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

Development of a Website for Disseminating Knowledge About listening Effort for Professionals

Introduction  Permanent education in health aims to ensure that professionals are constantly learning in the workplace and in the last few years institutions resorted to the technology-mediated education modality and new teaching possibilities were explored. In Brazil, between 2017 and 2021, only six articles and five monographs were published about listening effort. Objective  The objective of this study was to develop a website with scientific content on the topic listening effort for Speech -Language Therapist and Audiologist with free online access. Methods  The study was carried out in five stages: Analysis, contemplating the search for scientific materials to prepare the material. Design, in which the writing and design of the website was carried out. Development, carrying out the adequacy of the online material. Implementation, a stage in which professionals in the area evaluated the quality of the material after consenting to participation through a free and informed consent term. Review, stage in which the researcher analyzed the evaluators' responses. Results  The five stages of elaboration of the website were carried out, which was evaluated by professionals in the area. The average of responses to all applied questions rated the website as "superior". Conclusion  The website development was validated for online availability.

Participatory approaches for developing a practical handbook integrating health information for supporting individuals with mild cognitive impairment and their families

AIM

This study aimed to develop a patient-centred handbook that integrates information on lifestyle modifications and psychological support strategies for individuals with mild cognitive impairment (MCI). This article provides a comprehensive record of the development process.

METHODS

We adopted a participatory research model for the methodology, which comprised five phases and involved an interdisciplinary team specializing in dementia and health literacy. Data were initially collected via interviews conducted among patients with MCI (n = 5) and their families (n = 5). Given the study's preliminary nature, depth and richness of the qualitative data were the key concerns for determining the sample size, rather than broad generalizability. We ensured the inclusion of diverse experiences and perspectives by facilitating the creation of patient questions (PQs) that merged scientific evidence with patient perspectives. To enhance the handbook's accessibility and utility, we continuously evaluated the same using patient interviews, health literacy tool assessments and team discussions. This comprehensive approach harmonized scientific knowledge and patient experience, leading to the development of a personalized MCI management guide.

RESULTS

The handbook comprises nine domains, encompassing 38 selected PQs: MCI, lifestyle, lifestyle-related diseases, exercise, nutrition, social participation, cognitive training, psychological care and family support. The health literacy handbook was evaluated based on Clear Communication Index scores. The results revealed that 73.7% of the PQs were deemed difficult prerevision, whereas only 5.3% remained challenging postrevision. The formative evaluation underscored the need for more detailed explanations prerevision, whereas postrevision comments focused primarily on editorial suggestions.

CONCLUSION

The inclusion of patients' perspectives right from the outset ensured that the handbook met their specific needs. The final version, which reflects all stakeholders' inputs, is now slated for imminent publication.

PATIENT OR PUBLIC CONTRIBUTION

Patients and the public participated extensively throughout the project, from initial interviews to material evaluation and refinement.

The Chinese Version of the Patient Education Materials Assessment Tool for Printable Materials: Translation, Adaptation, and Validation Study

BACKGROUND

Providing people with understandable and actionable health information can considerably promote healthy behaviors and outcomes. To this end, some valid and reliable scales assessing the patient-friendliness of health education materials, like the PEMAT-P (Patient Education Materials Assessment Tool for printable materials), have been well developed in English-speaking countries. However, the English version of the PEMAT-P has not been translated and adapted into simplified Chinese and validated in mainland China.

OBJECTIVE

This study sought to translate the PEMAT-P tool into a simplified Chinese (Mandarin) version (C-PEMAT-P, a Chinese version of the Patient Education Materials Assessment Tool for printable materials) and verify its validity and reliability for assessing the comprehensibility and actionability of health education resources written in simplified Chinese. As a result, the validated C-PEMAT-P could be used to guide health researchers and educators to design more comprehensible and actionable materials for more tailored and targeted health education and interventions.

