Patients' use of health-teaching materials at three readability levels

The usage pattern of patients' drug information leaflet for oral non-prescription drugs among university students in the United Arab Emirates: cross-sectional study

Background

Very few extensive studies have measured the prevalence and usage pattern of drug information leaflet (DIL) for oral non-prescription drugs (ONPDs) or identified the associated risk factors for not reading DIL among university students in the UAE.

Objective

The current study aimed to estimate the prevalence of the usage pattern of DIL for ONPDs, and delineate the associated risk factors for not reading the DIL among university students.

Methods

A cross-sectional survey-based multistage sampling technique conducted among 2875 students at three major universities in UAE. The self-administered validated questionnaire was constructed and developed based on Andersen's behavioral model. Binomial logistic regression performed to ascertain the effects of 25 potential predictors on the likelihood that participants not reading (discarded) the DIL after reading them. The primary outcome measure was reading (discarding without reading) the DIL, and the associated behaviours.

Results

2875 university students were eligible to participate in the study, but only 2519 students agreed to participate, indicating an 88% of intent participation. However, only 2,355 (81.9%) students completed the questionnaire. 1348 respondents reported using NPD (response rate 46.9%) during the past three months before conducting the study, which comprised the sample analysis (1307 were excluded). More than three-quarters of them read the DIL (always or often) at the first use (1049 of 1348, 77.8%). Approximately a quarter of those who read the DIL reported that they discarded them after reading (24.1%). The survey has identified four risk factors for not reading the DIL: those who get the drug information from physicians or pharmacists had lower odds of discarding the DIL (odds ration [OR] = 0.491, 95% confidence interval [CI]: 0.273-0.884, p value< 0.05). Medical students had lower odds of discarding the DIL (OR = 0.598, 95% CI: 0.412-0.868, p value< 0.05). Those participants who believe that NPDs are as effective as prescription drugs had lower odds of discarding the DIL (OR = 0.342, 95% CI: 0.123-0.948, p value< 0.05). Participants who use more than one NPD to treat a single symptom a day have higher odds of discarding the DIL (OR = 1.625, 95% CI: 1.122 -2.355, p value< 0.05).

Conclusion

The prevalence of drug usage pattern in this population was 57.5% as 1348 subjects reported using NPD during the past 90 days before conducting the study. We have identified four risk factors for not reading the DIL, those who get the drug information from physicians or pharmacists, medical students, those respondents who believe that NPDs were as effective as prescription drugs, and respondents self-treating a single symptom with more than one NPD. It was evident from the findings that usage pattern of NPD for DIL varied among the students, with no specific pattern dominating.

Exploring fear of childbirth in Kenya through evaluation of the readability of Wijma Delivery Expectancy/Experience Questionnaire Version A (W-DEQ-A)

BACKGROUND

Several tools measuring fear of childbirth (FOC) have been developed in the last three decades, however concerns about their readability have been raised.

AIM

To explore the fear of childbirth in a sample of women of reproductive age by evaluating the readability of Wijma Delivery Expectancy/Experience Questionnaire version A (W-DEQ-A).

METHODS

The Flesch Reading Ease Formula, the Flesch-Kincaid Grade Level, the FOG Scale, the SMOG Index, the Coleman-Liau Index, the Automated Readability Index, and the Linsear Write Formula were used to evaluate the readability of the W-DEQ-A. Also, focus group discussions were held to validate the findings of the readability scales mentioned above.

FINDINGS

The SMOG Index (score = 7.6), Coleman-Liau Index (score = 7.6), and the Linsear Write Formula (score = 9.4) were easily readable by women of reproductive age who had at least secondary school education (grade 12). Concerns were raised over some terms used such as desolate and deserted, which were rarely used in day to day English language conversations.

CONCLUSIONS

In this study, participants observed that W-DEQ- A was readable if administered to expectant women with a basic secondary school certificate; but there is a need to simplify some words. It was emphasized that societal dynamics play an important role in the fear of childbirth and therefore the questionnaire should address all aspects contributing to fear of childbirth and not merely the feelings and thoughts women may have at the prospect of labor and delivery.

