Limited literacy revisited implications for patient education

Identifying gaps in consumer health library collections: a retrospective review

Background:

The objective of this study was to determine if search request forms, which are used when a patron's request for information cannot be fulfilled at the time of contact with the library team, can be used to identify gaps in consumer health library collections.

Case Presentation:

Search request forms were collected from 2013 to 2020 and analyzed independently by two reviewers. Search request forms were included if they were complete and contained a record of how the request was fulfilled. Descriptive statistics were used to summarize patron characteristics. Search request forms were iteratively coded to identify themes in the data and determine if resources provided to patrons could be found within the library collection. The study team subsequently reviewed search request forms to determine reasons for identified gaps. Two hundred and forty-nine search request forms were analyzed. Six main content themes were identified: 1) understanding the cancer diagnosis, 2) cancer treatments, 3) understanding disease prognosis, 4) support during and after treatment, 5) natural health products and therapeutic effects in oncology, and 6) research literature. The majority of patrons were patients (53%). Over half (60%) of the submitted search request forms reflected collection gaps, and many (16%) contained queries for information about rare cancer diagnoses. The main reason that queries could not be satisfied was that there was limited consumer health information on the requested topics (53%).

Conclusions:

Search request forms are a useful resource for assessing gaps in consumer health library collections.

A Strategy Study on Risk Communication of Pandemic Influenza: A Mental Model Study of College Students in Beijing

Purpose

To understand the characteristics of risk perception of influenza pandemic in college students with prominent frequency and the differences between these risk perceptions and professionals. Then, offering a proposal for the government to improve the efficiency of risk communication and health education.

Methods

According to the mental model theory, researchers first draw a framework of key risk factors, and then they ask these students about the understanding of the framework with questionnaire and then making concept statistics and content analysis on the respondents’ answers.

Results

Researchers find some students’ misunderstanding of pandemic including excessive optimism to the consequences of a pandemic, a lack of detailed understanding of mitigation measures, and negative attitudes towards health education and vaccination. Most students showed incomplete and incorrect views about concepts related to the development and exposure factors, impact and mitigation measures. Once threatened, it may lead to the failure of decision-making. The majority of students we interviewed had positive attitudes towards personal emergency preparedness for a pandemic influenza and specialized health education in the future.

Conclusion

Researchers suggest that the government should make a specific pandemic guidance plan by referring to the risk cognitive characteristics of college students shown in the research results, and update the methods of health education to college students.

How are health literacy principles incorporated into breast cancer chemotherapy education? A review of the literature

BACKGROUND

Chemotherapy is commonly used in combination with other treatments for breast cancer. However, low adherence to chemotherapy is a growing concern, particularly among breast cancer patients. Side effects such as nausea and vomiting, fatigue, and arthralgia can contribute to reduced adherence. Other factors such as provider communication and limited insurance coverage can affect adherence. Studies have shown that as much as 28% of patients with breast cancer did not continue with their prescribed dose of chemotherapy. Research suggests that chemotherapy education materials can be critical to addressing problems with non-adherence, and may include written materials, verbal instruction, and multimedia programs. Despite this wide variety, the effectiveness and benefit of chemotherapy education hinges on the patients' health literacy. Breast cancer patients with low health literacy may be unclear about chemotherapy or face difficulty adhering to treatment if they do not understand the information provided to them. Thus, this scoping review summarizes the existing research on how health literacy principles are incorporated into breast cancer chemotherapy education materials.

METHODS

Using a combination of keywords (e.g. chemotherapy, education) and Medical subject headings (MeSH) terms (e.g., drug therapy, antineoplastic agents), we searched five databases (1977-2017): CINAHL, PubMed, PsycINFO, Cochrane Library, and Web of Science.

RESULTS

Eight of 4,624 articles met the inclusion criteria. Five articles incorporated health literacy principles (e.g., plain language, maintaining an active voice, using white space) into the development of written materials. Few articles used a theoretical framework to guide education material development (n = 3). Of the three articles that described pilot-testing of educational materials, two used post-tests only and one used a pre/post-test design.

CONCLUSIONS

Findings indicated that limited research exists regarding the use of health literacy principles in chemotherapy education materials. Much of the development of chemotherapy education is not grounded in theory and the application of health literacy principles is limited. Implementing health literacy principles may improve overall comprehension of education thereby increasing adherence.

