Exploring the Pathways of Diabetes Foot Complications Treatment and Investigating Experiences From Frontline Health Care Professionals: Protocol for a Mixed Methods Study

BACKGROUND

Diabetes affects more than 4.3 million individuals in the United Kingdom, with 19% to 34% developing diabetes-related foot ulceration (DFU) during their lifespan, which can lead to an amputation. In the United Kingdom, every week, approximately 169 people have an amputation due to diabetes. Preventing first-ever ulcers is the most effective strategy to reduce the occurrence of diabetes-related amputations, but research in this space is lacking.

OBJECTIVE

This protocol seeks to document the experiences and perspectives of frontline health care professionals who work with people who have diabetes and diabetes-related foot problems. Special attention is given to their perceptions of barriers to effective care, their views about barriers to effective and inclusive engagement with people with diabetes, and their experience with the first-ever DFU. Another aspect of the study is the focus on whether clinical management is affected by data sharing, data availability, and interoperability issues.

METHODS

This is a mixed methods explanatory protocol, which is sequential, and its purpose is to use the qualitative data to explain the initial quantitative data collected through a survey of frontline health care professionals. Data analysis of quantitative data will be completed first and then synthesized with the qualitative data analysis. Qualitative data will be analyzed using the framework method. This study will use joint displays to integrate the data. Ethical approval has been granted by the ethics committee of Staffordshire University.

RESULTS

The quantitative data collection started in March 2023 and will close in May 2024. The qualitative interviews commenced in November 2023 with volunteer participants who initially completed the survey.

CONCLUSIONS

This study's survey focuses on data interoperability and the interviews focus more on the perspectives and experiences of clinicians and their perceived barriers for the effective management of diabetes foot ulcers. Including a geographically relevant and diverse cohort of health care professionals that spans a wide range of roles and care settings involved in diabetes-related foot care is very important for the successful application of this protocol. Special care is given to advertise and promote participation as widely as possible. The qualitative part of this protocol is also limited to 30-40 interview participants, as it is not realistic to interview higher numbers, due to time and resource constraints.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/54852.

Challenges Addressing Lung Cancer Screening for Patients With Multimorbidity in Primary Care: A Qualitative Study

PURPOSE

Many individuals who are eligible for lung cancer screening have comorbid conditions complicating their shared decision-making conversations with physicians. The goal of our study was to better understand how primary care physicians (PCPs) factor comorbidities into their evaluation of the risks and benefits of lung cancer screening and into their shared decision-making conversations with patients.

METHODS

We conducted semistructured interviews by videoconference with 15 PCPs to assess the extent of shared decision-making practices and explore their understanding of the intersection of comorbidities and lung cancer screening, and how that understanding informed their clinical approach to this population.

RESULTS

We identified 3 themes. The first theme was whether to discuss or not to discuss lung cancer screening. PCPs described taking additional steps for individuals with complex comorbidities to decide whether to initiate this discussion and used subjective clinical judgment to decide whether the conversation would be productive and beneficial. PCPs made mental assessments that factored in the patient's health, life expectancy, quality of life, and access to support systems. The second theme was that shared decision making is not a simple discussion. When PCPs did initiate discussions about lung cancer screening, although some believed they could provide objective information, others struggled with personal biases. The third theme was that ultimately, the decision to be screened was up to the patient. Patients had the final say, even if their decision was discordant with the PCP's advice.

CONCLUSIONS

Shared decision-making conversations about lung cancer screening differed substantially from the standard for patients with complex comorbidities. Future research should include efforts to characterize the risks and benefits of LCS in patients with comorbidities to inform guidelines and clinical application.

Baclofen in the treatment of alcohol use disorder: tailored doses matter

AIMS

To address the question of tailored baclofen prescribing in alcohol use disorder (AUD) in relation to dose-dependent efficacy and the potential danger of high doses and to provide suggestions for the use of high doses of baclofen in the treatment of AUD. The context is the approvement in France of baclofen in the treatment of AUD without dose limitation, making French physicians, who usually prescribe baclofen in a tailored manner, often use high or very high doses.

METHODS

A narrative review of the results of randomized controlled trials (RCTs) and observational studies that used tailored baclofen prescribing and of the severe adverse effects of baclofen that have been reported in the literature.