Information needs of people seeking fertility services in Canada: a mixed methods analysis

BACKGROUND

Infertility is a challenging experience associated with high levels of psychological distress. Many people seeking fertility services use the internet to obtain information about their conditions and treatments.

OBJECTIVES

This mixed-methods study aimed to describe the information-seeking experience of people seeking fertility services with respect to the fulfillment of their individually defined information needs and explore relationships between the fulfillment of information needs and psychological outcomes.

METHODS

One hundred and four participants completed a survey with close-ended and open-ended questions about their experience using an informational web-based application (app) called 'Infotility' and about their mental well-being before and after using the app. The questionnaires administered were the The Mobile Application Rating Scale (uMARS), the Fertility Quality of Life questionnaire (FertiQol), the Patient Empowerment Questionnaire (PEQ) and the General Anxiety Disorder 7-item Scale (GAD-7). Eleven participants completed in-depth qualitative interviews about their experience using the app. A thematic analysis was used to interpret qualitative results and quantitization was used to dichotomize participants into those with met information needs versus those with unmet information needs. Google Analytics was used to compare participants' reported experience with their actual use of the app.

RESULTS

The results of this study show that there is variability in the amount of information that people seeking fertility services wish to receive. Participants whose information needs were met reported improved psychological outcomes after using the app, while those with unmet needs showed no change in their psychological outcomes.

CONCLUSIONS

Our results suggest that fulfilling information needs was associated with improved psychological outcomes in people seeking fertility services. Our results also suggest that individual differences in information needs should be considered when developing health educational materials.

Best-practices for the design and development of prescription medication information: A systematic review

OBJECTIVE

To present evidence supporting best-practices for prescription drug labeling and educational materials.

METHODS

Articles were selected from three online databases (PubMed, Embase, CINAHL). Eligible manuscripts were: 1) English-language, 2) randomized, controlled trials, and 3) focused on improving prescription drug labeling practices.

RESULTS

Forty-nine articles were reviewed, and included both regulated label materials and pharmacy or health systems-generated tools. Best-practices included use of plain language principles, typographic cues, quantitative descriptors, and standardized formats, when applicable. Common outcomes included preference and comprehension, while few studies examined actual medication use (e.g. adherence, harms) or clinical health outcomes. Approximately half of studies directly engaged patients' perspectives in intervention development, which may have helped increase tool effectiveness.

CONCLUSIONS

Several best practices were apparent in the literature, particularly for written materials and pharmacy-generated container labeling. Design principles for supplemental instructions and multimedia tools were less cohesive, albeit less researched. The impact of patient involvement in tool design is promising, though requiring further study.

PRACTICE IMPLICATIONS

Definitive studies to inform practice standards on how to best communicate medication information to consumers are needed, especially as communication modalities continue to evolve. Increased research on if and how to incorporate patient-centered decision-making into the development process should be considered.

Literacy, Cultural Diversity, and Client Education

Client education offers many challenges to health care professionals. There is a mismatch between the reading level of most clients and the reading level of printed materials used in health education. Social and cultural factors also influence how our clients are able to learn about their health. These problems can lead to noncompliance with treatments, missed appointments, wrong dosages of medication, and undue fear among our clients. There are things that health care professionals can do to make written materials more user-friendly and culturally more acceptable.

Investigating the impact of message format, involvement, scientific literacy, and education on attitude toward reducing cancer risk through regulation

Recent research links perfluorooctanoic acid (PFOA) to increased breast cancer risk. Efforts to inform the lay public about potential risks associated with PFOA need to be accessible in their content as many individuals, including highly educated ones, have low scientific literacy. This study investigates the role of message format, as well as personal involvement, scientific literacy, and education in influencing attitudes about PFOA regulation. Participants (N = 2,078) were exposed to one of three message formats about PFOA and then responded to survey questions related to their attitude about the need for new regulation. Results revealed that issue involvement was positively related to favorable attitude regarding new regulation, while education and advocacy status were negatively related; cancer experience, scientific literacy, and message format did not influence attitude about new regulation. Implications of the results are discussed as they relate to communicating uncertain risk information to inform and influence lay individuals.

