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Mbongueh MC, Gisèle EL, Clément ANJ. The effects of education intervention on the knowledge of some reproductive health issues amongst secondary school students in Douala IV Municipality, Cameroon. Afr J Reprod Health 2024; 28:92-98. [PMID: 38583071 DOI: 10.29063/ajrh2024/v28i3.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Abstract
This study aimed to determine the effects of education intervention on the knowledge of some reproductive health issues amongst secondary school students. It was longitudinal and interventional study carried out in two phases. Participants were adolescents and young adults randomly selected from secondary establishments using a Probability Proportional to Size sampling method. In phase 1, data were obtained by the use of questionnaire and analyzed using Epi-Info 6.04 and SPSS version 17.0. Education intervention was utilized in 3 randomly selected schools (experiment), but not in 3 others (control). Phase 2 carried out 6 months after the end of the first intervention consisted of collecting baseline data. There was a significant association between knowledge on unintended pregnancy and STIs mainly with type of establishment, class, age group, sex, religion (p<0.001 respectively) and being sexually active (p=0.016). There was a significant increase of awareness in the experimental schools (34.1% vs 76.5%, p<0.0001), but not in the control schools (34.5% vs 35.5%, p>0.10). Health education had a significant impact on the knowledge of participants. We recommend reproductive health education through the framework of school to be used as a national policy in African developing countries.
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Affiliation(s)
| | - Etame L Gisèle
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon
| | - Assob N J Clément
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon
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Gadd N, Lee S, Sharman MJ, Obamiro K. Educational interventions to improve bowel cancer awareness and screening in Organisation for Economic Co-operation and Development countries: A scoping review. Prev Med Rep 2024; 39:102653. [PMID: 38384964 PMCID: PMC10879007 DOI: 10.1016/j.pmedr.2024.102653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 02/23/2024] Open
Abstract
Objectives Summarise theory informed educational interventions for improving bowel cancer awareness and screening. Methods A search was conducted in PubMed, EMBASE, Web of Science and CINAHL. English studies from 2016 to 2022 which implemented community-based bowel cancer awareness and/or screening education interventions for adults in Organisation for Economic Co-operation and Development countries were included. Results Sixty-two studies were included, 32 measured both screening and awareness (24 measured screening only, 6 measured awareness only). Education interventions were grouped and summarised in five education types: lay community health education/counselling (n = 28), education material (n = 5), health professional education/counselling (n = 10), mass media (n = 5) and other (n = 19). Other included education interventions which did not fit into the four types previously mentioned. Six studies tested more than one education type. Each type within these studies were reported/summarised separately within the appropriate education type. Lay educators resulted in improved awareness and screening. Brochures were effective education materials for screening and combined with lay educators resulted in increased awareness. State-wide mass media campaigns significantly improved screening uptake for up to 2-months post-campaign. Fear and loss-framed messaging improved screening intentions compared to humour or gain-based messaging. Decision aids had limited improvements in awareness. Facebook campaign and telephone counselling had limited improvements in screening. Conclusions Lay community health educators, brochures, and mass media campaigns occurring multiple times a year may be effective interventions in improving screening and/or awareness. Such approaches should be considered when developing community education. Education interventions should include multiple components suggested above to maximise improvements of awareness and screening.
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Affiliation(s)
- Nicola Gadd
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston 7250, Australia
| | - Simone Lee
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston 7250, Australia
| | - Matthew J Sharman
- School of Health Sciences, University of Tasmania, Launceston 7250, Australia
| | - Kehinde Obamiro
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston 7250, Australia
- Central Queensland Centre for Rural and Remote Health, James Cook University, Emerald, Queensland, Australia
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Setiawan L, Graef K, Schmolze D, Alem A, Taylor L. Building pathology capacity in sub-Saharan Africa to improve breast cancer diagnosis and treatment: training laboratory technicians in high-quality manual immunohistochemistry. BMC Cancer 2024; 24:32. [PMID: 38172837 PMCID: PMC10763384 DOI: 10.1186/s12885-023-11756-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND To address the need for a skilled workforce in breast cancer (BC) pathology in sub-Saharan Africa (SSA), we implemented an education program to train laboratory technicians in manual immunohistochemistry (IHC). METHODS A quality improvement education project was developed. Interactive webinars were held every six months with didactics and presentations from African experts with experience in IHC. We conducted knowledge assessments and surveys on current practice, equipment, and human resources. A digital mentorship platform (DMP) was created for discussions, sharing SOPs, and networking. For one year (2022-2023), we followed developments in pathology capacity, practice changes, and educational needs. A paired t-test was used to calculate the significance of changes in knowledge immediately after the webinar and comfort level with topics 35 days after the webinar. RESULTS Two hundred and sixty six participants from 10 SSA countries attended the first webinar, a series of six lectures on IHC theory, methods, and practice. Ninety-five participants from nine SSA countries provided a baseline assessment of pathology capacity and feedback. Mean knowledge increased by 17.4% immediately after the webinar (from 41.8% pre-webinar to 59.2% post, p = < 0.0001). Self-reported comfort level in topics 35 days after the webinar increased by 11.3%, but this was not statistically significant (mean 3.36 pre- to 3.74 post, p = 0.1). Over six months, recordings were accessed 412 times. After six months, the second webinar had 93 participants from eight SSA countries. Membership in the DMP increased from 64 to 172; recordings were viewed 412 times in six months; and 113 participants from nine SSA countries completed surveys. Among 74 respondents who perform IHC, 43.5% reported moderate or significant positive practice changes such as improved antigen retrieval techniques and optimization of preanalytical variables. Over half (52.7%, n = 39) reported the quality of slides had moderately or significantly improved. After one year, a third webinar had 98 participants from eight SSA countries. Thirty-eight completed surveys, DMP membership increased to 199, and 1 reported launching IHC in a lab in Nigeria. CONCLUSIONS Our program 1) reached hundreds of participants and provided a baseline assessment of pathology capacity across nine SSA countries; 2) created a novel mechanism to build pathology capacity and assess progress with this cohort; and 3) improved practices and the preparation of slides for over half performing manual IHC. After one year, interest was sustained. Tracking impact on diagnosis and treatment of BC in the region is needed long-term.
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Affiliation(s)
| | - Katy Graef
- BIO Ventures for Global Health, Seattle, WA, USA
| | - Dan Schmolze
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Alemwosen Alem
- Pathology Department, Hawassa University College of Health Science, Hawassa, Ethiopia
| | - Lesley Taylor
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
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Kado K, Okada H, Suzuki S, Satake M, Yamazaki T, Kurosawa M, Yamamoto M, Takahashi M, Nakayama T. Study of assessment of knowledge and understanding for coping with sick days among patients with diabetes in community pharmacy: a cluster randomized controlled trial (SAKURA trial). J Pharm Policy Pract 2023; 16:104. [PMID: 37749648 PMCID: PMC10521466 DOI: 10.1186/s40545-023-00614-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 09/16/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Awareness regarding coping with sick days among patients with diabetes is limited. Thus, we evaluated the effectiveness of sick-day education by community pharmacists among patients with type 2 diabetes (T2D) using sick-day educational materials (sick-day cards). METHODS A cluster randomized controlled trial was conducted. Pharmacists in the intervention group educated patients with T2D on coping with sick days (adjusting medication dosage and seeking medical advice) using sick-day cards compared with the usual counseling. Differences in questionnaire scores ("Anxiety", "Intention", "Attitude", and "Knowledge" about sick days) before and after the intervention were compared between the groups. RESULTS Overall, 318 patients with T2D (intervention, 119; control, 199) participated in this study, and 270 (intervention, 92; control, 178) patients were examined. There were no significant differences in "Anxiety", "Intention", or "Attitude" scores between the two groups, but "Knowledge" scores improved in the intervention group. For all intervention groups (92/92), a physician reviewed and approved medication and adjustment doses for sick days on the cards. CONCLUSIONS According to patients' responses, sick-day education using teaching materials improved patient knowledge. This may help patients and their caregivers cope with sick days appropriately through medication dose adjustment and fluid intake. Research registration number: UMIN000043161 (February 1, 2021), https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr.cgifunction=brows&action=brows&recptno=R000048124&type=summary&language=J.