METHODS

We translated the PEMAT-P into simplified Chinese in the following three steps: (1) forward-translating the PEMAT-P into simplified Chinese, (2) back-translating the simplified Chinese version into English, and (3) testing translation equivalence linguistically and culturally by examining the original English version of the PEMAT-P and the back-translated English version of the tool. Any discrepancies between the original English tool and the back-translated English tool were resolved through a panel discussion among the research team of all authors to produce a revised forward-translated Chinese version (C-PEMAT-P). We then evaluated the clarity of construction and wording as well as the content relevance of the C-PEMAT-P using a 4-point ordinal scale to determine its content validity. After that, 2 native Chinese speakers (health educators) used the C-PEMAT-P to rate 15 health education handouts concerning air pollution and health to validate their reliability. We calculated the Cohen coefficient and Cronbach α to determine the interrater agreement and internal consistency of the C-PEMAT-P, respectively.

RESULTS

We finalized the translated Chinese tool after discussing the differences between the 2 English versions (original and back-translated) of the PEMAT-P, producing the final Chinese version of the PEMAT-P (C-PEMAT-P). The content validity index of the C-PEMAT-P version was 0.969, the Cohen coefficient for the interrater scoring agreement was 0.928, and the Cronbach α for internal consistency was .897. These values indicated the high validity and reliability of the C-PEMAT-P.

CONCLUSIONS

The C-PEMAT-P has been proven valid and reliable. It is the first Chinese scale for assessing the comprehensibility and actionability of Chinese health education materials. It can be used as an assessment tool to evaluate health education materials currently available and a guide to help health researchers and educators design more comprehensible and actionable materials for more tailored and targeted health education and interventions.

An evaluation of the suitability, readability, quality, and usefulness of online resources for patients with cancer receiving immunotherapy

OBJECTIVE

To evaluate the suitability, readability, quality, and usefulness of available online resources about the side effects of immunotherapy.

METHODS

Resources were identified through online searches (Google, Microsoft Bing, and Yahoo search engines) and evaluated using the Suitability Assessment Materials (SAM), three readability formulae, the DISCERN tool (quality), and a checklist of symptom management strategies and self-management skills (usefulness). Hierarchical cluster analysis identified resources scoring highly for suitability and quality. Factors associated with the clusters were identified using Fischer's exact tests.

RESULTS

The 51 resources retained for evaluation were of low suitability and quality and exceeded recommended reading levels. Resources were lacking key features to support learning (e.g., illustrations) as well as information about the risks of treatments and the effect of treatments on quality of life. Few resources addressed key self-management skills of problem-solving and taking action. The cluster analysis identified "low" and "moderate" clusters for suitability and quality, and pamphlets and booklets were more likely to be in the moderate cluster as compared to webpages.

CONCLUSION

There is a lack of high-quality resources to support patients' learning to self-manage side effects of immunotherapy.

PRACTICE IMPLICATIONS

Results identify the best available online resources for self-managing side effects of immunotherapy and gaps for future work. Based on findings, a template for patient education materials was developed.

Translating and Adapting the DISCERN Instrument Into a Simplified Chinese Version and Validating Its Reliability: Development and Usability Study

BACKGROUND

There is a wide variation in the quality of information available to patients on the treatment of the diseases afflicting them. To help patients find clear and accessible information, many scales have been designed to evaluate the quality of health information, including the Patient Education Materials Assessment Tool; the Suitability Assessment of Materials for evaluation of health-related information for adults; and DISCERN, an instrument for judging the quality of written consumer health information on treatment choices. These instruments are primarily in English. Few of them have been translated and adapted into simplified Chinese tools for health information assessment in China.

OBJECTIVE

This study aimed to translate and adapt DISCERN into the first simplified Chinese version and validate the psychometric properties of this newly developed scale for judging the quality of patient-oriented health information on treatment choices.

METHODS

First, we translated DISCERN into simplified Chinese using rigorous guidelines for translation and validation studies. We tested the translation equivalence and measured the content validity index. We then presented the simplified Chinese instrument to 3 health educators and asked them to use it to assess the quality of 15 lung cancer-related materials. We calculated the Cohen κ coefficient and Cronbach α for all items and for the entire scale to determine the reliability of the new tool.

RESULTS

We decided on the simplified Chinese version of the DISCERN instrument (C-DISCERN) after resolving all problems in translation, adaptation, and content validation. The C-DISCERN was valid and reliable: the content validity index was 0.98 (47/48, 98% of the items) for clarity and 0.94 (45/48, 94% of the items) for relevance, the Cronbach α for internal consistency was .93 (95% CI 0.699-1.428) for the whole translated scale, and the Cohen κ coefficient for internal consistency was 0.53 (95% CI 0.417-0.698).