Listenability as a tool for advancing health literacy

Health literacy research and practice has focused mainly on the readability of written documents. Yet oral communication plays at least as important a role in the interpersonal ecology in which people make real decisions about their health. Moreover, the single-minded quest for short sentences and simple vocabulary inherent in the readability paradigm can subvert the effort to engage in patient- or consumer-centered communication. Listenability is the quality of discourse that eases the cognitive burden that aural processing imposes. Listenability is a function of oral-based language plus "considerate" rhetorical structures. The Listenability Style Guide presented in this article offers evidence-based recommendations for producing listenable discourse. A study testing the applicability of the Listenability Style Guide to postsurgical discharge instructions was conducted. College students either heard or read discharge instructions composed in either high or moderate listenability. Comprehension was higher for this population in reading than in listening. Across modalities, the high listenability version was easiest to comprehend. Incorporating listenability concerns in research and practice is consistent with emerging, broad conceptions of health literacy and with the dictates of the National Action Plan to Improve Health Literacy.

Health literacy -- a heterogeneous phenomenon: a literature review

BACKGROUND AND AIM

A growing responsibility on the part of individuals to make decisions in health issues implies the need of access to health information and personal skills to comprehend the information. Health literacy comprises skills in obtaining, understanding and acting on information about health issues in ways that promote and maintain health. A lack of health literacy may have effects at both the individual and societal levels. There are thus reasons for health care professionals to gain a comprehensive understanding of health literacy. The aim of this review was to explore how health literacy is described in the scientific literature and to give a synthesis of its different meanings.

METHODS

The review was based on approximately 200 scientific articles published 2000-2008. The analysis process was inspired by the methods of narrative literature review.

FINDINGS AND CONCLUSIONS

Two different approaches to health literacy became visible, one in which health literacy is expressed as a polarized phenomenon, focusing on the extremes of low and high health literacy. The definitions of health literacy in this approach are characterized by a functional understanding, pointing out certain basic skills needed to understand health information. The other approach represents a complex understanding of health literacy, acknowledging a broadness of skills in interaction with the social and cultural contexts, which means that an individual's health literacy may fluctuate from one day to another according to the context. The complex approach stresses the interactive and critical skills needed to use information or knowledge as a basis for appropriate health decisions. We conclude that health literacy is a heterogeneous phenomenon that has significance for both the individual and society. Future research will aim at the development of assessments that capture the broadness of skills and agents characteristic for health literacy as a complex phenomenon.

ESL-speaking immigrant women's disillusions: voices of health care in Canada: an ethnodrama

This article describes a research project that investigated whether language barriers play a part in immigrant women's health decreasing when they move to Canada. The findings are then represented in the form of an ethnodrama entitled "ESL-Speaking Immigrant Women's Disillusions: Voices of Health Care in Canada." I suggest that the play is catalytic because it encourages target audiences to empathize with the silenced voices of ESL-speaking immigrant women who live in Canada. I then conclude with a reflection about the potential that the genre of ethnodrama has for social change through its reflexive and critical nature.

A comparison between improvers and non-improvers among children with anemia enrolled in the WIC program

OBJECTIVES

To investigate differences between children ages one to five enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in the state of Texas whose anemia status improved and those whose anemia status did not improve.

METHODS

The study involved administration of a survey to a randomly selected stratified sample of parents and guardians of WIC children residing in the eleven public health regions in Texas. Subjects volunteered to complete the survey during a scheduled WIC appointment. A total of 459 usable surveys were completed. Fifty-one percent of the surveys were completed by parents/guardians of children classified as anemia improvers and 49% were completed by parents/guardians of children classified as anemia non-improvers.