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Affiliation(s)
- Keisuke Kado
- KRAFT Inc. Kyouikukikakubu, Palace Building 10F, 1-1-1 Marunouchi, Chiyoda-ku, Tokyo, 100-8225, Japan
| | - Hiroshi Okada
- Department of Health Informatics, Graduate School of Medicine and School of Public Health, Kyoto University Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| | - Shota Suzuki
- Department of Health Informatics, Graduate School of Medicine and School of Public Health, Kyoto University Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
- Institute for Clinical and Translational Science, Nara Medical University Hospital, 840 Shijo-cho, Kashihara, 634-8522, Japan
| | - Masako Satake
- KRAFT Inc. Kyouikukikakubu, Palace Building 10F, 1-1-1 Marunouchi, Chiyoda-ku, Tokyo, 100-8225, Japan
| | - Toru Yamazaki
- KRAFT Inc. Kyouikukikakubu, Palace Building 10F, 1-1-1 Marunouchi, Chiyoda-ku, Tokyo, 100-8225, Japan
| | - Mayumi Kurosawa
- KRAFT Inc. Kyouikukikakubu, Palace Building 10F, 1-1-1 Marunouchi, Chiyoda-ku, Tokyo, 100-8225, Japan
| | - Mie Yamamoto
- KRAFT Inc. Kyouikukikakubu, Palace Building 10F, 1-1-1 Marunouchi, Chiyoda-ku, Tokyo, 100-8225, Japan
| | - Miho Takahashi
- KRAFT Inc. Kyouikukikakubu, Palace Building 10F, 1-1-1 Marunouchi, Chiyoda-ku, Tokyo, 100-8225, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Graduate School of Medicine and School of Public Health, Kyoto University Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
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Byma EA, Lycette L. An integrative review of humanities-based activities in baccalaureate nursing education. Nurse Educ Pract 2023; 70:103677. [PMID: 37302353 DOI: 10.1016/j.nepr.2023.103677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/14/2023] [Accepted: 05/23/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE The American Association of the Colleges of Nursing has stressed the importance of the liberal arts as a foundation of nursing education that supports the development of clinical reasoning and judgments in their recently updated essentials for professional nursing education. The purpose of this research was to conduct an integrative review of the literature to explore the use of the humanities in baccalaureate nursing programs. RESEARCH QUESTION Among undergraduate nursing programs, what types of humanities interventions were used in nursing courses and what were the outcomes of these interventions? THEORETICAL FRAMEWORK This research was guided by the Aesthetic Knowing and Knowledge conceptual model by Chinn and Kramer, which is based on the Fundamental Patterns of Knowing in Nursing by Carper. METHODS An integrative review method, as outlined by Whittemore and Knafl, was used for this research. RESULTS After analysis of 227 titles, 19 studies were selected. Studies used art, literature, music and dance-based interventions. A key theme in examining the use of humanities in nursing education is its connection to aesthetic knowing in nursing. This included moral/ethical comportment, therapeutic use of self and scientific competence, as outlined in the Aesthetic Knowing and Knowledge conceptual model by Chinn and Kramer. Additionally, several other common themes emerged across the studies as nursing students reflected on the impact of the inclusion of humanities in their nursing curricula. Nursing student-recognized benefits included enhanced learning, emotional development, communication and new insights into best nursing practices. CONCLUSIONS Humanities-based interventions are a useful addition to undergraduate nursing education. Future research should use randomized controlled designs to strengthen the body of literature regarding this topic.
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Affiliation(s)
- Elizabeth A Byma
- Calvin University, Science Building 281, 1734 Knollcrest Circle SE, Grand Rapids, MI 49546, USA.
| | - Lisa Lycette
- Calvin University, Science Building 281, 1734 Knollcrest Circle SE, Grand Rapids, MI 49546, USA
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Höglander J, Holmström IK, Gustafsson T, Lindberg E, Söderholm HM, Hedén L, von Heideken Wågert P, Sundler AJ. Implementing A person-centred CommunicaTION (ACTION) educational intervention for in-home nursing assistants - a study protocol. BMC Geriatr 2023; 23:112. [PMID: 36841761 PMCID: PMC9960173 DOI: 10.1186/s12877-023-03831-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 02/16/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND In this study, the focus is on how to support the competence development needed for nursing assistants in home care. Home care services for older persons can be challenging concerning the nature of the interpersonal interaction and communication needed to care for and respond to the diverse needs of older people who seek to live well in our communities. This implies a need to offer more person-centred care (PCC) to older persons. However, there is a lack of knowledge on how to develop such competence. We, therefore, developed A Person-centred CommunicaTION (ACTION) programme, which is a web-based educational intervention aimed at supporting competence development for nursing assistants. The research objective is to evaluate the ACTION programme with respect to participants' responses to and the effect of the intervention. METHODS A multicentre case-control study with pre- and post-assessments was designed. The ACTION programme will be implemented at home care units, in two different geographic areas in Sweden. A total of 300 nursing assistants will be recruited: 150 for the intervention group and 150 for the control group. We will evaluate the impact measures and the process. Pre- and post-assessments will be performed with data collected via a) audio recordings of communication, b) a questionnaire on self-efficacy communication skills, PCC, empathy and job satisfaction, c) user data, evaluation forms, field notes and observations, and d) interviews. The data will be analysed with descriptive and analytic statistics and/or qualitative methods for meanings. DISCUSSION This study has the potential to contribute to the evidence supporting competence development required to offer person-centred and quality home care to older persons and to meet upcoming needs for flexible and easily accessible competence development. TRIAL REGISTRATION ISRCTN64890826. Registered 10 January 2022, https://www.isrctn.com/ISRCTN64890826.
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Affiliation(s)
- Jessica Höglander
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
| | - Inger K. Holmström
- grid.411579.f0000 0000 9689 909XSchool of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden ,grid.8993.b0000 0004 1936 9457Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Tanja Gustafsson
- grid.412442.50000 0000 9477 7523Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Elisabeth Lindberg
- grid.412442.50000 0000 9477 7523Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Hanna Maurin Söderholm
- grid.412442.50000 0000 9477 7523Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Lena Hedén
- grid.412442.50000 0000 9477 7523Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Petra von Heideken Wågert
- grid.411579.f0000 0000 9689 909XSchool of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Annelie J. Sundler
- grid.412442.50000 0000 9477 7523Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Agbar F, Zhang S, Wu Y, Mustafa M. Effect of patient safety education interventions on patient safety culture of health care professionals: Systematic review and meta-analysis. Nurse Educ Pract 2023; 67:103565. [PMID: 36731258 DOI: 10.1016/j.nepr.2023.103565] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/18/2022] [Accepted: 01/22/2023] [Indexed: 01/30/2023]
Abstract
AIM To synthesize and evaluate the cumulative effect of patient safety education intervention for health care professional staff in the hospital setting on their patient safety culture. BACKGROUND Patient security Culture is an important factor in ensuring patient safety and it is recommended as one of the pillars of preventive strategies in the healthcare system. DESIGN Systematic review and meta-analysis were prospectively registered with PROSPERO. METHODS This review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed, EMBASE, Ovid, CINAHL, Cochran Library, Web of Science and randomized control trial registration databases from January 1999 to February 2021. Studies on patient safety culture intervention were included. We assessed research quality using the jadad scale for RCTs and the Methodological Index for Non-Randomized Studies RESULTS: Sixteen studies with a total of 3438 participants in the intervention group and 3121 in the control group were included in the final analysis. The random-effect meta-analysis shows significant heterogeneity among studies that assessed patient safety culture as a mean percentage of positive responses or as a mean score of 1-5 scale. (I2 = 91% and 77%, respectively). Also, there was a significant difference between experimental and control group in the overall pooled effect of patient safety culture in the studies that used the mean percentage of positive response [Mean Difference = 5.24, 95% confidence interval (1.32, 9.16, Z = 2.62; P = 0.009] or the mean score [Mean Difference = 0.08, 95% confidence interval (0.01, 0.15), Z = 2.26; P = 0.02]. The difference was no longer significant in the mean score studies after excluding the studies with low-quality scores. Subgroup analysis showed no change in the pooled effect of the studies with quasi-experimental [Mean Difference = 7.84, 95% confidence interval (2.35, 13.33); Z = 2.80; p = 0.005) or before-after design [MD= 0.11, 95% confidence interval (0.07, 0.14); Z = 5.74; p = 0.000]. However, the patient safety education intervention remained effective after one year of follow-up. CONCLUSIONS Our review Provides empirical evidence on current efforts in patient safety education to improve a healthcare professional-patient safety culture. The Patient safety education program could improve the patient safety culture of health care professionals.
