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Igwesi-Chidobe CN, Sorinola IO, Ozumba BC, Godfrey EL. Challenges of Measuring Self-Reported Exposure to Occupational Biomechanical Risk Factors Amongst People with Low Literacy Engaged in Manual Labour: Findings from a Cross-Cultural Adaptation and Psychometric Investigation in an African Population with Chronic Low Back Pain. J Occup Rehabil 2024:10.1007/s10926-024-10171-5. [PMID: 38379049 DOI: 10.1007/s10926-024-10171-5] [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] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE Occupational biomechanical factors are implicated in the aetiology and progression of low back pain (LBP). This study cross-culturally adapted and psychometrically investigated the Occupational Risk Factor Questionnaire (ORFQ) in a low literate Nigerian Igbo population with chronic LBP. METHODS Forward and back translation of the original ORFQ by clinical and non-clinical translators was followed by an expert committee review. The adapted ORFQ was pre-tested amongst rural Nigerian adults with chronic LBP using cognitive think-aloud interviewing. Internal consistency (Cronbach's alpha) and test-retest reliability (unweighted and linear weighted k statistic for item-by-item agreement, and intra-class correlation coefficient-ICC) were investigated amongst 50 rural and urban Nigerian dwellers with chronic LBP. Spearman's correlation and regression analyses were conducted with the Igbo-ORFQ, and measures of disability [World Health Organisation Disability Assessment Schedule (WHODAS 2.0), Roland Morris Disability Questionnaire (RMDQ), Back performance scale (BPS)], pain intensity [Eleven-point box scale (BS-11)] and social support [Multidimensional Scale of Perceived Social Support (MSPSS)], to test construct validity with 200 rural Nigerian dwellers with chronic LBP. RESULTS Cross-cultural adaptation highlighted difficulty conceptualising and concretising exposure to biomechanical risk factors. Item-by-item agreement, internal consistency (α = 0.84) and intraclass correlation coefficient (ICC = 0.83) were good. Some unexpected direction of associations between the biomechanical components of the Igbo-ORFQ, and disability, pain intensity, and social support prohibits establishment of construct validity. CONCLUSION Prospective studies comparing the Igbo-ORFQ to other measures of exposure to occupational biomechanical risk factors are required to establish the construct validity of the Igbo-ORFQ.
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Affiliation(s)
- Chinonso Nwamaka Igwesi-Chidobe
- School of Allied Health Professions and Midwifery, Faculty of Health Studies, University of Bradford, Bradford, UK.
- Global Population Health (GPH) Research Group, University of Nigeria, Nsukka, Nigeria.
| | | | - Benjamin Chukwuma Ozumba
- Global Population Health (GPH) Research Group, University of Nigeria, Nsukka, Nigeria
- Faculty of Medicine, College of Medicine, University of Nigeria (Enugu Campus), Enugu, Nigeria
| | - Emma Louise Godfrey
- Department of Physiotherapy, School of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Mertens L, Dewitte H, Seuntjens L, Vanobberghen R, Aertgeerts B. The guided use of an e-health tool to strengthen health literacy. A pilot study in a multicultural diabetes population in a primary care clinic in Brussels. PEC Innov 2022; 1:100056. [PMID: 37213751 PMCID: PMC10194349 DOI: 10.1016/j.pecinn.2022.100056] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 05/23/2023]
Abstract
Objectives We aimed to investigate whether the use of an e-health tool, guided by a healthcare provider, can improve health literacy (HL) in primary care. Methods We set up a longitudinal prospective cohort study in a primary care clinic in Brussels. Diabetes patients were invited to participate in two study consultations with a trained healthcare provider, in which an e-health tool was introduced. The Health Literacy Questionnaire (HLQ) was used to evaluate HL before (n = 59) and after intervention (n = 41). The data were analysed within SPSS, Version 26. Additionally, impressions and experiences of both patients and healthcare providers were collected throughout the different phases of the study. Results Patients feel significantly stronger in finding good health information after intervention (p = 0.041), with relatively stronger progress for the subgroup with weaker digital skills (p = 0.029). Participants also declare understanding health information better after intervention (p = 0.050). Specifically, the lower educated participants feel reinforced to correctly evaluate and assess health information and come closer to the skill level of the higher educated patients after intervention. The relationship with the healthcare provider was also more markedly enhanced within the group of the lower educated (p = 0.008; difference between higher and lower educated), which could strengthen self-management in the long run. Conclusions The guided use of an e-health tool in primary care strengthens various patient HL skills. Most particularly the skills "the ability to find good health information" and "understand health information well enough to know what to do" are reinforced. Moreover, patient populations with lower HL, such as the lower educated and lower digitally skilled, show a greater learning potential. Innovation Our results offer further proof for the learnable and flexible nature of HL, and show that even a small e-health intervention, in a very diverse patient population, can produce significant, positive effects on HL. These results need to be considered as promising, and a motivation for further investments in more widely accessible e-health tools to further improve HL at population level and to bridge health differences.