CONCLUSIONS

C-DISCERN is the first simplified Chinese version of the DISCERN instrument. Its validity and reliability have been attested to assess the quality of patient-targeted information for treatment choices.

Patient education information material assessment criteria: A scoping review

BACKGROUND

Patient education information material (PEIM) is an essential component of patient education programs in increasing patients' ability to cope with their diseases. Therefore, it is essential to consider the criteria that will be used to prepare and evaluate these resources.

OBJECTIVE

This paper aims to identify these criteria and recognize the tools or methods used to evaluate them.

METHODS

National and international databases and indexing banks, including PubMed, Scopus, Web of Science, ProQuest, the Cochrane Library, Magiran, SID and ISC, were searched for this review. Original or review articles, theses, short surveys, and conference papers published between January 1990 and June 2022 were included.

RESULTS

Overall, 4688 documents were retrieved, of which 298 documents met the inclusion criteria. The criteria were grouped into 24 overarching criteria. The most frequently used criteria were readability, quality, suitability, comprehensibility and understandability.

CONCLUSION

This review has provided empirical evidence to identify criteria, tools, techniques or methods for developing or evaluating a PEIM. The authors suggest that developing a comprehensive tool based on these findings is critical for evaluating the overall efficiency of PEIM using effective criteria.

Assessment of the importance of ostomy patients' understanding of dietary and lifestyle recommendations

OBJECTIVE

the objective of our study was to evaluate the level of understanding of ostomy patients regarding lifestyle, diet, and high output stoma (HOS) management recommendations provided by healthcare professionals.

METHOD

a prospective study to follow up ostomy patients at nutritional consultations was designed. The follow-up process was performed 7-10 days after hospital discharge and again one month later. At the first visit, patients were instructed in the detection and management of HOS. At the second visit, the level of understanding of the training received was assessed using an evaluation questionnaire. A descriptive analysis of the answers to each of the questionnaire's items was performed. Fisher's exact test was used to evaluate differences in the level of understanding recorded with the questionnaire.

RESULTS

a total of 35 patients were recruited; 71.4 % did not provide correct answers to all the questions. There were no significant differences in the correctness of the answers to the questionnaire according to education level.

CONCLUSIONS

many patients do not adequately understand the information provided by healthcare professionals and this could have a negative impact on the incidence of clinical complications.

Content validation of educational materials on maternal depression in Nigeria

Background

This study describes the content validation process of the already developed English and Yoruba (poster and leaflet) and Yoruba (song) maternal depression educational materials in Nigeria.

Methods

This study is a cross sectional study which is a part of a larger study on training and supervision of Primary health care workers. Study utilized health professionals’ judgement for content validation, and maternal-child health clients’ evaluation for face validation with the use of Suitability Assessment of Materials (SAM). Six bilingual professionals validated both English and Yoruba version of materials (Song has only Yoruba version) and 50 clients evaluated each Yoruba material. Validity Index was calculated by formula and inter-rater agreement using intra-class coefficient (ICC) was analyzed on Professionals’ ratings. ICC, ‵t′ test and Pearson correlation were analyzed on professionals’ rating versus randomly selected six clients’ rating. Descriptive statistics, and fisher exact test were used for other statistical analysis with SPSS version 25.

Results

The mean age of the professionals for poster was 44.3 ± 6.0 years, for leaflet 39.8 ± 7.2 years, for song 43.8 ± 8.4 years. For maternal child health clients, mean age is: 30.7 ± 5.4 years for poster; 31.3 ± 5.2 for leaflet and 29.0 ± 5.1 for song. Outcomes of bilingual professionals’ validation are validity index: English {leaflet (0.94), poster (0.94)}, and Yoruba {leaflet (0.94) poster (0.94) and song (1.00)}. More than 80% clients rated the suitability of each material as superior. There is no significant relationship between clients’ sociodemographic characteristics and their ratings across content, literacy demand and cultural appropriateness domains of the three materials on fisher exact test. The inter-rater agreement among the professionals is excellent on leaflet and song ICC > 0.8, but it is weak on the poster ICC < 0.6. There is no inter-rater agreement on all the three Yoruba materials, but a negative linear correlation was found on the leaflet between the professionals’ ratings and the randomly selected clients’ ratings. ‵t′ test found no statistical difference in the ratings of the professionals and clients only on song material.

