A readability analysis of Australian stroke information

Supporting Cancer Survivors Following Treatment for Non-Hodgkin's and Hodgkin's Lymphoma: A Pilot Study Assessing the Feasibility and Process Outcomes of a Nurse-Led Intervention

OBJECTIVE

Lymphoma is the sixth most common cancer in Australia and comprises 2.8% of worldwide cancer diagnoses. Research targeting development and evaluation of post-treatment care for debilitating complications resulting from the disease and its treatment is limited. This study aimed to assess the feasibility and acceptability of a nurse-led survivorship intervention, post-treatment in Hodgkin's and non-Hodgkin's lymphoma survivors.

METHODS

A single-center, prospective, 3-arm, pilot, randomized controlled, parallel-group trial was used. People with lymphoma were recruited and randomized to the intervention (ENGAGE), education booklet only, or usual care arm. Participants receiving ENGAGE received an educational booklet and were offered 3 consultations (via various modes) with a cancer nurse to develop a survivorship care plan and healthcare goals. Participant distress and intervention acceptability was measured at baseline and 12-wk. Acceptability was measured via a satisfaction survey using a 11-point scale. Feasibility was measured using participation, retention rates, and process outcomes. Data were analyzed using descriptive statistics.

RESULTS

Thirty-four participants with HL and NHL were recruited to the study (11 = intervention, 11 = information only, 12 = usual care). Twenty-seven participants (79%) completed all time points from baseline to 12 wk. Seven (88%) of the 8 participants receiving ENGAGE completed all consultations using various modes to communicate with the nurse (videoconference 14/23, 61%; phone 5/23, 22%; face-to-face 4/23, 17%). Participants who completed the intervention were highly satisfied with ENGAGE.

CONCLUSION

The ENGAGE intervention is feasible and highly acceptable for lymphoma survivors. These findings will inform a larger trial assessing effectiveness and cost effectiveness of ENGAGE.

Patient Perceptions of the Quality of Information Provided in a Hospital Stroke Rehabilitation Unit

This study explored the extent, source and format of the information received by stroke rehabilitation patients and their perceptions of the quality of that information. Additionally, the readability levels of the written materials received were assessed. Fifteen patients were interviewed approximately 1.8 months post-inpatient rehabilitation.

Occupational therapists were the principal sources of information about returning home, equipment/ assistive devices, activities/exercise after stroke and the physical effects of stroke. The patients wanted additional information on the following topics that occupational therapists can address: treatments after stroke, the causes of stroke, risk factors/future prevention, stroke support groups, what to expect in rehabilitation and emotional problems/ difficulties during recovery.

Most information was verbal. Although 70% of the patients felt that they had not received enough information and 87% identified gaps in what they had received, the information was considered relevant to their needs, easy to read/understand and helpful in coping with lifestyle changes. Two-thirds had received written information, written at an average grade 12 equivalent; this was a level too high for educating lay people about health.

The implications for occupational therapists are that general information may be being provided at the expense of the information of most importance to the patients. Occupational therapists should assess and address patients' informational needs and identify the patients' preferred formats for receiving the information. The assessment of readability is also useful.

The Suitability of Written Education Materials for Stroke Survivors and Their Carers

This study evaluated the suitability of written materials for stroke survivors and their carers. Twenty stroke survivors and 14 carers were interviewed about the stroke information they had received and their perceptions of the content and presentation of materials of increasing reading difficulty. The mean readability level of materials (grade 9) was higher than participants' mean reading ability (grade 7-8). Satisfaction with materials decreased as the content became more difficult to read. Seventy-five percent reported that their information needs were not met in hospital. More stroke survivors with aphasia wanted support from health professionals to read and understand written information, and identified simple language, large font size, color, and diagrams to complement the text as being important features of written materials. Simple materials that meet clients' information needs and design preferences may optimally inform them about stroke.

