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

Implementation of Problem-Based Learning in Undergraduate Medical Education in Ethiopia: An Exploratory Qualitative Study

Background

The poor quality of health professional education in Ethiopia, which was rooted in a traditional curriculum, has posed significant challenges for graduates in effectively addressing real-life health problems. In response, there has been curricular reform by adopting problem-based learning across Ethiopian medical schools. Given the dearth of literature on the topic and the significance of context in the effective implementation of problem-based learning, it is imperative to provide local institutional evidence to pinpoint critical intervention areas and support the effective implementation of problem-based learning.

Methods

A qualitative design based on in-depth, individual, semi-structured interviews was used to explore medical educators, program coordinators, and educational leader's experiences and perspectives on the problem-based learning implementation in health sciences education. A total of 24 participants recruited from five undergraduate health science programs participated in the study. All sessions were audio recorded and transcribed verbatim. Results were analyzed following a qualitative thematic analysis method.

Results

Analysis of the transcripts revealed three main themes, along with their corresponding subthemes. Within the first main theme, participants discussed the importance of integrating Problem-Based Learning into undergraduate medical programs and the educational benefits it brings to medical education. The second main theme explored issues related to challenges in implementing problem-based learning which include inadequate staff training, deficiencies in curricular design and governance, constraints in educational resources, and a lack of preparedness in the educational environment. The third theme deals with the strategic recommendations to address the challenges that contributed to the poor implementation of problem-based learning in undergraduate medical schools.

Conclusion

Our study has addressed several issues related to the implementation of Problem-Based Learning in Ethiopian Health Sciences Colleges. The study's findings have the potential to provide educational stakeholders and policymakers with essential information to strategize successful problem-based learning implementation in undergraduate medical schools.

Health Literacy and Radiation Therapy: a Current State Assessment of Patient Education Materials

In order to mitigate low levels of health literacy among patients, there is need to evaluate patient education (PE) materials and to ensure that the information is readily accessible to patients. The quality and comprehensiveness of radiation therapy materials were evaluated at fourteen cancer centres. To assess quality, PE leaders independently conducted readability, actionability and understandability assessments of materials. To evaluate comprehensiveness, an assessment was conducted of the scope of symptoms covered in extant materials, and the modality they were produced in (e.g. pamphlet, video). A total of 555 PE materials were reviewed for comprehensiveness and modality and seventy underwent evaluation against health literacy best practice standards. Most materials (n = 64, 91%) had a reading grade level above the recommended grade 6 ([Formula: see text] = 9, range = 4-12). Under half (n = 34, 49%) scored at or above the 80% threshold for understandability ([Formula: see text] = 74%, 33-100%) and just over half (n = 36, 51%) scored at or above the 80% target for actionability ([Formula: see text] = 71%, 33-100%). Only two cancer centres (n = 2/14, 14%) had PE materials covering the breadth of symptoms related to radiation therapy and the vast majority of materials were pamphlets (89%). Findings indicate that most radiation therapy PE materials used in cancer centres do not meet health literacy best practices, and there is a disparity between cancer centres in the topics that are available to patients and family. This evaluation highlights the need to better incorporate health literacy best practices into the development of radiation therapy PE materials and strategies to improve accessibility of such health information.

A novel radiolytic rotenone derivative, rotenoisin A, displays potent anticarcinogenic activity in breast cancer cells

Chemotherapy for cancer treatment has therapeutic limitations, such as drug resistance, excessive toxic effects and undesirable adverse effects. Therefore, efforts to improve the safety and efficacy of chemotherapeutic agents are essential. Ionizing radiation can improve physiological and pharmacological properties by transforming structural modifications of the drug. In this study, in order to reduce the adverse effects of rotenone and increase anticancer activity, a new radiolytic rotenone derivative called rotenoisin A was generated through radiolytic transformation. Our findings showed that rotenoisin A inhibited the proliferation of breast cancer cells and increased the rate of apoptosis, whereas it had no inhibitory effect on primary epidermal keratinocytes compared with rotenone. Moreover, rotenoisin A-induced DNA damage by increasing reactive oxygen species (ROS) accumulation. It was also confirmed not only to alter the composition ratio of mitochondrial proteins, but also to result in structural and functional changes. The anticancer effect and molecular signalling mechanisms of rotenoisin A were consistent with those of rotenone, as previously reported. Our study suggests that radiolytic transformation of highly toxic compounds may be an alternative strategy for maintaining anticancer effects and reducing the toxicity of the parent compound.

The Experience of Chemotherapy Teaching and Readability of Chemotherapy Educational Materials for Women with Breast Cancer

Chemotherapy is one of the most common forms of treatment for women with breast cancer. While chemotherapy is often effective, managing side effects can be challenging. Chemotherapy education is critical in assisting patients to manage side effects and to improve the treatment experience. However, materials are often not thoroughly assessed for readability and format which could be problematic for patients learning self-care while in treatment. We used a mixed-method design to illuminate chemotherapy teaching and focused on readability and format of education materials. We scored the materials using three readability assessments: (1) Flesch Reading Ease (FRE), (2) Flesch-Kincaid (F-K), and (3) a Simple Measure of Gobbledygook (SMOG). We evaluated the format of the materials using Suitability Assessment of Materials (SAM) guidelines. Lastly, we used thematic analysis to describe the experience of 37 women with breast cancer undergoing chemotherapy education. The mean readability of the materials ranged from "difficult" to "fairly difficult" based on the FRE scoring, and the material was written on a 9th- to 13th-grade reading level. Most of the materials scored as "adequate" using SAM guidelines but lacked incorporation of graphics or illustrations. The thematic analysis revealed three major findings: (1) finding control in learning, (2) receiving unexpected support, and (3) learning in unforeseen ways. Nurses need to supplement chemotherapy education materials with individualized teaching to ensure comprehension. Additionally, nurses and website developers may want to consider implementing culturally appropriate information and use videos to combat challenging readability.

Information needs of breast cancer patients and how educational status influence their information needs in Ghana

Health information literacy plays a critical role in self-management practices among patients living with chronic health conditions. However, there are limited studies on information needs among breast cancer patients in Ghana. This paper therefore investigated the information needs of women living with breast cancer in Ghana and how educational status influenced their information needs. The study was conducted in two health facilities in Accra, Ghana (37 Military Hospital and Sweden Ghana Medical Centre). A total of 75 breast cancer patients were conveniently selected from the two health facilities for the study. The instrument used to elicit relevant data for this study was a questionnaire using the survey design. Data was analysed descriptively. The findings of the study revealed that the information needs of the breast cancer patients investigated were centred mainly around treatment and management information and less around preventive information. The patients also ranked diagnostic information as their highest need, followed by physical care information, treatment information, psychosocial information and disease-specific information in that order. Patients with higher education reported higher information need on all the five domains compared to those with lower education. The study therefore recommended that management of health facilities make health information literacy an integral component of their treatment and management of breast cancer.