: 10.1007/s11606-016-3608-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Shared decision making (SDM) occurs when patients and clinicians work together to reach care decisions that are both medically sound and responsive to patients' preferences and values. SDM is an important tenet of patient-centered care that can improve patient outcomes. Patients with multiple minority identities, such as sexual orientation and race/ethnicity, are at particular risk for poor SDM. Among these dual-minority patients, added challenges to clear and open communication include cultural barriers, distrust, and a health care provider's lack of awareness of the patient's minority sexual orientation or gender identity. However, organizational factors like a culture of inclusion and private space throughout the visit can improve SDM with lesbian, gay, bisexual, and transgender ("LGBT") racial/ethnic minority patients who have faced stigma and discrimination. Most models of shared decision making focus on the patient-provider interaction, but the health care organization's context is also critical. Context-an organization's structure and operations-can strongly influence the ability and willingness of patients and clinicians to engage in shared decision making. SDM is most likely to be optimal if organizations transform their contexts and patients and providers improve their communication. Thus, we propose a conceptual model that suggests ways in which organizations can shape their contextual structure and operations to support SDM. The model contains six drivers: workflows, health information technology, organizational structure and culture, resources and clinic environment, training and education, and incentives and disincentives. These drivers work through four mechanisms to impact care: continuity and coordination, the ease of SDM, knowledge and skills, and attitudes and beliefs. These mechanisms can activate clinicians and patients to engage in high-quality SDM. We provide examples of how specific contextual changes could make SDM more effective for LGBT racial/ethnic minority populations, focusing especially on transformations that would establish a safe environment, build trust, and decrease stigma.
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Affiliation(s)
- Rachel H. DeMeester
- Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637 USA
- Robert Wood Johnson Foundation Reducing Health Care Disparities Through Payment and Delivery System Reform Program Office, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637 USA
| | - Fanny Y. Lopez
- Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637 USA
| | - Jennifer E. Moore
- Institute for Medicaid Innovation, Washington, DC USA
- Department of Obstetrics & Gynecology, Medical School, University of Michigan, Ann Arbor, MI USA
| | - Scott C. Cook
- Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637 USA
- Robert Wood Johnson Foundation Reducing Health Care Disparities Through Payment and Delivery System Reform Program Office, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637 USA
| | - Marshall H. Chin
- Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637 USA
- Robert Wood Johnson Foundation Reducing Health Care Disparities Through Payment and Delivery System Reform Program Office, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637 USA
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Chan YFY, Richardson LD, Nagurka R, Hao K, Zaets SB, Brimacombe MB, Bentley S, Levine SR. Stroke education in an emergency department waiting room: a comparison of methods. Health Promot Perspect 2015; 5:34-41. [PMID: 26000244 DOI: 10.15171/hpp.2015.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 02/14/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Since the emergency department (ED) waiting room hosts a large, captive audience of patients and visitors, it may be an ideal location for conducting focused stroke education. The aim of this study was to assess the effectiveness of various stroke education methods. METHODS Patients and visitors of an urban ED waiting room were randomized into one of the following groups: video, brochure, one-to-one teaching, combination of these three methods, or control group. We administered a 13-question multiple-choice test to assess stroke knowledge prior to, immediately after, and at 1 month post-education to patients and visitors in the ED waiting room. RESULTS Of 4 groups receiving education, all significantly improved their test scores immediately post intervention (test scores 9.4±2.5-10.3±2.0, P<0.01). At 1 month, the combination group retained the most knowledge (9.4±2.4) exceeding pre-intervention and control scores (both 6.7±2.6, P<0.01). CONCLUSION Among the various stroke education methods delivered in the ED waiting room, the combination method resulted in the highest knowledge retention at 1-month post intervention.