Written Education Materials for Stroke Patients and Their Carers: Perspectives and Practices of Health Professionals

Inadequacies in the provision of written education materials to stroke patients and their carers have been reported. In this study, 20 stroke team health professionals were surveyed regarding their use of and perspectives on written education materials. Seventy percent of participants provided materials to 25% or fewer stroke patients and 90% believed that patients and carers are only occasionally or rarely provided with sufficient written information. Health professionals were uncertain which team members provided written information and identified the need to improve the quality of materials used. Stroke teams should implement a system that facilitates the routine provision of quality written materials to patients and carers, communication among team members, and documentation and verbal reinforcement of the information provided.

Frequency of symptoms and health seeking behaviours of menopausal women in an out-patient clinic in Port Harcourt, Nigeria

OBJECTIVES

This study was carried out to determine the frequency and severity of menopausal symptoms and health seeking behaviour of women with menopausal symptoms attending the General Outpatient Department of the University of Port Harcourt Teaching Hospital.

METHODS

This is a cross-sectional, descriptive study in which data was collected from menopausal women using a three-part, pre-tested questionnaire for a period of three months (July-September 2010). Part 1 consisted of information regarding socio-demographic and general medical information. Part 2 consisted of the modified version of the menopause rating scale (MRS). Part 3 sought for information on their health seeking behaviour. Data was analysed using EPI INFO version 6.04d software package.

RESULTS

A total of 385 women were recruited with ages ranging from 35 to 95 years, and a mean of 58.4 ± 10.39 years. The most prevalent menopausal symptoms were loss of libido (92.47%), muscle pain (87.53%), joint pain (85.45%) and tiredness (80.26%). Urinary symptoms had the least prevalence (7.79%). Results on the severity of menopausal symptoms showed that 28.25%, 49.84% and 21.9% were experiencing severe, moderate and mild menopausal symptoms, respectively. Loss of libido (79.21 %) was the most severe symptom followed by urinary symptoms (40%). The patent drug dealers were the most consulted (51.4%) followed by health workers (44.7%). The traditional healers were consulted by a small percentage (3.8%).

CONCLUSION

The most common menopausal symptom among the patients in this study was loss of libido and the least common was urinary symptoms. The symptoms are similar to findings in other parts of the world but their prevalence and severity differ. In spite of the available health facilities in these communities, the utilization of the services of patent drug dealers is still very high but the traditional healers were poorly utilized.

Quality and readability of information materials for people with brain tumours and their families

Written information is commonly used to inform patients about their disease and treatment but must be evidence-based and understandable to be useful. This study assessed the quality of the content and the readability of information brochures for people affected by brain tumours. We randomly selected 18 publicly available brochures. Brochures were assessed by criteria to assess the quality of content using the DISCERN instrument. Readability was tested using three commonly used formulas, which yield the reading grade level required to comprehend the brochure (sixth grade level recommended). The mean overall DISCERN score was 3.17 out of a maximum of 5 (moderate quality); only one achieved a rating greater than 4 (high quality). Only one brochure met the sixth grade readability criteria. Although brochures may have accurate content, few satisfied all of the recommended criteria to evaluate their content. Existing brochures need to be critically reviewed and simplified and consumer-focused brochures, produced.

Assessing the suitability of written stroke materials: an evaluation of the interrater reliability of the suitability assessment of materials (SAM) checklist

PURPOSE

Written materials are frequently used to provide education to stroke patients and their carers. However, poor quality materials are a barrier to effective information provision. A quick and reliable method of evaluating material quality is needed. This study evaluated the interrater reliability of the Suitability Assessment of Materials (SAM) checklist in a sample of written stroke education materials.

METHODS

Two independent raters evaluated the materials (n = 25) using the SAM, and ratings were analyzed to reveal total percentage agreements and weighted kappa values for individual items and overall SAM rating.

RESULTS

The majority of the individual SAM items had high interrater reliability, with 17 of the 22 items achieving substantial, almost perfect, or perfect weighted kappa value scores. The overall SAM rating achieved a weighted kappa value of 0.60, with a percentage total agreement of 96%.