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Kelekar A, Rubino I, Kavanagh M, Lewis-Bedz R, LeClerc G, Pedell L, Afonso N. Vaccine Hesitancy Counseling-an Educational Intervention to Teach a Critical Skill to Preclinical Medical Students. Med Sci Educ 2022; 32:141-147. [PMID: 35079448 PMCID: PMC8776394 DOI: 10.1007/s40670-021-01495-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION There has been a recent rise in public perception that vaccines are unsafe, fostering vaccine hesitancy (VH). Few interventions have focused on teaching medical students' communication skills for counseling vaccine-hesitant patients. METHODS Our educational intervention, designed for medical students, involved a self-study module followed by an interactive session on VH. Students practiced counseling vaccine-hesitant standardized patients (SPs). Faculty and SPs assessed student counseling skills. Students completed pre- and post-intervention surveys to assess attitudes and preparedness to counsel VH patients. RESULTS Students showed a better ability to talk to parents about Human Papillomavirus (HPV) vaccine concerns and Measles Mumps Rubella (MMR)/autism-related issues than to address patients' concerns related to the Varicella Zoster Virus (VZV) vaccine.Students' surveys pre- and post-intervention revealed significant improvement in their vaccination knowledge and comfort with counseling vaccine-hesitant patients. Student counseling skills as part of an Objective Structured Clinical Exam (OSCE) showed 73% of students asked about immunization and elicited SP concerns, but only 36% counseled appropriately. CONCLUSIONS In the face of emerging VH, physicians play a critical role in advising and influencing vaccination decisions. Therefore, it is a core responsibility of medical educators to train medical students on recommending vaccinations and responding effectively to vaccine-hesitant parents and patients. Our multifaceted interactive session provided preclinical students with knowledge and skills to improve communication skills with VH patients and parents and the need for ongoing practice of these VH counseling skills.
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Affiliation(s)
- Arati Kelekar
- Oakland University William Beaumont School of Medicine, Rochester, Michigan 48309 USA
| | - Ida Rubino
- Oakland University William Beaumont School of Medicine, Rochester, Michigan 48309 USA
| | - Maurice Kavanagh
- Oakland University William Beaumont School of Medicine, Rochester, Michigan 48309 USA
| | | | - Gabrielle LeClerc
- Oakland University William Beaumont School of Medicine, Rochester, Michigan 48309 USA
| | - Leon Pedell
- Oakland University William Beaumont School of Medicine, Rochester, Michigan 48309 USA
| | - Nelia Afonso
- Oakland University William Beaumont School of Medicine, Rochester, Michigan 48309 USA
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Bonney A, Metusela C, Mullan J, Barnett S, Rhee J, Kobel C, Batterham M. Clinical and healthcare improvement through My Health Record usage and education in general practice (CHIME-GP): a study protocol for a cluster-randomised controlled trial. Trials 2021; 22:569. [PMID: 34454563 PMCID: PMC8397855 DOI: 10.1186/s13063-021-05438-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 07/08/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There is an international interest in whether improved primary care can lead to a more rational use of health resources. There is evidence that educational interventions can lead to improvements in the quality of rational prescribing and test ordering. A new national platform for shared medical records in Australia, My Health Record (MHR), poses new opportunities and challenges for system-wide implementation. This trial (CHIME-GP) will investigate whether components of a multifaceted education intervention in an Australian general practice setting on rational prescribing and investigation ordering leads to reductions in health-service utilisation and costs in the context of the use of a national digital health record system. METHODS The trial will be undertaken in Australian general practices. The aim of the research is to evaluate the effectiveness of components of a web-based educational intervention for general practitioners, regarding rational use of medicines, pathology and imaging in the context of the use of the MHR system. Our target is to recruit 120 general practitioners from urban and regional regions across Australia. We will use a mixed methods approach incorporating a three-arm pragmatic cluster randomised parallel trial and a prospective qualitative inquiry. The effect of each education component in each arm will be assessed, using the other two arms as controls. The evaluation will synthesise the results embedding qualitative pre/post interviews in the quantitative results to investigate implementation of the intervention, clinical behaviour change and mechanisms such as attitudes, that may influence change. The primary outcome will be an economic analysis of the cost per 100 consultations of selected prescriptions, pathology and radiology test ordering in the 6 months following the intervention compared with 6 months prior to the intervention. Secondary outcome measures include the rates per 100 consultations of selected prescriptions, pathology and radiology test ordering 6 months pre- and post-intervention, and comparison of knowledge assessment tests pre- and post-intervention. DISCUSSION The trial will produce robust health economic analyses on the evidence on educational intervention in reducing unnecessary prescribing, pathology and imaging ordering, in the context of MHR. In addition, the study will contribute to the evidence-base concerning the implementation of interventions to improve the quality of care in primary care practice. TRIAL REGISTRATION ClinicalTrials.gov ACTRN12620000010998 . Registered on 09 January 2020 with the Australian New Zealand Clinical Trials Registry.
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Affiliation(s)
- Andrew Bonney
- University of Wollongong, Northfields Avenue, Wollongong, NSW 2522 Australia
| | - Christine Metusela
- University of Wollongong, Northfields Avenue, Wollongong, NSW 2522 Australia
| | - Judy Mullan
- University of Wollongong, Northfields Avenue, Wollongong, NSW 2522 Australia
| | | | - Joel Rhee
- University of Wollongong, Northfields Avenue, Wollongong, NSW 2522 Australia
| | - Conrad Kobel
- University of Wollongong, Northfields Avenue, Wollongong, NSW 2522 Australia
| | - Marijka Batterham
- University of Wollongong, Northfields Avenue, Wollongong, NSW 2522 Australia
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Gupta L, Lal PR, Gupta Y, Goyal A, Khanna A, Tandon N. Formative research to develop diabetes self-management education and support (DSMES) program for adults with Type 1 Diabetes. Diabetes Metab Syndr 2021; 15:102150. [PMID: 34186364 DOI: 10.1016/j.dsx.2021.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIM There is a lack of data on effectiveness of diabetes self-management education and support (DSMES) programs for South Asian adults with type 1 diabetes mellitus (T1DM). This formative research was conducted to explore existing practices on the said subject and gather information for planning an intervention program. METHODS AND MATERIALS We conducted in-depth semi-structured interviews with endocrinologists, dieticians, diabetes educators and adults with T1DM. The participants were selected from a mix of public and private health facilities. Thematic analysis using inductive and deductive approach was undertaken. The intervention was developed and refined using the principles of FUSED and COM-B models. RESULTS In total, 28 in-depth interviews were conducted, 18 with health care professionals and 10 with adult individuals with T1DM. The results demonstrated deficiencies in the implementation of a structured self-management program for diabetes owing to several patient and healthcare system-related factors. A detailed nutritional counseling was provided at all sites by a qualified dietitian, however, carbohydrate counting was not routinely practiced. The interviews of this formative research revolved around: (a) evaluation of the existing usual care and gaps in implementation of a structured DSMES program, and (b) development of themes that will help in formulation of an intervention package and its effective delivery to the participants. CONCLUSION This research study comprehensively investigated the existing practices among diabetes-health care professionals caring for persons living with T1DM and rendered insights towards development of a scientific DSMES program.