Aphasia friendly written health information: content and design characteristics

People with aphasia need communicatively accessible written health information. Healthcare providers require knowledge of how to develop printed education materials (PEMs) in formats that people with aphasia prefer and can read. This study aimed to explore formatting characteristics considered to be barriers and facilitators to reading PEMs. Semi-structured in-depth interviews were conducted with 40 adults with aphasia who were selected using maximum variation sampling across aphasia severity, reading ability, and time post-stroke. Participants were shown stroke and aphasia PEMs obtained from the recruiting stroke services, asked to rank them from most liked to least liked, and comment on factors that made the PEMs easier and harder to read. The majority of participants ranked the aphasia friendly stroke (56.4%, n = 22) and aphasia (87.2%, n = 34) PEMs as most liked. Forty-five facilitator and 46 barrier codes were identified using qualitative content analysis and grouped into two categories; (1) content characteristics and (2) design characteristics. Findings support many of the recommendations found within the literature for developing best practice PEMs and accessible information for other patient groups. Routine consideration of the facilitators and barriers identified will contribute to making written information more accessible to people with aphasia.

Beyond reading level: a systematic review of the suitability of cancer education print and Web-based materials

Consideration of categories related to reading comprehension--beyond reading level--is imperative to reach low literacy populations effectively. "Suitability" has been proposed as a term to encompass six categories of such factors: content, literacy demand graphics, layout/typography, learning stimulation, and cultural appropriateness. Our purpose was to describe instruments used to evaluate categories of suitability in cancer education materials in published reports and their findings. We searched databases and reference lists for evaluations of print and Web-based cancer education materials to identify and describe measures of these categories. Studies had to evaluate reading level and at least one category of suitability. Eleven studies met our criteria. Seven studies reported inter-rater reliability. Cultural appropriateness was most often assessed; four instruments assessed only surface aspects of cultural appropriateness. Only two of seven instruments used, the suitability assessment of materials (SAM) and the comprehensibility assessment of materials (SAM + CAM), were described as having any evidence of validity. Studies using Simplified Measure of Goobledygook (SMOG) and Fry reported higher average reading level scores than those using Flesh-Kincaid. Most materials failed criteria for reading level and cultural appropriateness. We recommend more emphasis on the categories of suitability for those developing cancer education materials and more study of these categories and reliability and validity testing of instruments.

Preferences among immigrant Hispanic women for written educational materials regarding upper respiratory infections

The need for culturally appropriate health education materials for Hispanic populations has been widely recognized, and Spanish-language materials are available through a number of private and governmental organizations. We convened two focus groups to elucidate preferences regarding how health-related messages are obtained and to identify which educational materials available in Spanish were preferred by 26 recently immigrated Hispanic homemakers who had received 15 different bimonthly written documents as part of a community-based clinical trial to prevent household transmission of colds and influenza. Participants gave three primary reasons for volunteering to participate in the study: to provide better care for their children (96.2%, 25/26), to get information (96.2%, 25/26), and to get free products (47.1%, 8/17). Their primary sources of health-related information were relatives and friends (42.9%, 6/14), clinicians (35.7%, 5/14), mass media (14.3%, 2/14) or the emergency room (7.1%, 1/14); none mentioned the internet. Materials using either a question and answer or true/false format were clearly preferred, even when other options were more colorful or had lower reading levels. Printed educational materials may be ineffective unless they include a more systematic assessment of the user's perceived needs for the information as well as consideration of format. In this population, a question and answer or true/false format and materials that could be shared with their children were greatly preferred.

Comparison of chemotherapy education and patient preferences in community versus academic gynecology oncology clinics

PURPOSE

To evaluate and compare patients' preferences in receiving chemotherapy education from health care teams in community versus academic clinics.

METHODS

Results from a 13-question questionnaire about the chemotherapy education preferences of patients in three community gynecology oncology clinics were compared to the results from a similar study previously conducted in an academic gynecology oncology clinic.

RESULTS

A total of 57% of the 203 community-clinic respondents (116) and 67% of the 282 academic-institution respondents (189) who completed questionnaires had previously received chemotherapy. Of the patients treated in community clinics, almost 60% preferred chemotherapy education to be provided in written form and directly by a health care professional compared to 87% of the patients in academic clinics. Overall, 88% of the patients in the community clinics believed they received adequate information, compared to 63% of the patients in the academic setting. Patients in the community clinics wanted to get more in-depth answers to questions such as 'What is chemotherapy?' (54%) and 'How it is given?' (55%). In addition, community patients also wanted to know more about 'Why chemotherapy stops working?' (72%) and 'What to do and who to call about side effects?' (60%). In the academic setting, patients were less likely to want to know more about these chemotherapy related questions (42, 35, 57, and 49, respectively).