RESULTS

The results show that RCTs using tailored doses of baclofen in AUD are not completely demonstrative, though they are encouraging according to certain meta-analyses, while observational studies that used tailored doses constantly show a good effectiveness of baclofen treatment. The results suggest that many severe adverse effects of baclofen could be related to a nonrespect by physicians of prescription rules and appropriate treatment monitoring.

CONCLUSIONS

The use of tailored doses shows that the dose required to suppress cravings is highly variable, low or high, depending on each case. Analysis of the circumstances in which severe adverse effects occur suggest that a careful monitoring of baclofen prescribing might prevent a large majority of severe adverse effects. We propose that the education of the patients and the prescription skills, seriousness, and availability of the prescribing physicians are of major importance in the managing of tailored baclofen treatment of AUD.

Evaluation of an educational program for people with dementia and their caregivers

OBJECTIVES

This study evaluated the impact of a 5-week educational and supportive program for people newly diagnosed with dementia and their caregivers.

METHODS

The study involved a pretest-posttest survey followed by interviews. Wilcoxon signed-rank test was conducted to determine postprogram changes. Kruskal-Wallis tests measured variation in responses between the people with dementia and their caregivers. Interviews were analysed using the NVivo software identifying themes against the program objectives of improving knowledge on dementia, coping strategies, communication and support services for people with dementia and their caregivers.

RESULTS

Fifty-three dyads (n = 106) completed the survey. There were significant improvements in participants' level of understanding of dementia (z = -8.04, p < 0.001), knowledge of local services (z = -8.11, p < 0.001) and coping with life with dementia (z = -6.93, p < 0.001). These findings were consistent with interview data from 16 dyads.

CONCLUSIONS

The increasing number of people with dementia and their caregivers living in the community present health challenges. Programs that assist this group to function well in the community are important. Evaluation of this program indicated improved outcomes in relation to adjusting to life with dementia, enhancing knowledge, fostering communication and reducing feelings of isolation. Areas of improvement included lengthening the program with ongoing contact sessions with program facilitators and other participants. Given the positive effects of the program on this vulnerable group of people, it maybe useful for health-care agencies involved in dementia care to conduct this type of program as a matter of routine treatment and care for people newly diagnosed with dementia.

Creation of a pharmacogenomics patient portal complementary to an existing institutional provider-facing clinical decision support system

Background

Applied pharmacogenomics presents opportunities for improving patient care through precision medicine, particularly when paired with appropriate clinical decision support (CDS). However, a lack of patient resources for understanding pharmacogenomic test results may hinder shared decision-making and patient confidence in treatment. We sought to create a patient pharmacogenomics education and results delivery platform complementary to a CDS system to facilitate further research on the relevance of patient education to pharmacogenomics.

Methods

We conceptualized a model that extended the data access layer of an existing institutional CDS tool to allow for the pairing of decision supports offered to providers with patient-oriented summaries at the same level of phenotypic specificity. We built a two-part system consisting of a secure portal for patient use and an administrative dashboard for patient summary creation. The system was built in an ASP.NET and AngularJS architecture, and all data was housed in a HIPAA-compliant data center, with PHI secure in transit and at rest.

Results

The YourPGx Patient Portal was deployed on the institutional network in June 2019. Fifty-eight unique patient portal summaries have been written so far, which can provide over 4500 results modules to the pilot population of 544 patients. Patient behavior on the portal is being logged for further research.

Conclusions

To our knowledge, this is the first automated system designed and deployed to provide detailed, personalized patient pharmacogenomics education complementary to a clinical decision support system. Future work will expand upon this system to allow for telemedicine and patient notification of new or updated results.

The most prominent problems of diabetes education in Iran: A qualitative content analysis

BACKGROUND

Education in vulnerable communities can be a health affordable strategy to promote patient empowerment. Recognition and understanding the problems of diabetes education are of significance to overcome the barriers and advance the educational and care services to control diabetes and promotion of society health. The aim of this study was to explore participants' perspectives, experiences, and preferences, regarding diabetes education problems.

MATERIALS AND METHODS

This descriptive, qualitative study was conducted from March 2016 to September 2017. The participants were 23 people including nine patients with diabetes and their family members and 14 members of diabetes healthcare team (physicians, nurses, and nutritionists). The data were collected through individual semi-structured interviews and analyzed through conventional content analysis approach proposed by Graneheim and Lundman. Some main categories and subcategories emerged.