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Affiliation(s)
- Lovely Gupta
- Department of Food and Nutrition, Lady Irwin College, University of Delhi, New Delhi, India
| | - Priti Rishi Lal
- Department of Food and Nutrition, Lady Irwin College, University of Delhi, New Delhi, India.
| | - Yashdeep Gupta
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
| | - Alpesh Goyal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Aparna Khanna
- Department of Food and Nutrition, Lady Irwin College, University of Delhi, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Conaghan C, Daly E, Pearce AJ, King DA, Ryan L. A systematic review of the effects of educational interventions on knowledge and attitudes towards concussion for people involved in sport - Optimising concussion education based on current literature. J Sports Sci 2020; 39:552-567. [PMID: 33081578 DOI: 10.1080/02640414.2020.1835223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Educational interventions aimed at increasing concussion knowledge and attitudes are designed according to different frameworks. The aim of this systematic review of the literature was to determine the effects of educational interventions on concussion knowledge and attitudes, while providing recommendations for future research in the area of concussion education interventions. Data were extracted from 25 papers following a systematic search of the CINAHL, PubMed/Medline, Science Direct, SPORTDiscus and Web of Science scientific databases. Interventions were designed according to expert opinion and recommendations from previous research, such as knowledge transfer frameworks, the Health Belief Model, Theory of Planned Behaviour or by unknown means. Interventions were presented using PowerPoint presentations, videos, interactive computer modules, tool-kits, games and as guidelines. Interventions designed according to expert opinion increased concussion knowledge during post-intervention testing up to 2 weeks after intervention administration, and occasionally increased attitudes, with both knowledge and attitude improvements tending to return to baseline levels over-time. Interventions designed according to recommendations from previous research tend to increase both knowledge and attitudes with lack of follow-up data to determine long-term effects. Future concussion educational interventions should be designed according to expert opinion and using a knowledge transfer framework. The long-term effects of interventions require more research in order to design more effective educational tools.
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Affiliation(s)
- Caomhan Conaghan
- Department of Natural Sciences, Galway-Mayo Institute of Technology, Galway, Ireland
| | - Ed Daly
- Department of Natural Sciences, Galway-Mayo Institute of Technology, Galway, Ireland
| | - Alan J Pearce
- College of Sport, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Doug A King
- Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand
| | - Lisa Ryan
- Department of Natural Sciences, Galway-Mayo Institute of Technology, Galway, Ireland
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Lopez-Olivo MA, des Bordes JKA, Lin H, Rizvi T, Volk RJ, Suarez-Almazor ME. Comparison of multimedia and printed patient education tools for patients with osteoporosis: a 6-month randomized controlled trial. Osteoporos Int 2020; 31:857-866. [PMID: 31844906 DOI: 10.1007/s00198-019-05210-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/23/2019] [Indexed: 11/30/2022]
Abstract
UNLABELLED We conducted a randomized controlled trial to compare the efficacy of adding a video tool to a printed booklet on osteoporosis. Both strategies were effective in increasing knowledge and decreasing decisional conflict. There was no difference in the measured outcomes between the intervention and control groups. Patient preferences and learning styles are key factors in deciding a presentation format when educating patients with osteoporosis. INTRODUCTION Innovative approaches to patient education about self-management in osteoporosis may improve outcomes. METHODS We conducted a randomized controlled trial to compare the efficacy of adding a multimedia patient education tool involving video modeling to a printed educational booklet on osteoporosis. Participants were post-menopausal women with osteoporosis. We assessed osteoporosis knowledge, decisional conflict, self-efficacy, and effectiveness in disease management at baseline, immediately post-intervention, and at 3 and 6 months. Linear regression models were used to explore changes in outcomes at 6 months with respect to baseline characteristics. RESULTS Two hundred and twenty-five women were randomized, 111 to receive the multimedia tool in addition to the booklet and 114 to receive the booklet alone. Knowledge and decisional conflict scores significantly improved in both groups at all post-intervention assessment points, but with no significant differences in score changes between the groups. Self-efficacy and disease management effectiveness showed no significant changes from baseline. In the entire cohort, younger age was associated with better effectiveness in disease management and Hispanic women had greater gains in knowledge at 6 months compared to White women. Women with limited health literacy who had received the multimedia tool in addition to the printed materials had higher decisional conflict than those who received printed materials alone. CONCLUSION Both multimedia and printed tools increased knowledge and decreased decisional conflict to the same extent, neither of the educational materials proved to be better than the other. For women with limited health literacy, receiving the booklet alone was more effective in reducing decisional conflict after 6 months, than adding the multimedia tool.
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Affiliation(s)
- M A Lopez-Olivo
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - J K A des Bordes
- Department of Family and Community Medicine, The University of Texas McGovern Medical School, 6431 Fannin St, Houston, 77030, TX, USA
| | - H Lin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, 77030, TX, USA
| | - T Rizvi
- Houston Rheumatology & Arthritis Specialists, Memorial Hermann, 23920 Katy Freeway, Katy, 77494, TX, USA
| | - R J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - M E Suarez-Almazor
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, 77030, TX, USA.
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Ebu NI, Amissah-Essel S, Asiedu C, Akaba S, Pereko KA. Impact of health education intervention on knowledge and perception of cervical cancer and screening for women in Ghana. BMC Public Health 2019; 19:1505. [PMID: 31711469 PMCID: PMC6849238 DOI: 10.1186/s12889-019-7867-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 10/29/2019] [Indexed: 11/20/2022] Open
Abstract
Background The burden of cervical cancer continues to rise in developing economies. Women in the sub-Saharan African region have higher chances of developing cervical cancer due to a greater prevalence of related risk factors. The purpose of this study was to determine the effect of health education intervention on cervical cancer and screening perceptions of women in the Komenda, Edina, Eguafo, and Abirem (K.E.E.A) District in the Central Region of Ghana. Methods A non-equivalent control-group design was used to select church women; 396 in the intervention group and 386 in the control group, aged 11 to 70 years in the K.E.E.A District in the Central Region of Ghana. Data was collected via a validated structured interview schedule and analysed using the paired - and independent-samples t-tests, Kruskal-Wallis test, and Mann-Whitney U test. Results A comparison of the mean differences between the pre-post-test scores for the intervention and control groups showed a statistically significant difference for knowledge of cervical cancer (t = 6.22, df = 780, p = 0.001), knowledge of cervical cancer screening (t = 5.96, df = 780, p = 0.001), perceived seriousness (t = 3.36, df = 780, p = 0.001), perceived benefits (t = 9.19, df = 780, p = 0.001), and perceived barriers (t = 3.19, df = 780, p = 0.001). However, perceived susceptibility for the intervention group reduced, evidenced by a decrease in the mean (mean = − 0.12) compared to the control group (mean = 0.93) and this was statistically significant (t = 2.72, df = 780, p = 0.007). Conclusions Health education interventions are critical in improving knowledge and perceptions, and increasing self-efficacy of women about cervical cancer and screening.