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Affiliation(s)
- Lien Mertens
- Department of Family Medicine and Primary Care, University of Leuven (KULeuven), Belgium
- Corresponding author at: Kapucijnenvoer 33 blok J, 3000 Leuven, Belgium.
| | - Harrie Dewitte
- Department of Family Medicine and Primary Care, University of Leuven (KULeuven), Belgium
| | - Lieve Seuntjens
- Department of Family Medicine and Primary Care, University of Antwerp (UAntwerpen), Belgium
| | - Rita Vanobberghen
- Department of Family Medicine and Primary Care, University of Brussels (Vrije Universiteit Brussel), Belgium
| | - Bert Aertgeerts
- Department of Family Medicine and Primary Care, University of Leuven (KULeuven), Belgium
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Bukini D, Mbekenga C, Nkya S, Purvis L, McCurdy S, Parker M, Makani J. A qualitative study on aspects of consent for genomic research in communities with low literacy. BMC Med Ethics 2020; 21:48. [PMID: 32532327 PMCID: PMC7291634 DOI: 10.1186/s12910-020-00488-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 06/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low literacy of study participants in Sub - Saharan Africa has been associated with poor comprehension during the consenting process in research participation. The concerns in comprehension are far greater when consenting to participate in genomic studies due to the complexity of the science involved. While efforts are made to explore possibilities of applying genomic technologies in diseases prevalent in Sub Saharan Africa, we ought to develop methods to improve participants' comprehension for genomic studies. The purpose of this study was to understand different approaches that can be used to seek consent from individuals with low literacy in Sub-Saharan African countries in genomic research to improve comprehension. METHODS Using qualitative study design, we conducted focus-group discussions, in-depth interviews and participant observations as data collection methods. This study was embedded in a hospital based genomic study on Sickle Cell Disease at Muhimbili National Hospital in Tanzania. Thematic content analysis was used to analyse the transcripts and field notes. RESULTS Findings from this study show that literacy level has little influence on understanding the research details. According to the participants of this study, the methods used to provide information, the language, and time spent with the study participants were the key factors influencing understanding. The availability of group sessions held before individual consent to allow for a detailed questions and answers format was agreed to be the best method to facilitate the comprehension. CONCLUSION The quality of the consenting process of participants will be influence by a number of factors. The type of research consented for, where the research will be implemented and who are the potential study participants are amongst the factors that need to be assessed during the consenting. Measures to improve participants' comprehension need to be developed when consenting participants with low literacy level in genomic studies.
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Affiliation(s)
- Daima Bukini
- Sickle Cell Programme, Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, UN Road, Upanga, Block 9, Dar es Salaam, Tanzania.
| | - Columba Mbekenga
- School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania
| | - Siana Nkya
- Sickle Cell Programme, Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, UN Road, Upanga, Block 9, Dar es Salaam, Tanzania
| | - Lisa Purvis
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth-Hitchcock Medical Centre, Hanover, NH, USA
| | - Sheryl McCurdy
- University of Texas Health Science Centre at Houston, School of Public Health, Houston, TX, USA
| | - Michael Parker
- Welcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Julie Makani
- Sickle Cell Programme, Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, UN Road, Upanga, Block 9, Dar es Salaam, Tanzania
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González-Duarte A, Zambrano-González E, Medina-Franco H, Alberú-Gómez J, Durand-Carbajal M, Hinojosa CA, Aguilar-Salinas CA, Kaufer-Horwitz M. II. THE RESEARCH ETHICS INVOLVING VULNERABLE GROUPS. Rev Invest Clin 2020; 71:217-225. [PMID: 31448777 DOI: 10.24875/ric.19002812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Vulnerability in research occurs when the participant is incapable of protecting his or her interests and therefore, has an increased probability of being intentionally or unintentionally harmed. This manuscript aims to discuss the conditions that make a group vulnerable and the tools and requirements that can be used to reduce the ethical breaches when including them in research protocols. The vulnerability can be due either to an inability to understand and give informed consent or to unequal power relationships that hinder basic rights. Excluding subjects from research for the only reason of belonging to a vulnerable group is unethical and will bias the results of the investigation. To consider a subject or group as vulnerable depends on the context, and the investigator should evaluate each case individually.