RESULTS

Three main categories showed the most prominent problems of diabetes education, namely, inadequate infrastructure for diabetes education, insufficient defined and de facto position for the role of diabetes nurse educator, and the failure in patient-oriented team approach in diabetes education.

CONCLUSION

This article addresses the most important problems of diabetes education. The fundamental strategy to overcome these problems seems to be the planning and management of diabetes education as a high priority in the noncommunicable disease management policies of the Ministry of Health and Medical Education.

Promoting Reflection on Medical Maximizing-Minimizing Preferences May Create Undesired Effects on Decisions About Low-Benefit and High-Benefit Care

Background

Medical maximizing-minimizing (MM) preferences predict a variety of medical decisions. We tested whether informing people about their MM preferences and asking them to reflect on the pros and cons of that preference would improve medical decisions when clear clinical recommendations exist.

Methods

We surveyed 1219 US adults age 40+ that were sampled to ensure a 50%/50% distribution of medical maximizers versus minimizers. Participants either received no MM feedback (Control) or received feedback about their MM type and instructions to reflect on how that MM type can be helpful in some circumstances and problematic in others (Reflection). All participants then completed five hypothetical decision scenarios regarding low-value care services (e.g., head computed tomography scan for mild concussion) and three about high-value care (e.g., flu vaccination).

Results

There were no significant differences between the Control and Reflection groups in five of eight scenarios. In three scenarios (two low-benefit and one high-benefit), we observed small effects in the nonhypothesized direction for the MM subgroup least likely to follow the recommendation (e.g., maximizers in the Reflection group were more likely to request low-benefit care).

Conclusions

Asking people to reflect on their MM preferences may be a counterproductive strategy for optimizing patient decision making around quality of care.

Targeted multimodality inhaler technique education pilot to self-identify errors for primarily Mandarin-speaking subjects

OBJECTIVE

Inhaler technique education among non-English speaking patients in the United States is understudied, with communication barriers and language differences serving as important challenges to education. A previous needs assessment at our institution identified an opportunity to improve inhaler education for our Mandarin-speaking population. This pilot study evaluates the feasibility of a multimodal intervention to identify errors in inhaler technique.

METHODS

Adult Mandarin-speaking subjects with chronic obstructive pulmonary disease or asthma participated in a hospital outpatient clinic inhaler training session that utilized multimedia education. Pre-intervention information on demographics, confidence, and disease control was gathered. Post-intervention, subjects were asked if they would change their inhaler technique and what they found useful.

RESULTS

On pre-intervention survey, eight of eleven (73%) subjects reported being very or completely confident in their inhaler technique. Following the intervention, seven (88%) of those 8 subjects self-identified errors in their technique. Video and handout were reported to be the most useful materials.

CONCLUSION

A multimodality inhaler technique education intervention helped self-identify errors in inhaler technique among non-English speaking subjects. Implementation and use of language-targeted educational interventions is feasible in an outpatient clinic setting.

Anxiety reduction after pre-procedure meetings in patients with CHD

BACKGROUND

Cardiac catheterisations for CHD produce anxiety for patients and families. Current strategies to mitigate anxiety and explain complex anatomy include pre-procedure meetings and educational tools (cardiac diagrams, echocardiograms, imaging, and angiography). More recently, three-dimensionally printed patient-specific models can be added to the armamentarium. The purpose of this study was to evaluate the efficacy of pre-procedure meetings and of different educational tools to reduce patient and parent anxiety before a catheterisation.

METHODS

Prospective study of patients ≥18 and parents of patients <18 scheduled for clinically indicated catheterisations. Patients completed online surveys before and after meeting with the interventional cardiologist, who was blinded to study participation. Both the pre- and post-meeting surveys measured anxiety using the State-Trait Anxiety Inventory. In addition, the post-meeting survey evaluated the subjective value (from 1 to 4) of individual educational tools: physician discussion, cardiac diagrams, echocardiograms, prior imaging, angiograms and three-dimensionally printed cardiac models. Data were compared using paired t-tests.

RESULTS

Twenty-three patients consented to participate, 16 had complete data for evaluation. Mean State-Trait Anxiety Inventory scores were abnormally elevated at baseline and decreased into the normal range after the pre-procedure meeting (39.8 versus 31, p = 0.008). Physician discussion, angiograms, and three-dimensional models were reported to be most effective at increasing understanding and reducing anxiety.