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Affiliation(s)
- Nancy Innocentia Ebu
- Department of Adult Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Salome Amissah-Essel
- Department of Health, Physical Education and Recreation, Faculty of Science and Technology Education, University of Cape Coast, Cape Coast, Ghana
| | - Christiana Asiedu
- Department of Adult Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Selorm Akaba
- Department of Agricultural Economics and Extension, School of Agriculture, University of Cape Coast, Cape Coast, Ghana
| | - Kingsley Asare Pereko
- Department of Community Medicine, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
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Sherf-Dagan S, Hod K, Mardy-Tilbor L, Gliksman S, Ben-Porat T, Sakran N, Zelber-Sagi S, Goitein D, Raziel A. The Effect of Pre-Surgery Information Online Lecture on Nutrition Knowledge and Anxiety Among Bariatric Surgery Candidates. Obes Surg 2019; 28:1876-1885. [PMID: 29455404 DOI: 10.1007/s11695-018-3134-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Best practices for patient education in bariatric surgery (BS) remain undefined. The aims of this study were to evaluate the effect of an online lecture on nutrition knowledge, weight loss expectations, and anxiety among BS candidates and present a new tool to assess this knowledge before BS. METHODS An interventional non-randomized controlled trial on 200 BS candidates recruited while attending a pre-BS committee. The first 100 consecutive patients were assigned to the control group and the latter 100 consecutive patients to the intervention group and were instructed to watch an online lecture of 15-min 1-2 weeks prior to surgery. All participants completed a BS nutrition knowledge and the state-trait anxiety inventory (STAI) questionnaires at the pre-BS committee and once again at the pre-surgery clinic. Body mass index (BMI), comorbidities, surgery type, marital status, and number of dietitian sessions were obtained from medical records. RESULTS Data for paired study questionnaires scores were available for 128 patients (n = 69 and n = 59 for the control and intervention groups, respectively), with a mean age and BMI of 40.3 ± 11.4 years and 41.3 ± 4.9 kg/m2, respectively. The BS nutrition knowledge and the state anxiety scores increased for both study groups at the pre-surgery clinic as compared to the pre-BS committee (P ≤ 0.028), but the improvement in the nutrition knowledge score was significantly higher for the intervention group (P = 0.030). No within or between-group differences were found for the trait anxiety items score. The "dream" and "realistic" weight goals were lower than the expected weight loss according to 70% excess weight loss (EWL) for both study groups at both time-points (P < 0.001 for all). CONCLUSION Education by an online lecture prior to the surgery improves BS nutrition knowledge, but not anxiety. ClinicalTrials.gov number: NCT02857647.
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Affiliation(s)
| | - Keren Hod
- Research division, Epidemiological service, Assuta Medical Center, Tel Aviv, Israel
| | | | - Shir Gliksman
- Department of Nutrition, Assuta Medical Center, Rishon LeZion, Israel.,School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Tair Ben-Porat
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Nasser Sakran
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel.,Department of Surgery A, Emek Medical Center, Afula, affiliated with Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Shira Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,Department of Gastroenterology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - David Goitein
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel.,Department of Surgery C, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Asnat Raziel
- Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel
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Manzoor I, Khan F, Navied U, Abbas SM. Impact Of An Educational Intervention On Knowledge Of Health Care Professionals Regarding Hiv-Aids In Lahore, Pakistan. J Ayub Med Coll Abbottabad 2019; 31:372-378. [PMID: 31535509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The Acquired Immunodeficiency Syndrome (AIDS) is a disease associated with stigmatization and discrimination worldwide. Even the health care professionals show negative attitude towards these patients. Worldwide need of health education is felt to address the gap in knowledge and attitude of health care professionals while dealing with patients suffering from this disease. METHODS It was an educational interventional study, conducted in Fatima Memorial College of Medicine and Dentistry in 2015. The sample was collected through Non-Probability purposive technique, targeting both male and female health care professionals interested in attending health education sessions on HIV-AIDS. A self-administered questionnaire was used to assess the knowledge of thirty participants for pre- and post- intervention. RESULTS The study participants included public health professionals (50%), dentists (16.7%) and clinical professionals (33.3%). A significant difference was observed in knowledge of health care professionals after intervention considering the important reasons as deteriorating moral value (p=0.045) for HIV epidemic in Pakistan, prevalence status of HIV/AIDS (p=0.046), awareness about the free voluntary counselling and testing (VCT) centres /services (p=0.019), interaction with an HIV positive person (p=0.01), discriminatory attitudes due to family member (p=0.032) and availability of services for people living with HIV in Pakistan (p=0.02). CONCLUSIONS Health educational intervention is a powerful tool for increasing awareness of health care professionals.
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Affiliation(s)
- Iram Manzoor
- Surgical Unit I, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Fawadia Khan
- Surgical Unit I, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Umbreen Navied
- Surgical Unit I, Benazir Bhutto Hospital, Rawalpindi, Pakistan
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Kelley KA, Schulman C, Lu KC, Tsikitis VL. Benign Anal Disease: Implementation of an Educational Program Across Specialties. J Surg Res 2019; 243:249-254. [PMID: 31252348 DOI: 10.1016/j.jss.2019.05.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 05/10/2019] [Accepted: 05/29/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Benign anal diseases, including hemorrhoids, fissures, abscesses, fistulas, and anal condylomata, affect 10%-15% of our population. Most patients seen by nonsurgical providers experience delayed treatment. We examined at our institution whether an educational session on anorectal diseases would benefit trainees from medical and surgical specialties. MATERIALS AND METHODS The study took place at Oregon Health & Science University, a primary institutional practice with 130 resident participants. An exploratory study using a 10-point pretest and posttest regarding these diseases was designed and administered to medical subspecialties, including general surgery (GS), emergency medicine, internal medicine, and family medicine, obstetrics/gynecology, and pediatric residents. Intervention was a 50-min presentation highlighting anatomy, history and physical findings, and disease treatment. The posttest was repeated after 6 mo to evaluate retention and overall satisfaction, and differences were evaluated. RESULTS With the exception of GS, posttest scores improved. Internal medicine improved most significantly. GS residents scored better on the pretest than other specialties; their posttest scores, however, declined. The survey demonstrated residents with prior education scored better on the pretest. PGY-1 and PGY-2 residents improved most on their posttest. On 6-mo retest, 17.6% of residents responded and posttest performance was 72%. CONCLUSIONS Nonsurgical residents have limited knowledge about benign anal diseases but demonstrate improvement after educational intervention. Surgery residents performed well, but demonstrate regression to the mean, common in test taking, but may also require a more advanced lecture. Formal institutional, regional, and national educational interventions are needed to improve the understanding of these diseases.
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Affiliation(s)
- Katherine A Kelley
- Division of GI and General Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon
| | - Caroline Schulman
- Division of GI and General Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon
| | - Kim C Lu
- Division of GI and General Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon
| | - V Liana Tsikitis
- Division of GI and General Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon.
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Nguyen TPL, Edwards H, Do TND, Finlayson K. Effectiveness of a theory-based foot care education program (3STEPFUN) in improving foot self-care behaviours and foot risk factors for ulceration in people with type 2 diabetes. Diabetes Res Clin Pract 2019; 152:29-38. [PMID: 31082445 DOI: 10.1016/j.diabres.2019.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/12/2019] [Accepted: 05/03/2019] [Indexed: 01/13/2023]
Abstract
AIMS To evaluate the effectiveness of a theory-based foot care education intervention program (3STEPFUN) for people with type 2 diabetes at low risk of developing a foot ulcer. METHODS A controlled, pre-test/ post-test quasi-experimental design was used. From 119 participants, 60 participants in the control group received usual care and a foot care brochure. Those in the intervention group received (1) a small group intensive education and hands-on skills session; (2) a foot care kit and documents; and (3) three regular booster follow-up phone calls over 6 months. Generalised Estimating Equations models were undertaken to examine the impact of the intervention on outcomes over time. RESULTS The intervention group had significantly improved outcomes compared to the control group over 6 months in the following aspects: improved preventive foot care behaviour (p = 0.001); and decreased prevalence of foot risk factors for ulceration (i.e. dry skin, corns/ callus) (OR: 0.04, 95% CI 0.01 - 0.13, p < 0.001). CONCLUSIONS The study's findings provide evidence of 3STEPFUN on improving foot self-care behaviour and preventing minor foot problems. Further study with formal RCT design and longer follow-up time to examine the effects on decreasing foot ulcer incidence is recommended.