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Affiliation(s)
| | | | - Heriberto Medina-Franco
- Research Committee of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Josefina Alberú-Gómez
- Research Committee of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Marta Durand-Carbajal
- Research Committee of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos A Hinojosa
- Research Committee of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos A Aguilar-Salinas
- Research Committee of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Martha Kaufer-Horwitz
- Research Committee of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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van Ruitenbeek GMC, Zijlstra FRH, Hülsheger UR. The Development of an Instrument to Measure the Work Capability of People with Limited Work Capacity (LWC). J Occup Rehabil 2019; 29:163-174. [PMID: 29869053 PMCID: PMC6510851 DOI: 10.1007/s10926-018-9774-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 06/08/2023]
Abstract
Purpose Participation in regular paid jobs positively affects mental and physical health of all people, including people with limited work capacities (LWC), people that are limited in their work capacity as a consequence of their disability, such as chronic mental illness, psychological or developmental disorder. For successful participation, a good fit between on one hand persons' capacities and on the other hand well-suited individual support and a suitable work environment is necessary in order to meet the demands of work. However, to date there is a striking paucity of validated measures that indicate the capability to work of people with LWC and that outline directions for support that facilitate the fit. Goal of the present study was therefore to develop such an instrument. Specifically, we adjusted measures of mental ability, conscientiousness, self-efficacy, and coping by simplifying the language level of these measures to make the scales accessible for people with low literacy. In order to validate these adjusted self-report and observer measures we conducted two studies, using multi-source, longitudinal data. Method Study 1 was a longitudinal multi-source study in which the newly developed instrument was administered twice to people with LWC and their significant other. We statistically tested the psychometric properties with respect to dimensionality and reliability. In Study 2, we collected new multi-source data and conducted a confirmatory factor analysis (CFA). Results Studies yielded a congruous factor structure in both samples, internally consistent measures with adequate content validity of scales and subscales, and high test-retest reliability. The CFA confirmed the factorial validity of the scales. Conclusion The adjusted self-report and the observer scales of mental ability, conscientiousness, self-efficacy, and coping are reliable measures that are well-suited to assess the work capability of people with LWC. Further research is needed to examine criterion-related validity with respect to the work demands such as work-behaviour and task performance.
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Affiliation(s)
- Gemma M C van Ruitenbeek
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, P. O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Fred R H Zijlstra
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, P. O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Ute R Hülsheger
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, P. O. Box 616, 6200 MD, Maastricht, The Netherlands
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Smith SK, Cai A, Wong M, Sousa MS, Peate M, Welsh A, Meiser B, Kaur R, Halliday J, Lewis S, Trevena L, Yanes T, Barlow-Stewart K, Barclay M. Improving women's knowledge about prenatal screening in the era of non-invasive prenatal testing for Down syndrome - development and acceptability of a low literacy decision aid. BMC Pregnancy Childbirth 2018; 18:499. [PMID: 30558569 PMCID: PMC6296052 DOI: 10.1186/s12884-018-2135-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 03/20/2018] [Accepted: 12/04/2018] [Indexed: 02/02/2023] Open
Abstract
Background Access to information about prenatal screening is important particularly in light of new techniques such as non-invasive prenatal testing (NIPT). This study aimed to develop and examine the acceptability of a low literacy decision aid (DA) about Down syndrome screening among pregnant women with varying education levels and GPs. Methods We developed a DA booklet providing information about first-trimester combined testing, maternal serum screening, and NIPT. GPs and women participated in a telephone interview to examine the acceptability of the DA and measure screening knowledge before and after reading the DA. The knowledge measure was designed to assess whether women had understood the gist of the information presented in the decision aid. It comprised conceptual questions (e.g. screening tells you the chance of having a baby with Down syndrome) and numeric questions (e.g. the accuracy of different screening tests). Results Twenty-nine women and 18 GPs participated. Regardless of education level, most women found the booklet ‘very’ clearly presented (n = 22, 76%), and ‘very’ informative (n = 23, 80%). Overall, women’s conceptual and numeric knowledge improved after exposure to the DA, from 4% having adequate knowledge to 69%. Women’s knowledge of NIPT also improved after receiving the decision aid, irrespective of education. Most GPs found it ‘very’ clearly presented (n = 13, 72%), and that it would ‘very much’ facilitate decision-making (n = 16, 89%). Conclusions The DA was found to be acceptable to women as well as GPs. A comprehensive evaluation of the efficacy of the decision aid compared to standard information is an important next step. Strategies are needed on how to implement the tool in practice. Electronic supplementary material The online version of this article (10.1186/s12884-018-2135-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sian Karen Smith
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia.