CONCLUSION

In this pilot study, we have found that pre-catheterisation meetings produce a measurable decrease in patient and family anxiety before a procedure. Discussions of the procedure, angiograms, and three-dimensionally printed cardiac models were the most effective educational tools.

Communicating laboratory results to patients and families

People are increasingly able to access their laboratory results via patient portals. The potential benefits provided by such access, such as reductions in patient burden and improvements in patient satisfaction, disease management, and medical decision making, also come with potentially valid concerns about such results causing confusion or anxiety among patients. However, it is possible to clearly convey the meaning of results and, when needed, indicate required action by designing systems to present laboratory results adapted to the people who will use them. Systems should support people in converting the potentially meaningless data of results into meaningful information and actionable knowledge. We offer 10 recommendations toward this goal: (1) whenever possible, provide a clear takeaway message for each result. (2) Signal whether differences are meaningful or not. (3) When feasible, provide thresholds for concern and action. (4) Individualize the frame of reference by allowing custom reference ranges. (5) Ensure the system is accessible. (6) Provide conversion tools along with results. (7) Design in collaboration with users. (8) Design for both new and experienced users. (9) Make it easy for people use the data as they wish. (10) Collaborate with experts from relevant fields. Using these 10 methods and strategies renders access to laboratory results into meaningful and actionable communication. In this way, laboratories and medical systems can support patients and families in understanding and using their laboratory results to manage their health.

Primary Care Providers' Preferences and Concerns Regarding Specific Visual Displays for Returning Hemoglobin A1c Test Results to Patients

Purpose. Patient portals of electronic health record systems currently present patients with tables of laboratory test results, but visual displays can increase patient understanding and sensitivity to result variations. We sought to assess physician preferences and concerns about visual display designs as potential motivators or barriers to their implementation. Methods. In an online survey, 327 primary care physicians (>50% patient care time) recruited through the online e-community/survey research firm SERMO compared hemoglobin A1c (HbA1c) test results presented in table format to various visual displays (number line formats) previously tested in public samples. Half of participants also compared additional visual formats displaying target goal ranges. Outcome measures included preferred display format and whether any displays were unacceptable, would change physician workload, or would induce liability concerns. Results. Most (85%-89%) respondents preferred visual displays over tables for result communications both to patients tested for diagnosis purposes and to diagnosed patients, with a design with color-coded categories most preferred. However, for each format (including tables), 11% to 23% rated them as unacceptable. Most respondents also preferred adding goal range information (in addition to standard ranges) for diagnosed patients. While most physicians anticipated no workload changes, 19% to 32% anticipated increased physician workload while 9% to 28% anticipated decreased workload. Between 32% and 40% had at least some liability concerns. Conclusions. Most primary care physicians prefer visual displays of HbA1c test results over table formats when communicating results to patients. However, workload and liability concerns from a minority of physicians represent a barrier for adoption of such designs in clinical settings.

Quality of Medical Advice Provided Between Members of a Web-Based Message Board for Patients With Implantable Defibrillators: Mixed-Methods Study

Background

Patients use Web-based medical information to understand medical conditions and treatments. A number of efforts have been made to understand the quality of professionally created content; however, none have described the quality of advice being provided between anonymous members of Web-based message boards.

Objective

The objective of this study was to characterize the quality of medical information provided between members of an anonymous internet message board addressing treatment with an implantable cardioverter-defibrillator (ICD).

Methods

We quantitatively analyzed 2 years of discussions using a mixed inductive-deductive framework, first, for instances in which members provided medical advice and, then, for the quality of the advice.

Results

We identified 82 instances of medical advice within 127 discussions. Advice covered 6 topical areas: (1) Device information, (2) Programming, (3) Cardiovascular disease, (4) Lead management, (5) Activity restriction, and (6) Management of other conditions. Across all advice, 50% (41/82) was deemed generally appropriate, 24% (20/82) inappropriate for most patients, 6% (5/82) controversial, and 20% (16/82) without sufficient context. Proportions of quality categories varied between topical areas. We have included representative examples.

Conclusions

The quality of advice shared between anonymous members of a message board regarding ICDs varied considerably according to topical area and the specificity of advice. This report provides a model to describe the quality of the available Web-based patient-generated material.

Patient education strategies in cataract surgery: A systematic review

OBJECTIVE

To systematically review the comparative effectiveness of patient education strategies in cataract surgery.