CONCLUSION

Health care professionals should evaluate the content and design characteristics of written education materials before using them with patients. A tool such as the SAM checklist can be used; however, raters should exercise caution when interpreting results from items with more subjective scoring criteria. Refinements to the scoring criteria for these items are recommended. The value of the SAM is that it can be used to identify specific elements that should be modified before education materials are provided to patients.

The effectiveness of baby books for providing pediatric anticipatory guidance to new mothers

OBJECTIVE

To assess whether embedding pediatric anticipatory guidance into books read to infants is an effective way to educate low-income, first-time mothers about injury-prevention and health-promotion practices.

PATIENTS AND METHODS

Primiparous women (N = 168) were randomly assigned to 1 of 3 groups: an educational-book group; a noneducational-book group; or a no-book group. Knowledge of anticipatory-guidance topics regarding children from birth to 12 months of age (eg, injury prevention, parenting, nutrition) was assessed during the third trimester of pregnancy and again when infants were approximately 2, 4, 6, 9, 12, and 18 months of age.

RESULTS

Women in the educational-book group scored consistently higher on knowledge than did those in the other 2 groups. Those in the educational-book group were found to have significantly higher knowledge scores than those in both the noneducational-book group (effect size [ES]: 0.3, P < .001) and the no-book group (ES: 0.3, P < .001) in the longitudinal model.

CONCLUSIONS

Books read by mothers to infants seem to be an effective way to provide anticipatory guidance to new mothers. However, future work is needed to determine if increased knowledge translates into safer and more developmentally appropriate parenting practices.

Stroke education: retention effects in those at low- and high-risk of stroke

OBJECTIVE

Relatively few studies have tracked retention effects of stroke education in low- and high-risk groups. Such information is important to improve the design of stroke prevention programs.

METHODS

The frequency of risk factors within the sample was defined as "high" if 30% or more of participants in that group had that risk. Only one stroke risk factor was present at this level in the low-risk group (n=29; all less than 50 years old). The high-risk group was 44 individuals aged 50 years or over, with four stroke risk factors present at this level. Stroke knowledge was tested on three occasions: baseline, post-education, and retention. Education consisted of reading a published stroke brochure.

RESULTS

Stroke knowledge improved over time, from baseline to post-education, but not from post-education to retention. The performance of both groups increased, but there was a differential learning effect: low-risk participants learned more than high-risk participants. Important information was learned and included details such when TIA symptoms dissipate. This particular issue was one about which both groups knew little at baseline (less than 15% of combined sample answered this item correctly), but post-education at least 75% of participants got this question correct.

CONCLUSION

Both low- and high-risk individuals can learn information about stroke and retain it over the short term. The "durable" effects in learning observed in this study are important because the benefit of brochure-only approaches to education have not yet been convincingly demonstrated.

PRACTICE IMPLICATIONS

Information about stroke from education brochures is retained by at-risk populations for at least 1 week.

Developing a stroke intervention program: what do people at risk of stroke want?

OBJECTIVE

There is currently little research examining what individuals who are at risk of a stroke want from an invention program. In order to increase the usefulness of such programs, qualitative research methods were used explore invention design issues such as factors affecting accessibility of programs and preferred health information sources.

METHODS

Thirty people, each with at least one stroke risk factor, participated in one of eight focus groups.

RESULTS

Broad support was indicated for our proposed intervention. Participants perceived the value and likely success of such a program enhanced if it: (a) was integrated with, and supported by, other respected health services; (b) included social components (particularly important to women); (c) produced long-term benefits; and (d) included information that was personally relevant and practical in terms of implementing change. Three reasons emerged for continuing stroke education campaigns as a component of intervention programs; these were: (a) a lack of awareness among some participants of gaps in their stroke knowledge; (b) participants' explicit requests for specific rather than general information; and (c) the apparent failure of some participants to self-identify as at risk.

CONCLUSION

This study yielded a number of important design considerations that should be taken into account when developing stroke intervention programs.

PRACTICE IMPLICATIONS

We discuss ways of maximising the personal relevance of stroke prevention information along theoretically important dimensions, and consumers' recommendations for the design and delivery of stroke intervention programs.