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Affiliation(s)
- Thi Phuong Lan Nguyen
- School of Nursing, Faculty of Health, Queensland University of Technology, Australia; Ho Chi Minh City University of Medicine and Pharmacy, Viet Nam.
| | - Helen Edwards
- Faculty of Health, Queensland University of Technology, Australia
| | | | - Kathleen Finlayson
- School of Nursing, Faculty of Health, Queensland University of Technology, Australia
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Mickan S, Hilder J, Wenke R, Thomas R. The impact of a small-group educational intervention for allied health professionals to enhance evidence-based practice: mixed methods evaluation. BMC Med Educ 2019; 19:131. [PMID: 31060553 PMCID: PMC6503357 DOI: 10.1186/s12909-019-1567-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/22/2019] [Indexed: 05/23/2023]
Abstract
BACKGROUND Healthcare professionals are recommended to use evidence-based practice (EBP) principles to update and improve clinical practice. Well-designed educational initiatives, together with practice and feedback opportunities can improve individuals' EBP knowledge, skills and attitudes. METHODS A concurrent mixed methods assessment was designed to evaluate the effectiveness and feasibility of four monthly workshops on allied health professionals' knowledge, skills, self-efficacy and behaviour. In between workshops, professionals were encouraged to practice and integrate EBP learnings with colleagues in their workplace. Participants completed three pre and post intervention assessments: Evidence-based Practice Confidence Scale; adapted Fresno test; and an adapted EBP Implementation Scale. A purpose designed satisfaction questionnaire was completed immediately after the educational intervention and follow up focus groups were conducted after 3 months. Mean change in assessment data was quantitatively assessed and comments from the clinician satisfaction questionnaire and focus groups were thematically analysed and interpreted together with quantitative data using the Classification Rubric for EBP Assessment tools in Education (CREATE). RESULTS Sixteen allied health professionals participated in the EBP workshops and completed all baseline and post intervention assessments. Seven clinicians participated in follow up focus groups. All clinicians reported a positive reaction to the learning experience, preferring short monthly workshops to a full day session. They self-reported improvements in self-efficacy (mean change 15 p < 0.001) and implementing EBP behaviours (mean change 7, p < 0.001) from pre- to post-intervention. Although the positive change in EBP knowledge measured by the adapted Fresno test was not statistically significant (mean change 10, p = 0.21), clinicians described examples of improved knowledge and skills across all five key steps of EBP during the focus groups. A further, post hoc analysis of individual questions in the two self-reported scales indicated consistent improvement across key EBP knowledge and skills. CONCLUSIONS A tailored small group EBP education intervention can enhance AHPs' self-efficacy to develop answerable questions, search the literature, critically appraise, apply and evaluate research evidence. Through practicing these behaviours and sharing new learning with their peers, allied health professionals can enhance their capability and motivation to use research evidence to potentially improve clinical practice.
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Affiliation(s)
- Sharon Mickan
- Allied Health Clinical Governance, Education and Research, Gold Coast Health, Executive Office Level 4, Block A, 1 Hospital Boulevard Southport, Gold Coast, QLD 4215 Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD Australia
| | - Joanne Hilder
- Allied Health Clinical Governance, Education and Research, Gold Coast Health, Executive Office Level 4, Block A, 1 Hospital Boulevard Southport, Gold Coast, QLD 4215 Australia
| | - Rachel Wenke
- Allied Health Clinical Governance, Education and Research, Gold Coast Health, Executive Office Level 4, Block A, 1 Hospital Boulevard Southport, Gold Coast, QLD 4215 Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD Australia
| | - Rae Thomas
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD Australia
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Davies CF, Kesten JM, Gompels M, Horwood J, Crofts M, Billing A, Chick C, May MT. Evaluation of an educational intervention to increase HIV-testing in high HIV prevalence general practices: a pilot feasibility stepped-wedged randomised controlled trial. BMC Fam Pract 2018; 19:195. [PMID: 30545301 PMCID: PMC6292019 DOI: 10.1186/s12875-018-0880-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/22/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND HIV-infected patients often present to primary care several times with HIV-indicator conditions before diagnosis but the opportunity to test by healthcare professionals (HCPs) is frequently missed. Current HIV testing rates in primary care are low and educational interventions to facilitate HCPs to increase testing and awareness of HIV are needed. METHOD We implemented a pilot feasibility stepped-wedged randomised controlled trial of an educational intervention in high HIV prevalence practices in Bristol. The training delivered to HCPs including General Practitioners (GP) aimed to increase HIV testing and included why, who, and how to test. The intervention was adapted from the Medical Foundation for HIV and Sexual Health HIV Testing in Practice (MEDFASH) educational tool. Questionnaires assessed HCP feedback and perceived impacts of the intervention. HIV testing rates were compared between control and intervention practices using 12 monthly laboratory totals. RESULTS 169 HCPs (from 19 practices) received the educational intervention. 127 (75%) questionnaires were completed. Delivery of the intervention was received positively and was perceived as valuable for increasing awareness, confidence and consideration of testing, with HCPs gaining more awareness of HIV testing guidelines. The main pre-training HIV testing barrier reported by GPs was the patient not considering themselves at risk, whilst for nurses it was a concern about embarrassing or offending the patient. Most HCPs reported the intervention addressed these barriers. The HIV testing rate increased more in the control than in the intervention practices: mean difference 2.6 (95% CI 0.5,4.7) compared with 1.9 (- 0.5,4.3) per 1000 patients, respectively. The number of HIV tests across all practices increased from 1154 in the first 6 months to 1299 in the second 6 months, an annual increase in testing rate of 2.0 (0.7,3.4) from 16.3 to 18.3 per 1000 patients. CONCLUSION There was a small increase in HIV testing rates over the study period, but this could not be attributed to the educational intervention. More effective and sustainable programmes tailored to each practice context are needed to change testing culture and HCP behaviour. Repeated training, supported by additional measures, such as testing prompts, may be needed to influence primary care HIV testing.
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Affiliation(s)
- Charlotte F Davies
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Joanna M Kesten
- Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.,National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol, NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, England.,National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Mark Gompels
- Department of Immunology, Southmead Hospital, North Bristol NHS Trust, Westbury-on-Trym, Bristol, BS10 5NB, UK
| | - Jeremy Horwood
- National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol, NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, England
| | - Megan Crofts
- Genitourinary medicine, Unity Sexual Health, Bristol Sexual Health Services, Tower Hill, Bristol, BS2 0JD, UK.
| | - Annette Billing
- NHS Bristol, North Somerset and South Gloucestershire CCG, South Plaza, Marlborough Street, Bristol, BS1 3NX, UK.
| | - Charlotte Chick
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Margaret T May
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
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21
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Reshetukha TR, Alavi N, Prost E, Kirkpatrick RH, Sajid S, Patel C, Groll DL. Improving suicide risk assessment in the emergency department through physician education and a suicide risk assessment prompt. Gen Hosp Psychiatry 2018; 52:34-40. [PMID: 29549821 DOI: 10.1016/j.genhosppsych.2018.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 02/26/2018] [Accepted: 03/01/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To determine the efficacy of two interventions on suicide risk assessment within emergency departments (EDs) on improving the documentation of suicide risk factors by emergency medicine and psychiatric physicians during suicide risk assessment. METHOD An educational intervention on suicide was provided to all emergency medicine and psychiatry physicians and was followed by the placement of a suicide risk assessment prompt within local EDs. The medical charts of all ED patients presenting with suicidal ideation or behaviours were reviewed immediately and six months after the interventions and compared to pre-intervention. Differences in the documentation of 40 biopsychosocial suicide risk factors between specialties and after the interventions were determined. RESULTS The documentation of 34/40 (p ≤ 0.008) and 33/40 (p ≤ 0.009) suicide risk factors was significantly improved by emergency medicine and psychiatry physicians, respectively, after the interventions and maintained six months later. Immediately and six months after the interventions, the documentation of 8/40 (p ≤ 0.041) and 14/40 (p ≤ 0.048) suicide risk factors, respectively, significantly differed between specialties. CONCLUSION This suggests that providing a brief educational intervention on suicide to emergency medicine and psychiatry physicians followed by placing a prompt for important, yet commonly undocumented risk factors within the ED is a low-cost and effective intervention for improving documentation of suicide risk assessments within the ED.