METHODS

A comprehensive literature search of five electronic databases was conducted for randomized controlled trials (RCTs) studying the efficacy of educational interventions for cataract surgery patients. Peer-reviewed articles published in English were considered for inclusion without restriction limits on publication date. General study characteristics, measurement methodologies, and outcome measures were narratively synthesized. Quality appraisal was conducted using the Oxford quality rating system (for individual studies) and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines (for bodies of evidence).

RESULTS

Sixteen RCTs were compiled for qualitative review. We identified 21 distinct patient outcomes, four (19%) with a multi-study evidence base: knowledge of cataracts/cataract surgery, knowledge of postoperative care, proficiency in postoperative care, and anxiety. Targeted interventions significantly increased educational efficacy in 11 (69%) studies, but there were consistent improvements only for patient understanding of cataracts/cataract surgery and postoperative care. Quality of evidence was poor for all outcomes examined in multiple studies, as well as for deciding to undergo cataract surgery (measured in one study). Cross-study examination revealed appreciable clinical and methodological heterogeneity.

CONCLUSIONS

Targeted interventions fostered patients' understanding of cataract surgery and postoperative care. Additional high-quality studies are needed to determine appropriate educational strategies that improve other clinical, performance, and humanistic outcomes.

Effect of Harm Anchors in Visual Displays of Test Results on Patient Perceptions of Urgency About Near-Normal Values: Experimental Study

Background

Patient-facing displays of laboratory test results typically provide patients with one reference point (the “standard range”).

Objective

To test the effect of including an additional harm anchor reference point in visual displays of laboratory test results, which indicates how far outside of the standard range values would need to be in order to suggest substantial patient risk.

Methods

Using a demographically diverse, online sample, we compared the reactions of 1618 adults in the United States who viewed visual line displays that included both standard range and harm anchor reference points (“Many doctors are not concerned until here”) to displays that included either (1) only a standard range, (2) standard range plus evaluative categories (eg, “borderline high”), or (3) a color gradient showing degree of deviation from the standard range.

Results

Providing the harm anchor reference point significantly reduced perceived urgency of close-to-normal alanine aminotransferase and creatinine results (P values <.001) but not generally for platelet count results. Notably, display type did not significantly alter perceptions of more extreme results in potentially harmful ranges. Harm anchors also substantially reduced the number of participants who wanted to contact their doctor urgently or go to the hospital about these test results.

Conclusions

Presenting patients with evaluative cues regarding when test results become clinically concerning can reduce the perceived urgency of out-of-range results that do not require immediate clinical action.

Parental knowledge and metabolic control of children and young adults with type 1 diabetes

INTRODUCTION

The authors aimed to answer the following questions: 1) What level of knowledge of type 1 diabetes do the parents of children and young adults with this disease have? 2) Will this level of knowledge increase after 1 year of observation? 3) Does improving the knowledge of young adults and their parents result in better metabolic control of the patients?

MATERIAL AND METHODS

This study included 227 patients between the ages of 5 and 20 years with type 1 diabetes. The research was conducted from March 2009 to June 2011. The following two time points were examined: the beginning of the study (test 1a) and one year later (test 1b). The knowledge levels of the patients and parents were obtained using a survey and a knowledge test.

RESULTS

Comparison of the results from the two study time points showed that the respondents had a significantly higher level of knowledge after 1 year (p = 0.001). The comparison of glycated hemoglobin levels between the two time points in patients with type 1 diabetes revealed that the levels were significantly higher at test 1b compared to test 1a (p = 0.0005).

CONCLUSIONS

The parents of children and young adults with type 1 diabetes demonstrate a satisfactory level of theoretical knowledge of therapeutic conduct and self-monitoring principles. The test 1b results demonstrated a higher level of theoretical knowledge in all respondents and poorer metabolic control. Poorer metabolic control in some patients suggests that metabolic control in type 1 diabetes depends on factors other than education. Further research is necessary to determine these additional factors.

Graphics help patients distinguish between urgent and non-urgent deviations in laboratory test results

Objective: Most electronic health record systems provide laboratory test results to patients in table format. We tested whether presenting such results in visual displays (number lines) could improve understanding.

Materials and Methods: We presented 1620 adults recruited from a demographically diverse Internet panel with hypothetical results from several common laboratory tests, first showing near-normal results and then more extreme values. Participants viewed results in either table format (with a “standard range” provided) or one of 3 number line formats: a simple 2-color format, a format with diagnostic categories such as “borderline high” indicated by colored blocks, and a gradient format that used color gradients to smoothly represent increasing risk as values deviated from standard ranges. We measured respondents’ subjective sense of urgency about each test result, their behavioral intentions, and their perceptions of the display format.