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Affiliation(s)
- Yu-Feng Yvonne Chan
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
| | - Lynne D Richardson
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
| | - Roxanne Nagurka
- Department of Emergency Medicine, Rutgers, New Jersey Medical School, Newark, New Jersey 07103, USA
| | - Ke Hao
- Department of Genetics and Genomic Sciences Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
| | - Sergey B Zaets
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
| | - Michael B Brimacombe
- Department of Biostatistics, Division of Biostatistics, Rutgers, New Jersey Medical School, Newark, New Jersey 07103, USA
| | - Susanne Bentley
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
| | - Steven R Levine
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
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Meschia JF, Bushnell C, Boden-Albala B, Braun LT, Bravata DM, Chaturvedi S, Creager MA, Eckel RH, Elkind MSV, Fornage M, Goldstein LB, Greenberg SM, Horvath SE, Iadecola C, Jauch EC, Moore WS, Wilson JA. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:3754-832. [PMID: 25355838 PMCID: PMC5020564 DOI: 10.1161/str.0000000000000046] [Citation(s) in RCA: 993] [Impact Index Per Article: 99.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of stroke among individuals who have not previously experienced a stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke. Further recommendations are provided for genetic and pharmacogenetic testing and for the prevention of stroke in a variety of other specific circumstances, including sickle cell disease and patent foramen ovale.
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13
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The effects of a traditional Korean medical stroke prevention education program on the awareness of stroke in elderly Koreans. Eur J Integr Med 2014. [DOI: 10.1016/j.eujim.2014.09.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Community health education at student-run clinics leads to sustained improvement in patients' hepatitis B knowledge. J Community Health 2014; 38:471-9. [PMID: 23161212 DOI: 10.1007/s10900-012-9631-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
While student-run clinics are often important healthcare safety nets for underserved populations, their efficacy for improving patient health knowledge has not been thoroughly explored. From September 2011 to April 2012, we assessed patients' retention of hepatitis B virus (HBV) knowledge after receiving student-led education at two student-run HBV screening and vaccination clinics. Patient education was provided by trained first and second-year medical, nursing, and pharmacy students, aided by a script and interpreters. Patient knowledge of HBV was evaluated at three points: before education, after the initial visit, and at one-month follow-up. Student-led education produced improved knowledge of HBV transmission, prevention, and management, which was retained 1 month after education for 52 patients tracked through time. Mean scores on an HBV knowledge survey improved from 56.4 % (SD = 15.2 %) at baseline to 66.6 % (SD = 15.1 %) after education, and 68.3 % (SD = 15.2 %) after one month. There was a statistically significant difference between the first and second (paired T test, p < 0.001) and the first and third tests (paired T test, p < 0.001), but no difference between the second and third tests (paired T test, p = 0.45). Multivariate analysis demonstrated that retention was correlated with patient educational background but independent of patient age, gender, income, primary language and number of years lived in the United States. Our study suggests that trained health professional students can effectively impart health knowledge that is retained by patients for at least 1 month. These results warrant consideration of student-led educational sessions at SRCs as a promising community health education model.
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Jones SE, Hamilton S. Introducing a new stop smoking service in an acute UK hospital: A qualitative study to evaluate service user experience. Eur J Oncol Nurs 2013; 17:563-9. [DOI: 10.1016/j.ejon.2013.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 01/17/2013] [Accepted: 01/26/2013] [Indexed: 10/27/2022]
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The waiting room: vector for health education? The general practitioner's point of view. BMC Res Notes 2012; 5:511. [PMID: 22988947 PMCID: PMC3599884 DOI: 10.1186/1756-0500-5-511] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 09/13/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND General practitioners (GPs) play a central role in disseminating information and most health policies are tending to develop this pivotal role of GPs in dissemination of health-related information to the public. The objective of this study was to evaluate use of the waiting room by GPs as a vector for health promotion. RESULTS A cross-sectional study was conducted on a representative sample of GPs using semi-structured, face-to-face interviews. A structured grid was used to describe the documents. Quantitative and qualitative analysis was performed. Sixty GPs participated in the study. They stated that a waiting room had to be pleasant, but agreed that it was a useful vector for providing health information. The GPs stated that they distributed documents designed to improve patient care by encouraging screening, providing health education information and addressing delicate subjects more easily. However, some physicians believed that this information can sometimes make patients more anxious. A large number of documents were often available, covering a variety of topics. CONCLUSION General practitioners intentionally use their waiting rooms to disseminate a broad range of health-related information, but without developing a clearly defined strategy. It would be interesting to correlate the topics addressed by waiting room documents with prevention practices introduced during the visit.