Conclusion

This study shows the process of validation of the English and Yoruba versions of the educational materials. This process should be leveraged in the content validation of other maternal-child health education materials in Africa.

Breast Implant-Associated Anaplastic Large Cell Lymphoma Online Education Tools: A Multimetric Analysis

PURPOSE

In light of highly publicized media coverage on breast implant recalls and Food and Drug Administration hearings on breast implant safety, online searches of these topics have surged. It is thus critical to determine whether such searches are providing meaningful information for those who use them. Patient/laywomen-directed online education materials on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) must not only be comprehensible but also accurate, actionable, and culturally concordant, especially as more diverse populations turn to the internet for breast implant-related information. This study assessed the overall suitability of BIA-ALCL patient-directed educational text and video-based materials online.

METHODS

This was a cross-sectional, multimetric investigation of online text- and video-based patient-directed educational materials for BIA-ALCL using multiple validated measures. Two reviewers assessed each resource. Kruskal-Wallis and Fisher exact analyses were used as appropriate to compare text- and video-based online resources.

RESULTS

In total, 30 websites and 15 videos were evaluated, more than half (56%) of which were from academic/physician or governmental/nonprofit sources. Overall, website and video content, as well as quality, varied by source. Academic/physician or governmental/nonprofit sources tended to be more comprehensive and have higher-quality information than commercial/media outlet sources. Median actionability of websites was 38%, well below the threshold of 70% used in the literature to identify actionable resources. The median suitability score for BIA-ALCL websites was 57%, which is considered "adequate" based on published thresholds. The mean overall Cultural Sensitivity Assessment Tool score for websites was 2.4; Cultural Sensitivity Assessment Tool scores higher than 2.5 are generally regarded as culturally sensitive. In general, videos were more understandable than websites. Substantial interrater reliability across the validated tools used in this study was noted using Pearson correlation coefficients.

CONCLUSIONS

Online resources varied in content and quality by source. As BIA-ALCL becomes an increasingly salient topic among both providers and patients, it is important to empower women with accurate information about this implant-associated cancer. Of available resources, providers should refer patients or those seeking more information to websites from governmental/academic organizations (".gov" or ".org" domains) and videos from academic/physician or governmental sources, given that among high-quality resources, these were most clear/comprehensible. Overall, there is a need for improved online content on this topic.

Assessing an educational booklet for promotion of healthy lifestyles in sedentary adults with cardiometabolic risk factors

OBJECTIVES

1) To evaluate and improve the suitability and readability of an educational booklet designed for use in an intervention aimed at promoting healthy lifestyles as a way to manage cardiometabolic risk factors in adults with low levels of physical activity and 2) to check its acceptability to real end users.

METHODS

A 7-phase methodology was used. The evaluation committee (9 experts, 6 potential end users) scored the booklet using the Suitability Assessment of Materials (SAM) and health education material (HEM) questionnaires on two occasions (original and revised version). Acceptability was also assessed by 75 real end users after a lifestyle intervention.

RESULTS

The SAM and HEM scores of the revised booklet were respectively 10% (SD = 9%) and 10% (SD = 7%) higher than the original booklet scores. The revised version attained "superior" scoring in all questionnaires: SAM, 87% (SD = 8%); HEM, 3.5 (SD = 0.4) out of 4; Acceptability, 3.7 (SD = 0.4) out of 4.

CONCLUSIONS

The suitability and readability of an educational booklet-to promote a healthy lifestyle-were improved following a systematic peer-review evaluation prior to its use in an intervention.

PRACTICE IMPLICATIONS

Improving the suitability and readability of educational resources can have a positive impact on patient knowledge and awareness, and hence on intervention effectiveness.

Readability in printed education materials for Chinese patients with systemic lupus erythematosus: a mixed-method design

OBJECTIVES

To assess the readability of printed education materials (PEMs) for patients with systemic lupus erythematosus (SLE) and to explore the perceptions of patients with SLE with different health literacy regarding the readability of PEMs.