Results: Visual displays reduced respondents’ perceived urgency and desire to contact health care providers immediately for near-normal test results compared to tables but did not affect their perceptions of extreme values. In regression analyses controlling for respondent health literacy, numeracy, and graphical literacy, gradient line displays resulted in the greatest sensitivity to changes in test results.

Discussion: Unlike tables, which only tell patients whether test results are normal or not, visual displays can increase the meaningfulness of test results by clearly defining possible values and leveraging color cues and evaluative labels.

Conclusion: Patient-facing displays of laboratory test results should use visual displays rather than tables to increase people’s sensitivity to variations in their results.

Implications for Training on Smartphone Medication Reminder App Use by Adults With Chronic Conditions: Pilot Study Applying the Technology Acceptance Model

BACKGROUND

The majority of middle-aged to older patients with chronic conditions report forgetting to take medications as prescribed. The promotion of patients' smartphone medication reminder app (SMRA) use shows promise as a feasible and cost-effective way to support their medication adherence. Providing training on SMRA use, guided by the technology acceptance model (TAM), could be a promising intervention to promote patients' app use.

OBJECTIVE

The aim of this pilot study was to (1) assess the feasibility of an SMRA training session designed to increase patients' intention to use the app through targeting perceived usefulness of app, perceived ease of app use, and positive subjective norm regarding app use and (2) understand the ways to improve the design and implementation of the training session in a hospital setting.

METHODS

A two-group design was employed. A total of 11 patients older than 40 years (median=58, SD=9.55) and taking 3 or more prescribed medications took part in the study on one of two different dates as participants in either the training group (n=5) or nontraining group (n=6). The training group received an approximately 2-hour intervention training session designed to target TAM variables regarding one popular SMRA, the Medisafe app. The nontraining group received an approximately 2-hour control training session where the participants individually explored Medisafe app features. Each training session was concluded with a one-time survey and a one-time focus group.

RESULTS

Mann-Whitney U tests revealed that the level of perceived ease of use (P=.13) and the level of intention to use an SMRA (P=.33) were higher in the training group (median=7.00, median=6.67, respectively) than in the nontraining group (median=6.25, median=5.83). However, the level of perceived usefulness (U=4.50, Z=-1.99, P=.05) and the level of positive subjective norm (P=.25) were lower in the training group (median=6.50, median=4.29) than in the nontraining group (median=6.92, median=4.50). Focus groups revealed the following participants' perceptions of SMRA use in the real-world setting that the intervention training session would need to emphasize in targeting perceived usefulness and positive subjective norm: (1) the participants would find an SMRA to be useful if they thought the app could help address specific struggles in medication adherence in their lives and (2) the participants think that their family members (or health care providers) might view positively the participants' SMRA use in primary care settings (or during routine medical checkups).

CONCLUSIONS

Intervention training session, guided by TAM, appeared feasible in targeting patients' perceived ease of use and, thereby, increasing intention to use an SMRA. Emphasizing the real-world utility of SMRA, the training session could better target patients' perceived usefulness and positive subjective norm that are also important in increasing their intention to use the app.

Exploring the potential impact of health promotion videos as a low cost intervention to reduce health inequalities: a pilot before and after study on Bangladeshis in inner-city London

Background

Coronary artery disease is the single most common cause of death in the UK. For those born in Bangladesh but dying in England and Wales, coronary artery disease causes 25% of all deaths. Cost-effective solutions are required to address this burden. Several studies have demonstrated the effectiveness of educational video intervention in informing patients in various settings.

Setting

A Bangladeshi women’s group in South London.

Questions

The effectiveness of a health educational video in influencing the knowledge and attitudes towards a preventable illness amongst Bangladeshis in London? The scope of videos for health promotion?

Methods

An educational video on the signs, symptoms and prevention of coronary artery disease was played to a Bangladeshi women’s group in South London in the Bengali language. Participants (n = 18, mean age = 53.7) completed a fifteen-question survey to assess their baseline knowledge prior to viewing (pre-test). The group then viewed the video and repeated the initial questionnaire, with additional questions to solicit their attitudes and perceptions (post-test).