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Affiliation(s)
- Taras R Reshetukha
- Queen's University Department of Psychiatry, Providence Care Hospital, 752 King Street West, Postal Bag 603, Kingston, ON K7L 7X3, Canada.
| | - Nazanin Alavi
- Queen's University Department of Psychiatry, Providence Care Hospital, 752 King Street West, Postal Bag 603, Kingston, ON K7L 7X3, Canada; University of Toronto Department of Psychiatry, Centre for Addiction and Mental Health, Department of Psychiatry, 100 Stokes Street, Toronto, ON M6J 1H4, Canada.
| | - Eric Prost
- Queen's University Department of Psychiatry, Providence Care Hospital, 752 King Street West, Postal Bag 603, Kingston, ON K7L 7X3, Canada.
| | - Ryan H Kirkpatrick
- Queen's University Department of Psychiatry, Providence Care Hospital, 752 King Street West, Postal Bag 603, Kingston, ON K7L 7X3, Canada.
| | - Saad Sajid
- Queen's University Department of Psychiatry, Providence Care Hospital, 752 King Street West, Postal Bag 603, Kingston, ON K7L 7X3, Canada.
| | - Charmy Patel
- Queen's University Department of Psychiatry, Providence Care Hospital, 752 King Street West, Postal Bag 603, Kingston, ON K7L 7X3, Canada.
| | - Dianne L Groll
- Queen's University Department of Psychiatry, Providence Care Hospital, 752 King Street West, Postal Bag 603, Kingston, ON K7L 7X3, Canada.
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Abstract
PURPOSE OF REVIEW The present review was undertaken in order to summarize and evaluate recent research investigating taste exposure, sensory learning, and nutrition education interventions for promoting vegetable intake in preschool children. RECENT FINDINGS Overall, taste exposure interventions yielded the best outcomes for increasing vegetable intake in early childhood. Evidence from sensory learning strategies such as visual exposure and experiential learning also show some success. While nutrition education remains the most common approach used in preschool settings, additional elements are needed to strengthen the educational program for increasing vegetable intake. There is a substantial gap in the evidence base to promote vegetable intake in food fussy children. The present review reveals the relative importance of different intervention strategies for promoting vegetable intake. To strengthen intervention effects for improving vegetable intake in preschool children, future research could consider integrating taste exposure and sensory learning strategies with nutrition education within the preschool curriculum.
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Valdez A, Napoles AM, Stewart SL, Garza A. A Randomized Controlled Trial of a Cervical Cancer Education Intervention for Latinas Delivered Through Interactive, Multimedia Kiosks. J Cancer Educ 2018; 33:222-230. [PMID: 27573420 PMCID: PMC5332337 DOI: 10.1007/s13187-016-1102-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
US Latina women experience disproportionately high cervical cancer incidence and mortality rates. These health disparities are largely preventable with routine pap tests and human papillomavirus (HPV) screening. This study tested the efficacy of a cervical cancer education intervention to improve risk factor knowledge, attitudes, self-efficacy, and self-reported behavior related to cervical cancer screening among low-income Latinas who had not been screened in the past 2 years, compared to a usual care control group. Low-income Latinas who had not had a pap test in the prior 2 years were recruited from three Federally Qualified Health Centers and randomly assigned to intervention and control groups, with in-person assessment at baseline and 6-month follow-up. Women in the intervention group received a one-time low-literacy cervical cancer education program through an interactive, multimedia kiosk in either English or Spanish based on their language preference. Compared to the control group, the intervention group demonstrated greater knowledge (p < 0.0001) and more favorable attitudes at follow-up; fewer intervention group women never thought of getting a pap test (46 vs. 54 %, p = 0.050) or agreed that it is fate whether a woman gets cervical cancer or not (24 vs. 31 %, p = 0.043). The groups did not differ significantly on the proportion who had obtained or made an appointment for a pap test at follow-up (51 vs. 48 %, p = 0.35). Both groups reported high levels of self-efficacy regarding pap screening at post-intervention. A one-time interactive, multimedia educational intervention improved cervical cancer knowledge and attitudes among low-income Latinas but had no effect on cervical cancer-screening behavior. Exposure of the control group to the pre-test conducted on the multimedia kiosk may have influenced their screening behavior.
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Affiliation(s)
- Armando Valdez
- HealthPoint Communications Institute, 10 Jordan, Avenue Los Altos, CA, 94022, USA.
| | - Anna M Napoles
- University of California, San Francisco, San Francisco, CA, 94143, USA
| | | | - Alvaro Garza
- San Joaquin County Public Health Services, Stockton, CA, 95205, USA
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Jacobsen FF, Mekki TE, Førland O, Folkestad B, Kirkevold Ø, Skår R, Tveit EM, Øye C. A mixed method study of an education intervention to reduce use of restraint and implement person-centered dementia care in nursing homes. BMC Nurs 2017; 16:55. [PMID: 28936121 PMCID: PMC5604397 DOI: 10.1186/s12912-017-0244-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 09/01/2017] [Indexed: 11/15/2022] Open
Abstract
Background People living with dementia in nursing homes are most likely to be restrained. The primary aim of this mixed-method education intervention study was to investigate which factors hindered or facilitated staff awareness related to confidence building initiatives based on person-centred care, as an alternative to restraint in residents with dementia in nursing homes. The education intervention, consisting of a two-day seminar and monthly coaching sessions for six months, targeted nursing staff in 24 nursing homes in Western Norway. The present article reports on staff-related data from the study. Methods We employed a mixed-method design combining quantitative and qualitative methods. The P-CAT (Person-centred Care Assessment Tool) and QPS-Nordic (The General Nordic questionnaire for psychological and social factors at work) instruments were used to measure staff effects in terms of person-centred care and perception of leadership. The qualitative data were collected through ethnographic fieldwork, qualitative interviews and analysis of 84 reflection notes from eight persons in the four teams who facilitated the intervention. The PARIHS (Promoting Action on Research Implementation in Health Services) theoretical framework informed the study design and the data analysis. Six nursing homes were selected for ethnographic study post-intervention. Results Qualitative data indicated increased staff awareness related to using restraint - or not- in the context of person-centered care. A slight increase in P-CAT supported these findings. Thirteen percent of the P-CAT variation was explained by institutional belonging. Qualitative data indicated that whether shared decisions of alternative measures to restraint were applied was a function of dynamic interplay between facilitation and contextual elements. In this connection, the role of the nursing home leaders appeared to be a pivotal element promoting or hindering person-centered care. However, leadership-staff relations varied substantially across individual institutions, as did staff awareness related to restraint and person-centeredness. Conclusions Leadership, in interplay with staff culture, turned out to be the most important factor hindering or promoting staff awareness related to confidence building initiatives, based on person-centered care. While quantitative data indicated variations across institutions and the extent of this variation, qualitative data offered insight into the local processes involved. A mixed method approach enabled understanding of dynamic contextual relationships. Trial registration The trial is registered at Clinical Trials gov. reg. 2012/304 NCT01715506. Electronic supplementary material The online version of this article (10.1186/s12912-017-0244-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frode F Jacobsen
- Center for Care Research, Western Norway, Bergen, Norway.,Western Norway University of Applied Sciences, P.O.Box 7030, N-5020 Bergen, Norway.,VID Specialized University, Bergen, Norway
| | - Tone Elin Mekki
- Center for Care Research, Western Norway, Bergen, Norway.,Western Norway University of Applied Sciences, P.O.Box 7030, N-5020 Bergen, Norway
| | - Oddvar Førland
- Center for Care Research, Western Norway, Bergen, Norway.,Western Norway University of Applied Sciences, P.O.Box 7030, N-5020 Bergen, Norway.,VID Specialized University, Bergen, Norway
| | - Bjarte Folkestad
- Center for Care Research, Western Norway, Bergen, Norway.,Uni Research Rokkan Centre, Bergen, Norway
| | - Øyvind Kirkevold
- Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Norwegian National Advisory Unit on Ageing and Health, Oslo, Norway
| | - Randi Skår
- Western Norway University of Applied Sciences, Bergen, Norway
| | - Eva Marie Tveit
- Center for Care Research, Western Norway, Bergen, Norway.,Bergen Tourist Information, Bergen, Norway
| | - Christine Øye
- Center for Care Research, Western Norway, Bergen, Norway.,Western Norway University of Applied Sciences, P.O.Box 7030, N-5020 Bergen, Norway
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25
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Kozlov E, Reid MC, Carpenter BD. Improving patient knowledge of palliative care: A randomized controlled intervention study. Patient Educ Couns 2017; 100:1007-1011. [PMID: 28034612 PMCID: PMC5879772 DOI: 10.1016/j.pec.2016.12.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 12/14/2016] [Accepted: 12/20/2016] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To determine if laypersons' knowledge about palliative care can improve with a brief education intervention. METHODS 152 adults were recruited to participate in a web-based randomized intervention trial that followed a 2 (content)×2 (format) between-subjects design. Groups received either a video intervention, an information page intervention, a video control, or an information page control. An ANCOVA with contrast coding of two factors was utilized to assess if knowledge, as measured by the Palliative Care Knowledge Scale (PaCKS), increased post intervention. RESULTS There was a significant difference between intervention group means and control group means on PaCKS scores from T1 to T2 F(1, 139)=11.10, p=0.00, ηp2=0.074. There was no significant difference in PaCKS change scores between the video intervention and information page intervention. CONCLUSIONS This study demonstrates that an information page and a brief video can improve knowledge of palliative care in laypersons. PRACTICE IMPLICATIONS Self-administered educational interventions could be made available in diverse settings in order to reach patients and their families who may benefit from but are unaware of palliative care. Interventions more intensive than the one tested in this study might result in even more significant improvements in knowledge.