DESIGN

A mixed-methods study, including a cross-sectional survey and semistructured interviews.

SETTING

The SLE PEMs were collected from 13 hospitals in China. The interviews were conducted in the Department of Rheumatology of a hospital in Hefei, China.

PARTICIPANTS

In the cross-sectional survey, convenience sampling was used to select the Chinese SLE PEMs, with 20 PEMs included. In the qualitative study, the patients with SLE were divided into two groups based on their health literacy. Then, purposive sampling was used to select participants in each group, with 18 patients recruited.

OUTCOME MEASURES

The readability of PEMs was assessed by the language analysis technology and the Chinese version of the Suitability Assessment of Materials (SAM-C) instrument.

RESULTS

For text factors of readability, the mean Chinese language difficulty coefficient was 67.09±8.03, which indicates that the text of PEMs was difficult to read. For non-text factors, the mean SAM-C score was 45.62±9.51. Eight PEMs were rated not suitable, 12 were adequate and none were superior. In the interviews, eight categories were identified: information source, content, actionability, plain language, pictures, tables, numbers and layout. Patients with different health literacy had discrepant views on the detail of basic information, the necessity of question list, the location of functional pictures and the application of mathematical symbols.

CONCLUSIONS

The readability of Chinese SLE PEMs does not perform well, and it is necessary to reduce the difficulty of words, shorten the length of sentences and improve the picture design and actionability. To develop PEMs tailored to patients' level of health literacy, patients' unique view of readability should be integrated into the design of PEMs.

Readability and suitability assessment of educational materials in promoting the quality of life for postmenopausal women

INTRODUCTION

Educational materials are frequently used by health providers to inform postmenopausal women about menopause acceptance behavior. However, little attention has been paid to the readability and suitability of these educational materials. The study aimed to determine the readability and suitability of educational materials in promoting the quality of life for postmenopausal women.

MATERIAL AND METHODS

Multiple instructional materials and books were used for the design and preparation of educational materials and were then tailored to the target group. Readability was measured by using the readability assessment of materials (RAM); and suitability was determined by the suitability assessment of materials (SAM) that considers characteristics such as content, graphics, layout/topography, and cultural appropriateness. Twenty reviewers, including 10 postmenopausal women, 5 postmenopausal women family members, and 5 health experts scored the educational materials.

RESULTS

The mean readability score ±standard deviation (SD) of the educational materials was10 ±1.6 and 8 ±1.4, for the pamphlet and daily activities' booklets, respectively, which were increased to 14 ±0.6 and, 16 ±1.3, after tailoring the content. The average SAM scores before and after tailoring the content were 45% for the pamphlet, which was increased to 81%; 45% for the daily activities' booklets, which was increased to 86%. The increase in all scores was significant (p < 0.001). The final tailored educational material was rated "superior media" on the SAM ratings.

CONCLUSIONS

Given that most of the printed materials are suitable for people with higher education levels, health providers are strongly advised to prepare simple and understandable education materials that may increase the likelihood of consumer perception and recall.

Effects of an educational intervention based on the multi-theory model on promoting the quality of life in postmenopausal women: a protocol

Introduction

Menopause is associated with symptoms and complications that can affect women's quality of life. Therefore, acceptance of the symptoms and complications can improve quality of life during this period. In this regard, the purpose of this study was to design an educational program based on the multi-theory model (MTM) to deal with complications of the menopausal period and improve the women's quality of life.

Material and methods

In designing this study, four phases are considered. In the first phase, the questionnaire of menopausal symptom acceptance behaviors will be designed based on the MTM using literature review and a panel of experts' viewpoints. The validity and reliability of the questionnaire will be confirmed at this stage. In the second phase, a descriptive study will be conducted by administering the questionnaire designed in the first phase along with the Menopause-Specific Quality of Life questionnaire. The third phase includes the curriculum design based on the findings of the descriptive study, investigations of various studies, and viewpoints of the experts' panel. Therefore, the main components of the intervention will be identified. These components will determine the influential constructs of the MTM according to the descriptive research. Later, the related interventions and messages will be produced and designed from different sources. Intervention strategies will include group discussion, lectures, confidence-building skills, movie screenings, role play, preparation of daily activities booklets for postmenopausal women, and training classes for husbands and children to improve social support for women. The interventions, contents, and messages designed with the presence of health professionals and members of the target community will be pre-tested by examining factors such as audience perception of the message, appropriateness of the education to the audience's literacy and culture, as well as attractiveness, credibility, and acceptance of the materials. Finally, the fourth phase will be the implementation of the pre-test/post-test educational intervention using the intervention and control groups.

