Imagined anatomy and other lessons from learner verification interviews with Mexican immigrant women

Developing a Cancer Prevention Health Education Resource: a Primer of Process and Evaluation

Limited women's health and cancer prevention materials are available that have been validated for vulnerable populations. Such materials are especially important for groups, which have intermittent and typically low-quality healthcare access and are at greatest risk for missing out on women's health and cancer prevention screening. Health education materials are developed from heterogeneous sources. Clinical and research teams have minimal guidance in terms of sources, timelines, outputs, and evaluation in the development of such materials. The goal of this paper is to share our process in developing and evaluating an up-to-date women's health and cancer prevention learning guide appropriate for a target population of women involved in the criminal justice system. A ten-page learning guide was drafted using the current evidence-based data, with the objective of providing educational material on four topics: cervical cancer, breast cancer, sexually transmitted infection, and unintended pregnancy prevention. The learning guide was then tested on a convenience sample of 33 women at a local county jail. Feedback was organized into three parts in which the participants Responded to open-ended question, "What is missing?" Rated each of the four topics for design and content Completed a usability assessment Common themes were participants' interest in learning about side effects of birth control and wanting more information on testing and treatment, specifically for sexually transmitted infections (STIs). Women were satisfied with the cancer prevention information presented to them. This report provides a framework for cancer prevention researchers who are developing health education materials for vulnerable populations.

Learner Verification: A Methodology to Create Suitable Education Materials

Background:

Learner verification and revision (LV&R) is a research methodological approach to inform educational message design with the aim of producing suitable, actionable, and literacy appropriate messages to aid in awareness, adoption of healthy behaviors, and decision-making. It consists of a series of participatory steps that engage users throughout materials development, revision, and refinement. This approach is congruent with Healthy People 2030 communication objectives to improve access to information among diverse, multicultural, multilingual populations, and enhance health care quality toward health equity.

Brief description of activity:

To illustrate LV&R, we describe its use in three cancer education projects that produced targeted information about (1) inherited breast cancer among African Americans (brochure); (2) colorectal cancer screening among Latinos (photo novella and DVD); and (3) smoking-relapse prevention among patients receiving cancer treatment (video). We discuss rationale for its application in the three exemplars and extrapolate lessons learned from our experiences when using this approach.

Implementation:

A qualitative approach entailing individual or group-based discussions helped to examine the elements of learner verification (i.e., attraction, comprehension, self-efficacy, cultural acceptability, persuasion). The following steps are reported: (1) preparation of materials, interview guide, and recruitment; (2) interviewing of participants; and (3) evaluation of responses. Data were analyzed by use of a coding system that placed participant responses from each of the elements into data summary matrices. Findings informed revisions and refinement of materials.

Results:

LV&R was effectively applied across the three cancer education projects to enhance the suitability of the materials. As a result, the materials were improved by using clearer, more salient language to enhance comprehension and cultural acceptability, by integrating design elements such as prompts, headers, and stylistic edits to reduce text density, incorporating preferred colors and graphics to improve aesthetic appeal, and including actionable terms and words to bolster motivation and self-efficacy.

Lessons learned:

Results suggest that LV&R methodology can improve suitability of education materials through systematic, iterative steps that engage diverse, multicultural, multilingual populations. This approach is a critical participa-tory strategy toward health equity, and is appropriate in a variety of education, research, and clinical practice settings to improve health communications. [HLRP: Health Literacy Research and Practice. 2021;5(1):e49–e59.]

Plain Language Summary:

This article describes the use of a systematic approach called “learner verification” used for developing educational materials. This approach involves obtaining feedback from audience members to ensure that the information is understandable, attractive in design, motivating, and culturally relevant.

Variation in Cervical Cancer Screening Preferences among Medically Underserved Individuals in the United States: A Systematic Review

Underutilization of effective screening is one driver of disparities in cervical cancer incidence and mortality. Consideration of patient preferences could help to improve screening rates in populations facing substantial barriers to preventive care. We conducted a systematic review of the literature on cervical cancer screening preferences among medically underserved patients in the United States. We searched six electronic databases (PubMed, Web of Science, EMBASE, Scopus, CINAHL, and PsycINFO) for articles published through February 2019 (Prospero ID: CRD42019125431). Among the 43 articles included, 23 reported screening modality preferences, 11 reported preferences related to provider demographics and attributes, six reported screening scheduling and results delivery preferences, and nine reported preferences related to health education and communication. This review demonstrates the wide variety of medically underserved patient preferences related to cervical cancer screening. It also draws attention to two key preference trends that emerged despite heterogeneity in study design, populations, and preference assessment. Consistent preferences for human papillomavirus self-testing over traditional Pap testing highlight a key potential mechanism for increasing cervical cancer screening uptake among medically underserved populations. In addition, preferences for gender- and language-concordant providers underscore the need for continued efforts toward expanding diversity among medical professionals.

Health Literacy and Cervical Cancer Screening Among Mexican-American Women

BACKGROUND

Health literacy is a requisite skill for making personal health and health care decisions. Low health literacy may contribute to lower cervical cancer screening rates and cervical cancer health disparities among Mexican-American women in South Texas.

OBJECTIVE

To explore older Mexican-American women's health literacy related to cervical cancer from the perspective of Zarcadoolas, Pleaseant, and Greer's health literacy model.

METHODS

We conducted five focus groups and seven individual interviews with 30 Mexican and Mexican-American women in South Texas. We analyzed demographic data using descriptive statistics and conducted thematic analysis of focus group and individual interview data.