Results

The intervention significantly improved the basic knowledge of coronary artery disease. There was a statistically significant improvement in the number of correct responses amongst participants with p = 0.0002 (mean change 2.28, 95% CI 1.29–3.27) and in the number of unsure responses p = 0.0042 (mean change 1.83, 95% CI 0.01–3.01). Upon viewing the video, all participants agreed that they wanted to implement the advice from the video into their current lifestyles.

Conclusion/Discussion

The educational video significantly improved the knowledge and attitudes pertaining to coronary artery disease amongst British-Bangladeshi individuals in the UK community setting. This project illustrated how commissioners may effectively utilise third-sector organisations through partnerships to implement innovative methods of health screening and promotion. Videos are a novel approach of providing culturally sensitive health education to ethnic minority groups, through screening in clinics and in local media.

Diagnosis of adverse events after hysterectomy with postoperative self-care web applications: A pilot study

Increased pressures from multiple sources are leading to earlier patient discharge following surgery. Our objective was to test the feasibility of self-care web applications to inform women if, when, and where to seek help for symptoms after hysterectomy. We asked 31 women recovering at home after hysterectomy at two centers to sign into a website on a schedule. For each session, the website informed them about normal postoperative symptoms and prompted them to complete an interactive symptom questionnaire that provided detailed information on flagged responses. We interviewed eight women who experienced an adverse event. Six of these women had used the web application regularly, each indicating they used the information to guide them in seeking care for their complications. These data support that self-care applications may empower patients to manage their own care and present to appropriate health care providers and venues when they experience abnormal symptoms.

A perspective on web-based information for patients with chronic lung disease

Although the majority of patients with a chronic disease obtain information about their condition from a health care professional, medical appointments may not allow sufficient time for educating patients and addressing questions. Internet resources can fill educational gaps and promote knowledge transformation. In a 2010 Pew Research Center report, the presence of a chronic disease increased the likelihood that a person would search online for health information. To provide the best medical care, it is important that health care providers are knowledgeable about medical information on the internet. This Perspective summarizes the major websites that present patient-focused medical information about three common lung diseases-asthma, chronic obstructive pulmonary disease, and idiopathic pulmonary fibrosis. These websites can be categorized as those sponsored by pharmaceutical companies, for-profit and nonprofit professional organizations, the National Health Lung and Blood Institute, health care organizations, and patient support groups. In addition, three novel websites about chronic obstructive pulmonary disease are described with the ostensible goal of providing user-friendly information with a focus on individual patients. One was developed as a public university-private partnership, whereas the other two were developed by individuals with interest and experience in respiratory diseases-a respiratory therapist and a pulmonologist. The websites described in this perspective, along with numerous other sources, provide medical information for patients with respiratory diseases that offer a marketplace for viewing. Health care professionals can recommend specific websites to patients to complement discussions during the office visit.

The eHealth Enhanced Chronic Care Model: a theory derivation approach

BACKGROUND

Chronic illnesses are significant to individuals and costly to society. When systematically implemented, the well-established and tested Chronic Care Model (CCM) is shown to improve health outcomes for people with chronic conditions. Since the development of the original CCM, tremendous information management, communication, and technology advancements have been established. An opportunity exists to improve the time-honored CCM with clinically efficacious eHealth tools.

OBJECTIVE

The first goal of this paper was to review research on eHealth tools that support self-management of chronic disease using the CCM. The second goal was to present a revised model, the eHealth Enhanced Chronic Care Model (eCCM), to show how eHealth tools can be used to increase efficiency of how patients manage their own chronic illnesses.

METHODS

Using Theory Derivation processes, we identified a "parent theory", the Chronic Care Model, and conducted a thorough review of the literature using CINAHL, Medline, OVID, EMBASE PsychINFO, Science Direct, as well as government reports, industry reports, legislation using search terms "CCM or Chronic Care Model" AND "eHealth" or the specific identified components of eHealth. Additionally, "Chronic Illness Self-management support" AND "Technology" AND several identified eHealth tools were also used as search terms. We then used a review of the literature and specific components of the CCM to create the eCCM.

RESULTS

We identified 260 papers at the intersection of technology, chronic disease self-management support, the CCM, and eHealth and organized a high-quality subset (n=95) using the components of CCM, self-management support, delivery system design, clinical decision support, and clinical information systems. In general, results showed that eHealth tools make important contributions to chronic care and the CCM but that the model requires modification in several key areas. Specifically, (1) eHealth education is critical for self-care, (2) eHealth support needs to be placed within the context of community and enhanced with the benefits of the eCommunity or virtual communities, and (3) a complete feedback loop is needed to assure productive technology-based interactions between the patient and provider.