RESULTS AND CONCLUSIONS

A majority of the respondents were the child's parent (97%). Most of the children were Hispanic/Latino (77%). More non-improvers than improvers were of young age (p < 0.01), had a parent/guardian who was 18-30 years of age (p < 0.01), lived in a household with four or more other children (p = 0.05) and were from households with a very low income (p = 0.03). Compared to improvers, non-improvers ate fewer snacks (p = 0.01) and a greater percentage never consumed dried fruits (p < 0.01). Knowledge level of the parents/guardians was similar for the two groups. A high percentage of parents/guardians of non-improvers incorrectly believed that their child's condition had improved. WIC staff and other public health educators can utilize these findings to identify those children with anemia who are at higher risk for non-improvement.

The readability of American Academy of Pediatrics patient education brochures

INTRODUCTION

The purpose of this study was to evaluate the readability of American Academy of Pediatrics (AAP) patient education brochures.

METHOD

Seventy-four brochures were analyzed using two readability formulas.

RESULTS

Mean readability for all 74 brochures was grade 7.94 using the Flesch-Kincaid formula, and grade 10.1 with SMOG formula (P = .001). Using the SMOG formula, no brochures were of acceptably low (< or =8th grade) readability levels (range 8.3 to 12.7). Using the Flesch-Kincaid formula, 41 of the 74 had acceptable readability levels (< or =8th grade). The SMOG formula routinely assessed brochures 2 to 3 grade levels higher than did the Flesch-Kincaid formula.

DISCUSSION

Some AAP patient education brochures have acceptably low levels of readability, but at least half are written at higher than acceptable readability levels for the general public. This study also demonstrated statistically significant variability between the two different readability formulas; had only the SMOG formula been used, all of the brochures would have had unacceptably high readability levels. Readability is an essential concept for patient education materials. Professional associations that develop and market patient education materials should test for readability and publish those readability levels on each piece of patient education so health care providers will know if the materials are appropriate for their patients.

Why carve up your continuous data?

Continuous data are commonplace in social, biophysical, and health research. For various reasons, researchers often carve up data into ordered chunks. Such data carving results in less information being carried by the data, a reduction or spurious increase in statistical power, and resultant Type I or Type II errors. We give examples of data carving in selected nursing literature, and illustrate how unnecessary categorization can produce erroneous statistical results. Finally, we propose credible alternatives to data carving.

Patient-oriented strategies for the prevention of drug interactions

Drug interactions are a common and serious problem arising from polypharmacy. Strategies to reduce the likelihood of the co-prescription of hazardous drug combinations are likely to enhance the quality of care provided for patients requiring polypharmacotherapy. Drugs for which patient-oriented information strategies may decrease the likelihood of drug interactions tend to be those of low therapeutic index. and have interaction potential with other drugs commonly prescribed or available without prescription.

Relationships among educational material readability, client literacy, perceived beneficence, and perceived quality

Illiteracy remains a pervasive problem that compromises quality health care, limits understanding of health information, and potentially leads to poor health outcomes. This study demonstrated that participants' measured reading level was significantly lower than both their stated years of education and readability of an educational pamphlet. A positive relationship was identified between measured reading level and pamphlet helpfulness (client-perceived beneficence). Participants perceived care quality as good to very good. Quality client education requires use of either educational materials appropriate for the measured reading level of clients or alternatives to written material.

Test of an educational brochure on advance directives designed for well-elderly people

The aim of this study was to test an advance directive brochure designed especially for well-elderly people. The brochure was developed using information from literature on preparing educational materials and from information gained from well-elderly focus groups. The information sought was in regard to what they knew and what they wanted to know about advance directives and what they found appealing in brochures on advance directives. Twenty well-elderly people participated in the study. Prior to data collection, the brochure was given to 10 nurses who were asked to evaluate it according to the Bernier Instructional Design Scale 2. Out of a possible 280 points, the brochure received 244. The participants in the study were asked to read the brochure and answer 15 questions about the content, user friendliness, and attractiveness of the brochure. The overall results were positive. The first five questions had to do with the appearance of the brochure. All 20 participants responded favorably to these questions. The next 10 questions had to do with understanding the content. A simple percentage was used to calculate the results. The participants understood 90.5% of the content. Based on these results, the brochure should be used in future intervention research and in discussions regarding the education of well-elderly people and the drafting of advance directives.