Impact of an Educational Comic to Enhance Patient-Physician-Electronic Health Record Engagement: Prospective Observational Study

"Black Women Should Not Die Giving Life": The lived experiences of Black women diagnosed with severe maternal morbidity in the United States

OBJECTIVE

We sought to understand the lived experiences of Black women diagnosed with severe maternal morbidity (SMM) in communities with high maternal mortality to inform practices that reduce obstetric racism and improve patient outcomes.

METHODS

From August 2022 through December 2022, we conducted a phenomenological, qualitative study among Black women who experienced SMM. Participants were recruited via social media and met inclusion criteria if they self-identified as Black cisgender women, were 18-40 years old, had SMM diagnosed, and lived within zip codes in the United States that have the top-five highest maternal mortality rates. Family members participated on behalf of women who were deceased but otherwise met all other criteria. We conducted in-depth interviews (IDIs), and transcripts were analyzed using inductive and deductive methods to explore birth story experiences.

RESULTS

Overall, 12 participants completed IDIs; 10 were women who experienced SMM and 2 were mothers of women who died due to SMM. The mean age for women who experienced SMM was 31 years (range 26-36 years) at the time of the IDI or death. Most participants had graduate-level education, and the average annual household income was 123,750 USD. Women were especially interested in study participation because of their high-income status as they did not fit the stereotypical profile of Black women who experience racial discrimination. The average time since SMM diagnosis was 2 years. Participants highlighted concrete examples of communication failures, stereotyping by providers, differential treatment, and medical errors which patients experienced as manifestations of racism. Medical personnel dismissing and ignoring concerns during emergent situations, even when raised through strong self-advocacy, was a key factor in racism experienced during childbirth.

CONCLUSIONS

Future interventions to reduce racism and improve maternal health outcomes should center on the experiences of Black women and focus on improving patient-provider communication, as well as the quality and effectiveness of responses during emergent situations. Précis statement: This study underscores the need to center Black women's experiences, enhance patient-provider communication, and address emergent concerns to mitigate obstetric racism and enhance maternal health outcomes.

Communicating the Gynecologic Brachytherapy Experience (CoGBE): Clinician perceived benefits of a graphic narrative discussion guide

PURPOSE

Many current radiotherapy patient education materials are not patient-centered. An interprofessional team developed Communicating the Gynecologic Brachytherapy Experience (CoGBE), a graphic narrative discussion guide for cylinder, intracavitary, and interstitial high-dose-rate (HDR) gynecologic brachytherapy. This study assesses perceived clinical benefits, usability, and anxiety-reduction of CoGBE.

METHODS AND MATERIALS

An electronic survey was sent to members of the American Brachytherapy Society. Participants were assigned to assess one of the three modality-specific CoGBE versions using a modified Systems Usability Scale (SUS), modified state-trait anxiety index (mSTAI), and Likert-type questions. Free response data was analyzed using modified grounded theory.

RESULTS

Median modified SUS score was 76.3 (interquartile range [IQR], 71.3-82.5) and there were no significant differences between guide types. Median mSTAI was 40 (IQR, 40-43.3) for all guides collectively. The cylinder guide had a significantly higher median mSTAI than the intracavitary and interstitial guides (41.6 vs. 40.0 and 40.0; p = 0.04) suggesting the cylinder guide may have less impact on reducing anxiety. Most respondents reported that CoGBE was helpful (72%), would improve patient understanding (77%) and consultation memorability (82%), and was at least moderately likely to be incorporated into their practice (80%). Qualitative analysis themes included personalization and relatability (positive); generalizability (negative); illustrations (both).

CONCLUSIONS

Clinicians rate CoGBE as usable with potential to reduce patient anxiety, especially with more invasive treatment modalities including intracavitary or interstitial high-dose-rate. CoGBE has the potential to improve patient-clinician communication for a wider range of patients due to its accessible, adaptable, and patient-centered design.

Spanish Adaptation and Evaluation of Clinical Discussion Guides: Communicating the External Beam Radiotherapy Experience (CEBRE) en Español

PURPOSE

Cancer is the leading cause of death for the Hispanic/Latinx United States (US) community, which comprises 64% of the US population with limited English proficiency. Despite the common use of radiation therapy for cancer treatment, there is a dearth of radiation therapy educational materials-at appropriate reading levels-available in Spanish. To address the gap in patient-centered educational resources for communicating with Spanish-speaking patients about radiation therapy, we sought to linguistically and culturally adapt the Communicating the External Beam Radiotherapy Experience (CEBRE) clinical discussion guide series into Spanish.