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Abstract
Although mortality from cardiovascular (CV) disease has fallen in the past decade, the burden of CV disease and related conditions remains high, with rates of hospitalization and disability and cost on the rise. Prevention and treatment of CV conditions often involve a complex regimen of lifestyle modification, medications, and/or symptom monitoring and management. Cardiovascular health professionals spend a great deal of time promoting awareness of and adherence to national guidelines for the prevention and management of CV conditions. In addition, patient education for hospitalized patients is becoming increasingly regulated by national organizations and payors. However, it is unclear which educational intervention elements or strategies are most effective for educating hospitalized CV patients and their families. The purpose of this systematic review of experimental and quasi-experimental studies was to identify and examine the characteristics and outcomes of CV health education interventions for hospitalized CV patients.
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Gavin JR, Fox KM, Grandy S. Race/Ethnicity and gender differences in health intentions and behaviors regarding exercise and diet for adults with type 2 diabetes: a cross-sectional analysis. BMC Public Health 2011; 11:533. [PMID: 21729303 PMCID: PMC3136427 DOI: 10.1186/1471-2458-11-533] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 07/05/2011] [Indexed: 01/28/2023] Open
Abstract
Background Self-management is the cornerstone of diabetes control and prevention of complications; however, it is undetermined whether differences in intention to adopt healthy lifestyles and actual healthy behavior exist across race/ethnic groups. This study evaluated the differences across racial-ethnic groups in self-reported medical advice received and health intentions and behaviors among adults with type 2 diabetes mellitus. Methods A cross-sectional analysis of the 2007 SHIELD US survey ascertained self-reported health intentions and behaviors for regular exercise, diet, and weight management among Non-Hispanic Caucasian (n = 2526), Non-Hispanic African-American (n = 706), and Hispanic (n = 179) respondents with type 2 diabetes. Results A similar proportion of respondents from each race-gender group (43%-56%) reported receiving healthcare advice to increase their exercise (P = 0.32). Significantly more minorities reported an intention to follow the exercise recommendation compared with Non-Hispanic Caucasians (P = 0.03). More Non-Hispanic African-American (29%) and Hispanic (27%) men reported exercising regularly compared with other race-gender groups (P = 0.02). Significantly more Non-Hispanic Caucasian women (74%) and Hispanic women (79%) reported trying to lose weight compared with other groups (P < 0.0001). Conclusions Differences in health intentions and healthy behaviors were noted across race-gender groups. More Non-Hispanic African-American men reported an intention to follow advice on exercising and self-report of exercising regularly was also higher compared with other race-gender groups. More Hispanic men reported high physical activity levels than other groups. Despite an increased willingness to follow healthcare recommendations for diet, >50% of respondents were obese among all race-gender groups.
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Affiliation(s)
- James R Gavin
- Strategic Healthcare Solutions, LLC, Monkton, MD 21111, USA
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Weinrich M, Stuart M. Coverage policy for neurorehabilitation: an international perspective. Neurorehabil Neural Repair 2011; 25:531-9. [PMID: 21427275 DOI: 10.1177/1545968310397207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coverage policy ultimately determines the delivery of services. This article summarizes the authors' effort to ascertain the extent of publically available information on coverage for neurorehabilitation services internationally. OBJECTIVE Present available data on neurorehabilitation coverage and examine the needs for further research in this area. METHODS Review of published literature, review of government Web sites, survey of World Federation of NeuroRehabilitation (WFNR) program chairs, and attendees of the 2010 World Congress of NeuroRehabilitation. RESULTS A wide variation in coverage was found internationally. Data are not routinely accessible. CONCLUSIONS Informed policy requires current data. There is an opportunity for the WFNR to provide leadership in policy for neurorehabilitation services by assembling and maintaining current data on coverage policy internationally.
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Affiliation(s)
- Michael Weinrich
- National Center for Medical Rehabilitation Research, Eunice Kennedy Shriver Institute for Child Health and Human Development, National Institutes of Health, Bethesda, MD 20852, USA.
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