KEY RESULTS

Several themes reflected the domains of health literacy, including fundamental literacy ("speaking of language"), science literacy (cancer prevention), cultural literacy ("we are different"), civic literacy (the availability of "consejos" [advice]), and media literacy (e.g., "telenovelas" [soap-operas] teach a lot). In this article, we present findings related to culture and language under the domains of fundamental and cultural literacy.

CONCLUSIONS

Mexican-American women's cultural values and language use may serve as both deterrents and incentives to cervical cancer screening. The meaning of words can be lost in translations. Health care providers can use this information to provide cervical cancer screening education congruent with Mexican-American's culture, language, and code switching. [HLRP: Health Literacy Research and Practice. 2019;3(1):e1-e8.].

PLAIN LANGUAGE SUMMARY

The understanding of culture and language can help health care providers improve cervical cancer screening practices among Mexican-American women. The results from this study can be used to individualize patient care and to develop education and communication strategies that are similar to the population we serve, including Mexican-American women.

Development of a Targeted Smoking Relapse-Prevention Intervention for Cancer Patients

We describe the series of iterative steps used to develop a smoking relapse-prevention intervention customized to the needs of cancer patients. Informed by relevant literature and a series of preliminary studies, an educational tool (DVD) was developed to target the unique smoking relapse risk factors among cancer patients. Learner verification interviews were conducted with 10 cancer patients who recently quit smoking to elicit feedback and inform the development of the DVD. The DVD was then refined using iterative processes and feedback from the learner verification interviews. Major changes focused on visual appeal, and the inclusion of additional testimonials and graphics to increase comprehension of key points and further emphasize the message that the patient is in control of their ability to maintain their smoking abstinence. Together, these steps resulted in the creation of a DVD titled Surviving Smokefree®, which represents the first smoking relapse-prevention intervention for cancer patients. If found effective, the Surviving Smokefree® DVD is an easily disseminable and low-cost portable intervention which can assist cancer patients in maintaining smoking abstinence.

A randomized controlled trial of a smoking cessation self-help intervention for dual users of tobacco cigarettes and E-cigarettes: Intervention development and research design

Electronic Nicotine Delivery Systems, also called electronic cigarettes or e-cigarettes, have been available for over a decade and use has been increasing dramatically. The primary reported reasons for use are to aid smoking cessation or reduction, yet a significant proportion appear to be long-term users of both products ("dual users"). Dual users may be motivated to quit smoking and might benefit from a behavioral intervention for smoking cessation. This paper describes the intervention development, as well as the design, methods, and data analysis plans for an ongoing randomized controlled trial (RCT). Formative research and learner verification were conducted to create a usable, understandable, and acceptable self-help intervention targeting dual users. The efficacy is being tested in an RCT with current dual users (N=2900) recruited nationally and randomized to one of three conditions. The Assessment Only (ASSESS) group only completes assessments. The Generic Self-Help (GENERIC) group receives non-targeted smoking cessation booklets and supplemental materials sent monthly over 18months. The e-cigarette Targeted Self-Help (eTARGET) group receives the newly developed intervention (targeted booklets and supplemental materials) sent over the same period. All participants complete self-report surveys every 3months over 2years. The primary study outcome is self-reported 7-day point prevalence abstinence. Cost-effectiveness metrics for the GENERIC and eTARGET interventions will also be calculated.

Experiences and preferences of care among Swedish immigrants following a prenatal diagnosis of congenital heart defect in the fetus: a qualitative interview study

Background

Immigrants experience significant challenges when in contact with healthcare and report less satisfaction with maternity care compared to native Swedes. Research that gives voice to pregnant immigrant women and their partners following a prenatal diagnosis of a fetal anomaly is scarce. Thus, the aim of this study was to explore experiences and preferences of care following a prenatal diagnosis of congenital heart defect among Swedish immigrants.

Methods

Pregnant immigrants and their partners were consecutively recruited following a prenatal diagnosis of a congenital heart defect in the fetus. Nine respondents were interviewed in five interviews, four with the aid of a professional interpreter. The material was analyzed using manifest qualitative content analysis.

Results

The analysis resulted in five categories: 1) “Trustworthy information”, 2) “Language barriers”, 3) “Psychosocial situation”, 4) “Peer support”, and 5) “Religious positions”.

Conclusion

The potential need for interpreter services, visual information, psychosocial support, coordination with welfare officers, and respect for religious positions about termination of pregnancy are all important aspects for health professionals to consider when consulting immigrants faced with a prenatal diagnosis of fetal anomaly in the fetus. Peer support within this context needs to be further explored in future studies.

Wellness and illness self-management skills in community corrections

Community corrections provide a readjustment venue for re-entry between incarceration and home for inmates in the US corrections system. Our goal was to determine how self-management skills, an important predictor of re-entry success, varied by demographic and risk factors. In this cross-sectional study, we analyzed responses of 675 clients from 57 community corrections programs run by the regional division of the Federal Bureau of Prisons. A self-administered survey collected data on self-management skills, demographics, and risk factors; significant associations were applied in four regression models: the overall self-management score and three self-management subscales: coping skills, goals, and drug use. Over one-quarter (27.2%/146) of participants had a mental health history. White race, no mental health history and high school education were associated with better overall self-management scores; mental health history and drug use in the past year were associated with lower coping scores; female gender and high school education were associated with better self-management goals; female gender was associated with better self-management drug use scores. Self-management programs may need to be individualized for different groups of clients. Lower scores for those with less education suggest an area for targeted, nurse-led interventions.