METHODS AND MATERIALS

From January to December 2021, we developed and applied a stepwise methodology for Spanish adaptation of the discussion guides involving (1) professional translation; (2) interprofessional review for linguistic and cultural appropriateness and medical accuracy; (3) design review; and (4) evaluation for readability, understandability, and actionability using validated tools. We applied 4 indices for readability evaluation: Gilliam-Peña-Mountain, Läsbarhetsindex, Rate Index, and the Spanish Simple Measure of Gobbledygook. Two trained reviewers assessed understandability and actionability using the Patient Education Materials Assessment Tool.

RESULTS

After 2 revision rounds, 4 CEBRE en español discussion guides were produced through an interprofessional, iterative translation and linguistic/cultural adaptation process. Readability scores across the 4 guides ranged from 4.3 to 7.3 grade-level equivalents, thereby meeting the American Medical Association's 8th-grade standard. Patient Education Materials Assessment Tool analysis yielded near-perfect scores along understandability and actionability domains.

CONCLUSIONS

The stepwise linguistic/cultural adaptation process yielded a patient-centered guide that is appropriately readable, understandable, and actionable for Spanish-speaking patients receiving radiation therapy in the US. Future work should include an external evaluation of CEBRE en español by clinicians and patients. The methodology described can be applied to adapting resources for patient-centered communication in other fields of medicine and into other languages as part of an interprofessional approach to delivering equitable health care for all.

Picturing Mental Health on Instagram: Insights from a Quantitative Study Using Different Content Formats

Background: COVID-19 has changed individual lives to the core. Through national curfews and social distancing, individuals’ social lives changed and led to increased levels of stress and mental health problems. As another consequence, communication, especially among young people, has shifted to social networking sites, where particularly young adults sought help for their mental health problems. In recent years, Instagram has received recognition for its health-enhancing potentials. On this social networking site, more than 1 billion users worldwide post 500 million stories and images per day. Methods: During COVID-19, increasing mental health incidences were reported throughout the world, and have led mental health influencers to gain in relevance. The proposed study is based on a quantitative survey. In order to test how different content formats utilized by mental health influencers —motivational quotes, comics, or influencer posts—are evaluated by Instagram users, a cross-sectional quantitative study was conducted in April 2021. Data collection was based on convenience sampling. In total, 532 Austrian respondents between 16 and 34 years of age participated in the survey. Results: Overall, the content that received the most favorable evaluations were both the motivational quote (M = 4.23) and the influencer post (M = 4.12), while the comics scored lower in terms of evaluations (M = 3.72). Conclusions: Respondents’ preference of content suggests that individuals seek out content that boosts their esteem or content with a “human touch”. Explanations as to why the selected content formats were preferred over the other formats are offered alongside a future research outlook.

Filipinos' health information-seeking behaviors and their implications for COVID-19 vaccination

OBJECTIVES

This study examined Filipinos' health information-seeking behaviors, specifically their information engagement and apprehension of getting the COVID-19 vaccine, the reasons for vaccination, and how these factors influenced their decision to get vaccinated.

DESIGN

Quantitative, cross-sectional, and predictive approaches.

SAMPLE

This study conducted a national online survey using convenience sampling (n = 2709).

MEASUREMENT

The Health Information Orientation Scale (HIOS) and Statista.com's "reasons for not getting a COVID-19 vaccination" were used to collect data. Demographic characteristics that predict information engagement and apprehension were identified using multivariate linear regression analysis.

RESULTS

Responses to information engagement and apprehension revealed "often true" and "sometimes true," respectively. The majority of participants intended to receive the COVID-19 vaccine. "Concerned about the vaccine's safety" is the most common reason for not getting vaccinated. Female gender, college graduate, employed, and using social media to obtain COVID-19 vaccine information were all significant predictors of information engagement and apprehension. Information engagement and apprehension were predicted by age and religion, respectively.

CONCLUSIONS

Policymakers should consider how people seek information regarding the COVID-19 vaccine and why some people refuse to get vaccinated. Additionally, public health nurses should educate the public about the safety of COVID-19 vaccines.