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Affiliation(s)
- Elissa Kozlov
- Weill Cornell Medical College, Department of Medicine, New York, NY, United States.
| | - M Carrington Reid
- Weill Cornell Medical College, Department of Medicine, New York, NY, United States
| | - Brian D Carpenter
- Washington University in St. Louis, Department of Psychological & Brain Sciences, St. Louis, MO, United States
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Hu Y, Chen Y, Wang Y, Song Q, Li Q. Prenatal vaccination education intervention improves both the mothers' knowledge and children's vaccination coverage: Evidence from randomized controlled trial from eastern China. Hum Vaccin Immunother 2017; 13:1-8. [PMID: 28319453 DOI: 10.1080/21645515.2017.1285476] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To verify the effectiveness of prenatal vaccination education intervention on improving mother's vaccination knowledge and child's vaccination status in Zhejiang province, eastern China. METHODS Pregnant women with ≥ 12 gestational weeks were recruited and randomly assigned into the intervention group and the control group. The intervention group were given a vaccination education session while the control group were not. Two round surveys were performed before and 3 months after the intervention. The vaccination status of child was extracted at 12 months of age from immunization information system. The differences of the vaccination knowledge, the coverage, the completeness and the timeliness of vaccination between 2 groups were evaluated. The effectiveness of vaccination education intervention was assessed, under the control of the other demographic variables. RESULTS Among the 1252 participants, 851 subjects replied to the post-survey. Significant improvements of vaccination knowledge between the pre- and the post- survey in the intervention group were observed (Mean ± S.D:1.8 ± 1.1 vs. 3.7 ± 1.2 for vaccines score and 2.7 ± 1.5 vs. 4.8 ± 1.0 for vaccine policy score, respectively). The coverage of fully vaccination was significantly higher in the intervention group (90.0% vs. 82.9%, P<0.01). The timeliness of fully vaccination was significantly higher in the intervention group (51.9% vs. 33.0%, P<0.01). In the intervention group, pregnant women were more likely to be with high score of knowledge (OR = 5.2, 95%CI: 2.6-8.8), and children were more likely to complete the full series of vaccination (OR = 3.4, 95%CI: 2.1-4.8), and children were more likely to complete the full series of vaccination in a timely manner (OR = 2.3, 95%CI: 1.6-3.5). CONCLUSIONS Vaccination education in the pregnant women can effectively improve the knowledge regarding immunization and increase the coverage, the completeness and the timeliness of childhood vaccination. Strong partnership needs to be established between the obstetricians and the vaccination staff to improve the performance of NIP.
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Affiliation(s)
- Yu Hu
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Binjiang District, Hangzhou , Zhejiang , China
| | - Yaping Chen
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Binjiang District, Hangzhou , Zhejiang , China
| | - Ying Wang
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Binjiang District, Hangzhou , Zhejiang , China
| | - Quanwei Song
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Binjiang District, Hangzhou , Zhejiang , China
| | - Qian Li
- a Institute of Immunization and Prevention, Zhejiang Provincial Center for Disease Control and Prevention , Binjiang District, Hangzhou , Zhejiang , China
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Ibinda F, Mbuba CK, Kariuki SM, Chengo E, Ngugi AK, Odhiambo R, Lowe B, Fegan G, Carter JA, Newton CR. Evaluation of Kilifi epilepsy education programme: a randomized controlled trial. Epilepsia 2014; 55:344-52. [PMID: 24447063 PMCID: PMC4233970 DOI: 10.1111/epi.12498] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2013] [Indexed: 11/30/2022]
Abstract
Objectives The epilepsy treatment gap is largest in resource-poor countries. We evaluated the efficacy of a 1-day health education program in a rural area of Kenya. The primary outcome was adherence to antiepileptic drugs (AEDs) as measured by drug levels in the blood, and the secondary outcomes were seizure frequency and Kilifi Epilepsy Beliefs and Attitudes Scores (KEBAS). Methods Seven hundred thirty-eight people with epilepsy (PWE) and their designated supporter were randomized to either the intervention (education) or nonintervention group. Data were collected at baseline and 1 year after the education intervention was administered to the intervention group. There were 581 PWE assessed at both time points. At the end of the study, 105 PWE from the intervention group and 86 from the nonintervention group gave blood samples, which were assayed for the most commonly used AEDs (phenobarbital, phenytoin, and carbamazepine). The proportions of PWE with detectable AED levels were determined using a standard blood assay method. The laboratory technicians conducting the assays were blinded to the randomization. Secondary outcomes were evaluated using questionnaires administered by trained field staff. Modified Poisson regression was used to investigate the factors associated with improved adherence (transition from nonoptimal AED level in blood at baseline to optimal levels at follow-up), reduced seizures, and improved KEBAS, which was done as a post hoc analysis. This trial is registered in ISRCTN register under ISRCTN35680481. Results There was no significant difference in adherence to AEDs based on detectable drug levels (odds ratio [OR] 1.46, 95% confidence interval [95% CI] 0.74–2.90, p = 0.28) or by self-reports (OR 1.00, 95% CI 0.71–1.40, p = 1.00) between the intervention and nonintervention group. The intervention group had significantly fewer beliefs about traditional causes of epilepsy, cultural treatment, and negative stereotypes than the nonintervention group. There was no difference in seizure frequency. A comparison of the baseline and follow-up data showed a significant increase in adherence—intervention group (36–81% [p < 0.001]) and nonintervention group (38–74% [p < 0.001])—using detectable blood levels. The number of patients with less frequent seizures (≤3 seizures in the last 3 months) increased in the intervention group (62–80% [p = 0.002]) and in the nonintervention group (67–75% [p = 0.04]). Improved therapeutic adherence (observed in both groups combined) was positively associated with positive change in beliefs about risks of epilepsy (relative risk [RR] 2.00, 95% CI 1.03–3.95) and having nontraditional religious beliefs (RR 2.01, 95% CI 1.01–3.99). Reduced seizure frequency was associated with improved adherence (RR 1.72, 95% CI 1.19–2.47). Positive changes in KEBAS were associated with having tertiary education as compared to none (RR 1.09, 95% CI 1.05–1.14). Significance Health education improves knowledge about epilepsy, but once only contact does not improve adherence. However, sustained education may improve adherence in future studies.
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Affiliation(s)
- Fredrick Ibinda
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
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