| | - Antonia Cai
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia
| | - Michelle Wong
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia
| | - Mariana S Sousa
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia.,Centre for Applied Nursing Research, School of Nursing and Midwifery, Western Sydney University, Ingham, Sydney, Australia.,South Western Sydney Local Health District, Institute for Applied Medical Research, Sydney, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Parkville, Australia
| | - Alec Welsh
- School of Women's and Children's Health, UNSW Sydney, Sydney, Australia.,Department of Maternal-Fetal Medicine, Royal Hospital for Women, Sydney, Australia
| | - Bettina Meiser
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia
| | - Rajneesh Kaur
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia
| | - Jane Halliday
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Sharon Lewis
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Lyndal Trevena
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Tatiane Yanes
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | | | - Margot Barclay
- Women's Services, Liverpool Hospital, Sydney, Australia.,Western Sydney University, Parramatta, Sydney, Australia
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Muscat DM, Shepherd HL, Morony S, Smith SK, Dhillon HM, Trevena L, Hayen A, Luxford K, Nutbeam D, McCaffery K. Can adults with low literacy understand shared decision making questions? A qualitative investigation. Patient Educ Couns 2016; 99:1796-1802. [PMID: 27344226 DOI: 10.1016/j.pec.2016.05.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 11/16/2015] [Revised: 04/04/2016] [Accepted: 05/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Participation in shared decision-making (SDM) may be difficult for adults with lower literacy. Tools to support consumers to engage in SDM are rarely designed for or evaluated with adults with lower literacy and/or poor English language. METHODS Qualitative interviews were conducted with 26 adults with lower literacy and/or poor English language skills to investigate (a) whether participants where able to read and understand two generic SDM consumer support tools (Smart Health Choices and AskShareKnow question-sets), (b) which question-set was easier for participants and, (c) perceived usefulness of the question-sets and barriers to use. Interviews were analysed using Framework Analysis. RESULTS Participants had difficulties understanding terms embedded within both the AskShareKnow and Smart Health Choices questions. Our findings suggest that the AskShareKnow question-set was easier for our participants than the Smart Health Choices questions, and clarification using a structured response was reasonably effective. While participants appreciated the usefulness of the questions, they identified important barriers to use. CONCLUSIONS Generic question-sets alone are not sufficient to support SDM for adults with lower literacy and/or poor English-language skills. PRACTICE IMPLICATIONS To ensure that SDM is accessible to all, we must consider how best to support adults with low literacy and/or poor English-language skills to participate in this process.
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Affiliation(s)
- Danielle M Muscat
- The Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, NSW, Australia
| | - Heather L Shepherd
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, NSW, Australia; Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, NSW, Australia
| | - Suzanne Morony
- The Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, NSW, Australia
| | - Sian K Smith
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Concord Clinical School, The University of Sydney, NSW, Australia; School of Psychology, The University of Sydney, NSW, Australia
| | - Lyndal Trevena
- The Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, NSW, Australia
| | - Andrew Hayen
- School of Public Health and Community Medicine, University of New South Wales, NSW, Australia
| | - Karen Luxford
- Patient-based care, Clinical Excellence Commission, NSW, Australia
| | - Don Nutbeam
- Office of the Vice Chancellor, University of Southampton, Southampton, UK
| | - Kirsten McCaffery
- The Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, NSW, Australia.