Results and conclusions

The present study provides good information about the needs and strategies to enhance the quality of life in postmenopausal women by utilizing a menopausal acceptance training program. Therefore, designing a program to increase the menopausal acceptance in postmenopausal women can be effective in improving the quality of life and reducing the treatment and medical care costs.

Educational technologies for health education on stroke: an integrative review

OBJECTIVE

to identify in the scientific literature the educational technologies used in the health education process related to stroke.

METHOD

integrative review, whose eligibility criteria of the articles were: match the keywords "health education" and "stroke"; be a research paper; be in Portuguese, English and Spanish; be available electronically in the databases LILACS, PubMed/Medline, Scopus and CINAHL; year of publication between 2000 and 2016.

RESULTS

24 publications were found. The analysis was carried out by means of analytical and interpretive readings. There were many educational technologies used in the health education process for stroke.

FINAL CONSIDERATIONS

the printed material for general public stood out, aiming to the recognition of alert signs of the disease and the emergency decision-making before suspicious cases of the disease.

Challenges When Translating and Culturally Adapting a Measurement Instrument: The Suitability and Comprehensibility of Materials (SAM+CAM)

There is evidence that low suitability and comprehensibility of printed education materials (PEMs) affects patients’ and relatives’ ability to read and comprehend information. However, few instruments measure the suitability of written information, and none exist in the Swedish language. The aim was to describe the translation and adaptation of the Suitability and Comprehensibility of Materials (SAM+CAM) instrument into the Swedish language and health care context and to explore challenges related to this process. The SAM+CAM instrument was translated and culturally adapted in five steps: forward translation, synthesis, back translation, expert review, and pretests. Differences were found when translating and culturally adapting the SAM+CAM instrument in the areas of semantic, idiomatic, and experiences. Participants revealed several clarity inconsistencies between items. They also identified linguistic differences and unfamiliar wording; they found that the instrument was perplexing to use and lacked knowledge regarding the specific health care areas in the examined PEMs. The cultural perspective is a significant factor that influences the usability of PEMs. Therefore, expert groups of participants are useful when adapting instruments to different cultures. The Swedish SAM+CAM instrument requires experienced and highly qualified raters.

Evaluating the readability and suitability of construction occupational safety and health materials designed for workers

INTRODUCTION

Printed materials for training and hazard communication are an essential part of occupational safety and health programs, but must be understood by their intended audience.

METHODS

Researchers collected 103 safety training handouts, brochures, and Safety Data Sheets and scored them for readability and suitability using four standard health communication instruments: the SMOG test, the Flesch-Kincaid Reading Ease Assessment, the SAM (Suitability Assessment of Materials), and CCI (the CDC Clear Communication Index).

RESULTS

Some of the materials used unfamiliar and technical terms. The SAM and CCI checklists revealed several elements of design and layout known to facilitate communication and comprehension, but missing from most of the materials scored.

CONCLUSION

Occupational safety and health professionals preparing curricula and handouts for distribution to workers should incorporate some form of readability and suitability assessment to help ensure their written materials are clear and comprehensible to all segments of their audience.

Suitability of asthma education materials for school-age children: Implications for health literacy

AIMS AND OBJECTIVES

To investigate the suitability of asthma education materials for school-age children with asthma and elucidate how these children used their health-literacy abilities to identify whether the materials can be accepted, comprehended and applied.

BACKGROUND

Effective asthma self-management education is influenced by the suitability of materials and an individual's health literacy.

DESIGN

A mixed-method research design was developed using quantitative and qualitative surveys.

METHODS

The suitability of the materials was assessed on the basis of the Chinese version of the Suitability Assessment of Materials by five experts. In addition, five school-age children (age: 8-12 years) were recruited and interviewed.