CONCLUSIONS

The revised model, eCCM, offers insight into the role of eHealth tools in self-management support for people with chronic conditions. Additional research and testing of the eCCM are the logical next steps.

Pre-surgery education for elective cardiac surgery patients: a survey from the patient's perspective

BACKGROUND/AIM

Multidisciplinary pre-admission patient education is commonly recommended for elective surgery patients, and may involve the provision of written information and presentations from the health team. However, the occupational therapy role with elective sternotomy patients in our setting is confined to the post-operative period. We aimed to evaluate cardiac surgery patients' perception of the effectiveness and timing of pre-admission multidisciplinary written information and post-operative verbal education provided by occupational therapy.

METHODS

This cross-sectional study involved a written survey, which was posted to 375 people who had undergone cardiac surgery in 2009-2010. Questions were designed to elicit patient perceptions of both pre-operative written information and post-operative education relating to post-operative precautions and return to activity received from occupational therapy.

RESULTS

There were 118 surveys returned equalling a 31.4% response rate. Eighty-nine per cent of respondents recalled receiving and reading the pre-surgery information booklet, and this was significantly correlated with feeling prepared for the post-operative experience and adherence with precautions (P < 0.0001). Exactly 30.4% of respondents stated that they experienced stress and anxiety in relation to post-operative expectations, and 47.3% felt the information provided in the occupational therapy education sessions would have been more beneficial for their understanding and coping if provided prior to surgery.

CONCLUSIONS

Multidisciplinary written pre-surgery education appears to be providing patients with a good understanding of what to expect following surgery. The results suggest that pre-operative verbal education from occupational therapy would assist in reducing anxiety in a subgroup of patients.

Barriers and Facilitators of Online Patient Portals to Personal Health Records Among Persons Living With HIV: Formative Research

Background

Federal meaningful use standards are promoting adoption of online portals to personal health records (PHRs). However, relatively little is known regarding barriers and facilitators for vulnerable groups such as persons living with human immunodeficiency virus (PLWH).

Objective

The objective of this study was to assess barriers and facilitators to use of online PHRs among PLWH.

Methods

We conducted formative research using a written waiting room survey among 120 PLWH regarding barriers and facilitators of portal PHR use. We supplemented findings with data collected from a PLWH focus group, where some members had personal experience with use of a portal.

Results

The survey had 90 respondents. Eight PLWH participated in the focus group. Most patients (77/90, 86%) reported having at least some experience using the Internet and most expressed interest in features offered by the portal. Notably, 70% (63/90) expressed some interest in being taught how to use it to communicate with their provider. Focus group themes reinforced these findings, but also voiced concern regarding access to private computers.

Conclusions

Many PLWH in our sample have experience using computers and most are interested in PHR features. However, computer or broadband access and privacy are important barriers.

Patients' experiences from their received education about the process of kidney transplant: A qualitative study

BACKGROUND

Kidney transplant needs long term treatment, care and a follow up. Patients with kidney transplant need support in fields of knowledge, skills and motivations. Several researches showed existing challenges regarding education of these patients. A qualitative study was conducted to define patients' experiences from their received education about the process of kidney transplant.

MATERIALS AND METHODS

This was a qualitative study with a content analysis approach. Sampling was purposive up to data saturation. The participants aged 18-60 years, had experienced transplantation. The data were collected by semi-structural individual in-depth interviews with 18 participants. The interviews were analyzed by Graneheim and Lundman content analysis method.

FINDINGS

Three general themes of "educational experiences at the beginning of transplantation", "educational experiences in post transplantation care", and "patients' struggle to enhance their awareness in order to preserve their transplanted kidney" were emerged.

CONCLUSIONS

The findings showed that patients' did not receive adequate knowledge about kidney transplant process. This issue reveals an unstructured and uncoordinated education given to kidney transplant patients by health team members during kidney transplant process. With regard to high motivation of the patients, designing such educational program based on self-management in the process of kidney transplant for these recipients is essential. Nurses in their educational role can enable the patients through educating them about problem solving methods and selection of the best solution to preserve their transplanted kidney and consider renal transplant recipient self-management as their first priority toward these patients.