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Paiva CE, Siquelli FAF, Zaia GR, de Andrade DAP, Borges MA, Jácome AA, Giroldo GASN, Santos HA, Hahn EA, Uemura G, Paiva BSR. Development of a new multimedia instrument to measure cancer-specific quality of life in Portuguese-speaking patients with varying literacy skills. Springerplus 2016; 5:972. [PMID: 27429882 PMCID: PMC4932016 DOI: 10.1186/s40064-016-2675-6] [Citation(s) in RCA: 4] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 06/26/2016] [Indexed: 12/21/2022]
Abstract
Purpose To develop and validate a new multimedia instrument to measure health-related quality of life (HRQOL) in Portuguese-speaking patients with cancer. Methods A mixed-methods study conducted in a large Brazilian Cancer Hospital. The instrument was developed along the following sequential phases: identification of HRQOL issues through qualitative content analysis of individual interviews, evaluation of the most important items according to the patients, review of the literature, evaluation by an expert committee, and pretesting. In sequence, an exploratory factor analysis was conducted (pilot testing, n = 149) to reduce the number of items and to define domains and scores. The psychometric properties of the IQualiV-OG-21 were measured in a large multicentre Brazilian study (n = 323). A software containing multimedia resources were developed to facilitate self-administration of IQualiV-OG-21; its feasibility and patients’ preferences (“paper and pencil” vs. software) were further tested (n = 54). Results An exploratory factor analysis reduced the 30-item instrument to 21 items. The IQualiV-OG-21 was divided into 6 domains: emotional, physical, existential, interpersonal relationships, functional and financial. The multicentre study confirmed that it was valid and reliable. The electronic multimedia instrument was easy to complete and acceptable to patients. Regarding preferences, 61.1 % of them preferred the electronic format in comparison with the paper and pencil format. Conclusions The IQualiV-OG-21 is a new valid and reliable multimedia HRQOL instrument that is well-understood, even by patients with low literacy skills, and can be answered quickly. It is a useful new tool that can be translated and tested in other cultures and languages. Electronic supplementary material The online version of this article (doi:10.1186/s40064-016-2675-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carlos Eduardo Paiva
- Divisão de Mama e Ginecologia, Departamento de Oncologia Clínica, Barretos Cancer Hospital, Rua Antenor Duarte Vilella, 1331, Bairro Dr Paulo Prata, Barretos, São Paulo CEP: 14784-400 Brazil ; Health-Related Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil ; Center for Research Support - NAP, Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil
| | - Felipe Augusto Ferreira Siquelli
- Health-Related Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil ; Barretos School of Health Sciences, Dr. Paulo Prata - FACISB, Barretos, São Paulo 14785-002 Brazil
| | - Gabriela Rossi Zaia
- Health-Related Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil ; Barretos School of Health Sciences, Dr. Paulo Prata - FACISB, Barretos, São Paulo 14785-002 Brazil
| | | | | | - Alexandre A Jácome
- Department of Clinical Oncology, Mater Dei Hospital, Belo Horizonte, Minas Gerais 30140-093 Brazil
| | | | - Henrique Amorim Santos
- Health-Related Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil ; Barretos School of Health Sciences, Dr. Paulo Prata - FACISB, Barretos, São Paulo 14785-002 Brazil
| | - Elizabeth A Hahn
- Department of Medical Social Sciences and Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL 60611 USA
| | - Gilberto Uemura
- Botucatu Medical School, Universidade Estadual Paulista -UNESP, Botucatu, São Paulo 18618-970 Brazil
| | - Bianca Sakamoto Ribeiro Paiva
- Health-Related Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil ; Center for Research Support - NAP, Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil
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Bass SB, Gordon TF, Gordon R, Parvanta C. Using eye tracking and gaze pattern analysis to test a "dirty bomb" decision aid in a pilot RCT in urban adults with limited literacy. BMC Med Inform Decis Mak 2016; 16:67. [PMID: 27267603 PMCID: PMC4897859 DOI: 10.1186/s12911-016-0304-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 02/12/2016] [Accepted: 06/01/2016] [Indexed: 11/10/2022] Open
Abstract