CONCLUSIONS

Patients preferred to receive written chemotherapy education that was reviewed with a healthcare professional and that gave more detailed information about the chemotherapeutic drugs themselves and how to prevent and manage side effects. As a result of this questionnaire, the patient education materials used at our institution will be revised to better address patients' preferences in both treatment settings.

Healthcare organizations, linguistic communities, and the emblematic model of palliative care

The linguistic-communicative paradigm offers some interesting perspectives in a context where the perception of patient needs is considered a critical step in high-quality care. This study describes healthcare organizations as linguistic communities based on the conceptual framework of Habermas' communicative action theory. Four communicative models are present in healthcare settings: objectifying-instrumental (hegemonic model), where elements of interaction are objectified for clinical purposes; dialogic model with strategic perspectives, in which conversations are used unilaterally as tools to access subjective states; non-dialogic-transmissional model, in which linguistic exchanges are replaced with artifacts to transmit information; and full communicative model (present in palliative care based in homecare and informal caregivers, emphasizing health team/family interactions). Based on these premises, we considered palliative care an emblematic communicative model based on multidisciplinary teams devoted to transdisciplinary collaboration. In these settings, linguistic interaction with patients and their families could provide a solid basis for organization of healthcare networks.

Risk communication for public health emergencies

This review defines crisis risk communication, traces its origins to a number of applied fields, and then shows how basic principles have become incorporated into emergency preparedness and risk communication for public health. Literature from four different disciplines that inform crisis risk communications are reviewed. These are (a) environmental risk communication, (b) disaster management, (c) health promotion and communication, and (d) media and communication studies. Current curricula and training materials are briefly reviewed. Although this literature review suggests much progress has been made to incorporate and disseminate crisis risk communication principles into public health practice, and case studies suggest that public health workers have gained skills and experience, this emerging field still lacks in-depth evaluation of the effectiveness of event-specific crisis risk communication efforts.

Meeting information needs on cancer-related fatigue: an exploration of views held by Italian patients and nurses

BACKGROUND

Interest in cancer-related fatigue has been growing over the last two decades and efforts have been dedicated to investigate this topic. However, research addressing the adequacy of educational resources for patients with this distressing and common symptom is lacking. Only one study has been undertaken and this explored Swiss and British patients' views.

MATERIALS AND METHODS

The current study replicated and extended the study previously undertaken in the United Kingdom (UK) and Switzerland. It sought views on the adequacy of materials on cancer-related fatigue available to patients with cancer living in Italy, and to determine the educational preferences and needs of Italian patients with cancer-related fatigue. These were attained through conduct of two focus groups. One was undertaken with Italian patients and the other with a group of Italian nurses.

MAIN RESULTS

Findings from this study supported patients' desire for timely, accurate and individualised information. Barriers to effective fatigue education included the limited dialogue regarding fatigue initiated in clinical settings. It appeared that nurses and patients held different priorities in symptom management. Further, it was acknowledged that there was often insufficient time to inform patients adequately about fatigue. Participants considered written materials as helpful complements to oral information, thus supporting the provision of information in both forms. However, it was clear that fewer written resources concerning cancer-related fatigue were available in Italy compared to either in Switzerland or in the UK.

CONCLUSION

The study supported the view within the current literature that whilst cancer-related fatigue is recognised as a frequent and disruptive symptom, patient education about this symptom and its management still needs to be enhanced. The resources available to educate patients about cancer-related fatigue should be improved and made more accessible to patients who experience it.

Suitability of prostate cancer education materials: applying a standardized assessment tool to currently available materials

Written educational materials serve as important teaching instruments for prostate cancer patients and their families. However, they must be understandable for their intended audiences. We examined prostate cancer brochures and pamphlets using the Suitability Assessment of Materials (SAM) instrument for the materials' overall suitability, readability, and cultural appropriateness. These factors are crucial to ensure that patients are able to understand and relate to the information. Our evaluation of 29 materials demonstrated that the majority, 22 (75.8%), scored "adequate" for their overall suitability. However, 26 materials (90%) scored "not suitable" for their reading grade level, while 55% of the materials could not be rated on cultural appropriateness because of lack of cues about the intended audience. Also, many of the materials scored poorly on content, graphics, self-efficacy, and learning motivation and stimulation. Most of the materials did well with typography and layout. Overall, the findings point to the need to carefully assess written materials used for multicultural audiences with low reading ability.