RESULTS

In total, 25 pieces of asthma education material for children were collected. On the basis of their type, the materials were categorised as nine brochures, 11 leaflets and five videos. Of the 25 materials, 17 were rated as superior materials, whereas eight were rated as adequate materials. The suitability scores of the video-based materials were significantly higher than those of the brochures and leaflets (p = .006). One print material was considered to have a reading level suitable for fifth-grade or younger children, whereas the remaining materials were considered suitable for sixth-grade or older children. The following six health-literacy domains were identified: recognising asthma through body knowledge, posing reflective questions, identifying self-care difficulties, receiving adult guidance, learning with enjoyment and addressing learning requirements.

CONCLUSIONS

The video-based materials had integrated content and were appealing to children. Cartoon animations, interactive computer games, and skill demonstrations may enhance learning stimulation and motivation and increase learning effects in children.

RELEVANCE TO CLINICAL PRACTICE

The present results may help healthcare providers to understand children's capacities to manage their disease, effectively address children's requirements and function as a key resource for children to strengthen their literacy in asthma management.

A Systematic Review of Tests Assessing Stroke Knowledge

BACKGROUND

Accurate assessment of stroke knowledge (SK) is fundamental to the successful understanding of, monitoring of, and intervening to improve the SK of patients and the public.

PURPOSE

The purpose of this study is to perform a systematic review of the existing SK tests and appraise their conceptual basis, feasibility, and psychometric properties. We conducted 2-step searching of MEDLINE, CINAHL, PsycINFO, and Scopus electronic databases from January 1, 2000, to December 31, 2014, to identify relevant SK tests for the appraisal.

RESULTS

Our study found 59 SK tests, out of a total of 93 articles, with full content available that had been referred to in the published literature. Ten of them had been used in more than 1 study, and 2 (the Stroke Knowledge Test and the Stroke Action Test) of them have had at least 1 of their psychometric properties validated. Only 1 test (the Stroke Knowledge Test) was developed using rigorous methodology, covers a wide range of concepts, and met all feasibility criteria; however, its limitations include no articulated conceptual basis, inadequate internal consistency reliability (α = .65), and lack of some validated psychometric properties.

CONCLUSIONS

Our study revealed that current available tools are not sufficiently able to accurately and reliably assess SK to promote stroke prevention and management.

CLINICAL IMPLICATIONS

This study highlights the attention of applying current SK tests and need for revising existing tests or developing a new test.

Suitability assessment of health education brochures in Qassim province, Kingdom of Saudi Arabia

Background:

Health education is the cornerstone of primary health care. Health education materials distributed to the community should, therefore, be suitable and effective. The purpose of this study was to evaluate the health education brochures, designed and disseminated by Ministry of Health institutions in the Qassim province.

Materials and Methods:

The study was a cross-sectional review of health education brochures. We used a structured evaluation form, comprising general information on the brochures and a modified Suitability Assessment of Materials (SAM) score sheet. The SAM consisting of 22 criteria in six groups, includes content, literacy demands, graphics, layout/typography, learning stimulation/motivation, and cultural appropriateness. SAM criteria categorize written material into “superior,” “adequate” and “not suitable.” Two qualified consultant family physicians evaluated the brochures. Data were analyzed using Epi Info version 3.4 statistical package.

Results:

We evaluated 110 brochures, the majority of which addressed chronic health conditions such as mental health, diabetes mellitus and hypertension. Seventy-four (67.3%) brochures were evaluated as “adequate,” 34 (30.9%) as “not suitable” and 2 (1.8%) as “superior.” “Cultural appropriateness” was the highest scoring factor, with 92 (83.6%) brochures falling into either the “superior” or “adequate” category. With regard to “content,” 88 (80.0%) brochures fell into either the “superior” or “adequate” category. This was the second highest scoring factor. Graphics was the factor that scored the least. Seventy-five (68.2%) brochures were rated in this factor as “not suitable.”

Conclusions:

Although two-thirds of our brochures were considered “adequate,” the majority needed improvement to their graphics and learning stimulation factors. We recommend that guidelines for designing health education brochures should be formulated to improve the quality of health education brochures.

A novel Interactive Health Communication Application (IHCA) for parents of children with long-term conditions: Development, implementation and feasibility assessment

BACKGROUND

Few evidence-based, on-line resources exist to support home-based care of childhood long-term conditions.