Background Eye tracking is commonly used in marketing to understand complex responses to materials, but has not been used to understand how low-literacy adults access health information or its relationship to decision making. Methods This study assessed how participants use a literacy appropriate “dirty bomb” decision aid. Participants were randomized to receive a CDC “factsheet” (n = 21) or literacy-appropriate aid (n = 29) shown on a computer screen. Using 7 content similar slides, gaze patterns, mean pupil fixation time and mean overall time reading and looking at slides were compared. Groups were also compared by literacy level and effect on 'confidence of knowledge' and intended behavior. Results Results revealed differing abilities to read densely written material. Intervention participants more precisely followed text on 4 of 7 content-similar slides compared to control participants whose gaze patterns indicated unread text, or repeated attempts at reading the same text, suggesting difficulty in understanding key preparedness messages. Controls had significantly longer pupil fixations on 5 of 7 slides and spent more overall time on every slide. In those with very low literacy, intervention participants were more likely than controls to say they understood what a “dirty bomb” is and how to respond if one should occur. Conclusions Results indicate limited- literacy adults, especially those with very low literacy, may not be able to understand how to respond during a “dirty bomb” using available materials, making them vulnerable to negative health events. This study provides insights into how individuals perceive and process risk communication messages, illustrating a rich and nuanced understanding of the qualitative experience of a limited literacy population with written materials. It also demonstrates the feasibility of using these methods on a wider scale to develop more effective health and risk communication messages designed to increase knowledge of and compliance with general health guidelines, and enhance decision making. This has application for those with learning disabilities, those with limited media-literacy skills, and those needing to access the diverse array of assistive technologies now available. Eye tracking is thus a practical approach to understanding these diverse needs to ensure the development of cogent and salient communication. Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0304-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah Bauerle Bass
- Department of Social and Behavioral Sciences, Risk Communication Laboratory, Temple University, College of Public Health, 1301 Cecil B. Moore Ave., Philadelphia, PA, 19122, USA.
| | - Thomas F Gordon
- Department of Psychology, University of Massachusetts-Lowell, Health and Social Sciences Bldg., Suite 300, 113 Wilder St., Lowell, MA, 01854, USA
| | - Ryan Gordon
- Department of Social and Behavioral Sciences, Risk Communication Laboratory, Temple University, College of Public Health, 1301 Cecil B. Moore Ave., Philadelphia, PA, 19122, USA
| | - Claudia Parvanta
- Department of Behavioral and Social Sciences, University of the Sciences, 600 S. 43rd St., Philadelphia, PA, 19104, USA
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Muscat DM, Morony S, Shepherd HL, Smith SK, Dhillon HM, Trevena L, Hayen A, Luxford K, Nutbeam D, McCaffery K. Development and field testing of a consumer shared decision-making training program for adults with low literacy. Patient Educ Couns 2015; 98:1180-1188. [PMID: 26277281 DOI: 10.1016/j.pec.2015.07.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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: 01/23/2015] [Revised: 07/15/2015] [Accepted: 07/20/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Given the scarcity of shared decision-making (SDM) interventions for adults with low literacy, we created a SDM training program tailored to this population to be delivered in adult education settings. METHODS Formative evaluation during program development included a review of the problem and previous efforts to address it, qualitative interviews with the target population, program planning and field testing. RESULTS A comprehensive SDM training program was developed incorporating core SDM elements. The program aimed to improve students' understanding of SDM and to provide them with the necessary skills (understanding probabilistic risks and benefits, personal values and preferences) and self-efficacy to use an existing set of questions (the AskShareKnow questions) as a means to engage in SDM during healthcare interactions. CONCLUSIONS There is an ethical imperative to develop SDM interventions for adults with lower literacy. Generic training programs delivered direct-to-consumers in adult education settings offer promise in a national and international environment where too few initiatives exist. PRACTICE IMPLICATIONS Formative evaluation of the program offers practical insights into developing consumer-focused SDM training. The content of the program can be used as a guide for future efforts to engage consumers in SDM.