Comunicação instrumental, diretiva e afetiva em impressos hospitalares

Este trabalho se ocupa dos típicos sistemas semânticos extraídos dos recursos comunicativos de equipes hospitalares, que tentam validar informações como um "objeto" a ser transferido aos pacientes. Descrevemos modelos de comunicação textual em 58 impressos de orientações aos pacientes de cinco unidades hospitalares, coletados de 1996 a 2002. Identificamos três categorias fundamentadas na teoria dos atos de fala (Austin, Searle e Habermas): (1) Proferimentos cognitivo-instrumentais - descrições por meio de termos técnicos validados por argumentação auto-referente, incompleta ou inacessível; função educativa implícita. (2) Proferimentos técnico-diretivos - auto-referentes (contexto dos setores de origem); deslocamento freqüente de atos cotidianos para o terreno técnico com função disciplinadora; impessoalidade. (3) Modulações expressivas: necessidade de conexões intersubjetivas para fortalecer laços de confiança; tendência à infantilização. Concluímos que as categorias estudadas expõem: base em origens fragmentárias; pressupostos de univocidade de mensagens e consumo invariante da informação (motivações e interesses idealizados, alheios às perspectivas individuais); pressuposto de interesses universais como geradores de conhecimento.

[Communication prostheses and behavioral alignment in hospital leaflets]

Review was made of publications that describe experience with printed material distributed to the lay public in hospital institutions. From the 146 leaflets examined, those aimed at professionals or disabled people, thus leaving 75 papers that illustrate the present pattern for the rationality behind the production, use and evaluation of this type of resource. In a general manner, such leaflets invest in the power of "ideal printed information" to align behavior with the hospital's biomedical agenda. The underlying rationality that permeates them perceives the "perfect information package" as one that efficiently describes its technical content for the purpose of unidirectional persuasion, is up-to-date in relation to readability scales and embellished by graphic design, and emphasizes the priorities defined by the professionals. Such "communication prostheses" should be capable of electronic validation by means of software suitable for proportioning the "doses" to the subject matter. Information as a drug, cognitivism, the lack of research on message reception and the need for communicative action for the deconstruction of systems of closed thinking within the hospital environment have been discussed.

Quality and efficacy of educational materials on cancer-related fatigue: views of patients from two European countries

Cancer-related fatigue is a symptom with great implications for the quality of life of those that experience it. It is regarded as one of the most distressing symptoms that people with cancer develop. Its aetiology is complex, and although the mechanisms underlying fatigue have not been fully clarified it is evident that it is exacerbated by treatments intended to cure or palliate the disease. Patients at risk of cancer-related fatigue need access to information that will enable them to manage it effectively. There are a growing number of materials available to patients in different European countries on this topic, but it is unclear how useful patients find these. This study was undertaken to explore this through conducting focus groups with patients in the United Kingdom and Switzerland. One focus group was conducted in each country. Findings from these determined that individuals voiced common concerns: fatigue had not been addressed in the clinical setting - individuals surmised why this occurred; participants had not accessed materials on cancer-related fatigue previously; they made recommendations for future resources for patients. However, what was evident was that unless patients can access materials on this topic, their quality becomes purely an academic issue.

Using the intranet to deliver patient-education materials

Patient education is a critical part of healthcare delivery. Many factors reduce the amount of time nurses can devote to patient teaching. One mode of patient teaching, the use of printed materials, is an efficient and effective way to deliver and reinforce patient education. However, several barriers are associated with the method, including outdated or exhausted supplies of stock materials, expenses related to developing and printing materials, limited storage space, and the inability to locate materials when needed. The authors identified the intranet, an internal network that operates within a larger World Wide Web site, as a potential solution to these barriers. The Outpatient Oncology Clinic and Treatment Center of the Nebraska Health System, a fast-paced care setting in Omaha, agreed to serve as the project pilot area to evaluate using the intranet to generate patient-education materials. Teaching sheets about medication and symptom management, created by the oncology staff, were the first patient-education materials to be made available on the intranet. Advantages of using the intranet for patient education include online storage, decreased costs, easy access, real-time updates and distribution, and unlimited supply availability.

Perspectives on cancer patient education

OBJECTIVES

To provide an overview on cancer patient education.

DATA SOURCES

Literature related to demographic and health care trends, patient education, health literacy, and cancer patient information needs.

CONCLUSIONS

Cancer patients need information related to diagnosis, treatment, side effects, self-care needs, and effects on work and relationships. Planned patient teaching includes a variety of teaching strategies and written materials, and contributes to better patient outcomes. Inadequate health literacy and other barriers present challenges to providing effective patient education.

IMPLICATIONS FOR NURSING PRACTICE

More research is warranted in developing assessment tools and effective health education techniques and in measuring outcomes and costs related to patient education. The education needs of cancer patients will not drastically change in the next century. How nurses meet those needs, however, will change as we apply new learning theories and technologies of teaching.