METHODS

In a feasibility study, children with stages 3, 4, or 5 chronic kidney disease, parents and professionals collaboratively developed a novel Online Parent Information and Support (OPIS) application. Parents were randomized to an intervention arm with access to OPIS or a control arm without access. OPIS usage was assessed using Google Analytics. Parents in the intervention arm completed the Suitability Assessment of Materials (SAM) and User Interface Satisfaction (USE) questionnaires and participated in qualitative interviews.

RESULTS

Twenty parents accessed OPIS with a mean of 23.3 (SD 20.8, range 2-64) visits per user. Responses from the SAM and USE questionnaires were positive, most respondents rating OPIS highly and finding it easy to use. Qualitative suggestions include refinement of OPIS components, enabling personalization of OPIS functionalities and proactive endorsements of OPIS by professionals.

CONCLUSIONS

Implementation of OPIS into standard practice is feasible in the centre where it was developed. Suggested developments will augment reported strengths to inform ongoing testing in the wider UK network of units. Our design and methods are transferrable to developing and evaluating web-applications to support home-based clinical care-giving for other long-term conditions.

Readability, suitability and comprehensibility in patient education materials for Swedish patients with colorectal cancer undergoing elective surgery: a mixed method design

OBJECTIVE

To characterize education materials provided to patients undergoing colorectal cancer surgery to gain a better understanding of how to design readable, suitable, comprehensible materials.

METHOD

Mixed method design. Deductive quantitative analysis using a validated suitability and comprehensibility assessment instrument (SAM+CAM) was applied to patient education materials from 27 Swedish hospitals, supplemented by language technology analysis and deductive and inductive analysis of data from focus groups involving 15 former patients.

RESULTS

Of 125 patient education materials used during the colorectal cancer surgery process, 13.6% were rated 'not suitable', 76.8% 'adequate' and 9.6% 'superior'. Professionally developed stoma care brochures were rated 'superior' and 44% of discharge brochures were 'not suitable'. Language technology analysis showed that up to 29% of materials were difficult to comprehend. Focus group analysis revealed additional areas that needed to be included in patient education materials: general and personal care, personal implications, internet, significant others, accessibility to healthcare, usability, trustworthiness and patient support groups.

CONCLUSION

Most of the patient education materials were rated 'adequate' but did not meet the information needs of patients entirely. Discharge brochures particularly require improvement.

PRACTICE IMPLICATIONS

Using patients' knowledge and integrating manual and automated methods could result in more appropriate patient education materials.

Assessment of printed patient-educational materials for chronic kidney disease

BACKGROUND

Awareness of chronic kidney disease (CKD) is suboptimal among patients with CKD, perhaps due to poor readability of patient education materials (PEMs). We reviewed the suitability and readability of common PEMs that focused on 5 content areas: basics of CKD, risk factors for CKD development, risk factors for CKD progression, complications of CKD and self-management strategies to improve kidney health.

METHODS

Three reviewers (nephrologist, primary care physician, patient) used the Suitability Assessment of Materials to rate PEMs on message content/stimulation of learning, typography, visuals and layout and determined literacy level. Mean ratings were calculated for each PEM by content area and overall (superior = 70-100; adequate = 40-69; inadequate = <40). Linear regression was used to determine the impact of literacy level on mean rating.

RESULTS

We reviewed 69 PEMs from 19 organizations, divided into 113 content area sections. Most (79%) PEM sections were 'adequate' (mean rating, 58.3%). Inclusion of patient-centered content and opportunities for patient interaction were associated with 'superior' ratings. Mean ratings (SD) were similar across content areas: basics of CKD, 58.9% (9.1); risk factors for CKD development, 57.0% (12.3); risk factors for CKD progression, 58.5% (12.0); CKD complications, 62.3% (15.7), and self-management strategies, 62.2% (12.3). ≤6th grade literacy level (vs. >6th grade) was associated with an 11.7 point higher mean rating.

CONCLUSION

Most PEMs for kidney disease were adequate. Outstanding PEMs shared characteristics of patient centeredness, a low literacy level, and patient interaction. Providers should be aware of strengths and limitations of PEMs when educating their patients about CKD.