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Affiliation(s)
- Danielle M Muscat
- The Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), Sydney School of Public Health, The University of Sydney, NSW, Australia
| | - Suzanne Morony
- The Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), Sydney School of Public Health, The University of Sydney, NSW, Australia
| | - Heather L Shepherd
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), Sydney School of Public Health, The University of Sydney, NSW, Australia; Psycho-Oncology Co-Operative Research Group (PoCoG), School of Psychology, The University of Sydney, NSW, Australia
| | - Sian K Smith
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), Concord Clinical School, The University of Sydney, NSW, Australia; School of Psychology, The University of Sydney, NSW, Australia
| | - Lyndal Trevena
- The Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), Sydney School of Public Health, The University of Sydney, NSW, Australia
| | - Andrew Hayen
- School of Public Health and Community Medicine, University of New South Wales, NSW, Australia
| | - Karen Luxford
- Patient-Based Care, Clinical Excellence Commission, NSW, Australia
| | | | - Kirsten McCaffery
- The Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), Sydney School of Public Health, The University of Sydney, NSW, Australia.
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11
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Chaudry BM, Connelly K, Siek KA, Welch JL. Formative evaluation of a mobile liquid portion size estimation interface for people with varying literacy skills. J Ambient Intell Humaniz Comput 2013; 4:779-789. [PMID: 24443659 PMCID: PMC3891775 DOI: 10.1007/s12652-012-0152-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Chronically ill people, especially those with low literacy skills, often have difficulty estimating portion sizes of liquids to help them stay within their recommended fluid limits. There is a plethora of mobile applications that can help people monitor their nutritional intake but unfortunately these applications require the user to have high literacy and numeracy skills for portion size recording. In this paper, we present two studies in which the low- and the high-fidelity versions of a portion size estimation interface, designed using the cognitive strategies adults employ for portion size estimation during diet recall studies, was evaluated by a chronically ill population with varying literacy skills. The low fidelity interface was evaluated by ten patients who were all able to accurately estimate portion sizes of various liquids with the interface. Eighteen participants did an in situ evaluation of the high-fidelity version incorporated in a diet and fluid monitoring mobile application for 6 weeks. Although the accuracy of the estimation cannot be confirmed in the second study but the participants who actively interacted with the interface showed better health outcomes by the end of the study. Based on these findings, we provide recommendations for designing the next iteration of an accurate and low literacy-accessible liquid portion size estimation mobile interface.
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Affiliation(s)
- Beenish Moalla Chaudry
- School of Informatics and Computing, Indiana University, 901 E. 10th St., 47408 Bloomington, IN, USA
| | - Kay Connelly
- School of Informatics and Computing, Indiana University, 901 E. 10th St., 47408 Bloomington, IN, USA
| | - Katie A. Siek
- Department of Computer Science, University of Colorado, 430 UCB, 80309-0430 Boulder, CO, USA
| | - Janet L. Welch
- Department of Adult Health Nursing, Indiana University Purdue University Indianapolis, 1111 Middle Drive, Nursing E403 Indianapolis, 46202-5107 Boulder, IN, USA
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12
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Kuhajda MC, Thorn BE, Gaskins SW, Day MA, Cabbil CM. Literacy and cultural adaptations for cognitive behavioral therapy in a rural pain population. Transl Behav Med 2013; 1:216-23. [PMID: 24073046 DOI: 10.1007/s13142-011-0026-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [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: 11/25/2022] Open
Abstract
Low literacy and chronic pain have been identified as significant problems in the rural USA. Cognitive behavioral therapy (CBT) is a widely used efficacious psychosocial treatment for chronic pain; adaptations for low-literacy rural populations are lacking. This paper reports on preparatory steps implemented to address this deficit. Adapting an existing group, CBT patient workbook for rural adults with low literacy is described, and adaptations to reduce cognitive demand inherent in CBT are explained via cognitive load theory. Adhering to health literacy guidelines, the patient workbook readability was lowered to the fifth grade. Two key informant interviews and four focus groups provided the impetus for structural and procedural adaptations. Using health literacy guidelines and participant feedback, the patient workbook and treatment approach were adapted for implementation in low-literacy rural adult chronic pain populations, setting the stage for proceeding with a larger trial using the adapted materials.
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Affiliation(s)
- Melissa C Kuhajda
- Department of Psychiatry and Behavioral Medicine, University of Alabama School of Medicine, Tuscaloosa Campus, P.O. Box 870326, Tuscaloosa, AL 35487-0326 USA
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