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To become active partners in chronic illness management, patients need relevant information which clearly explains treatment choices. This paper describes a method of producing information to feed into production of a guidebook for people with irritable bowel syndrome (IBS). Users were involved throughout the development process. Five focus groups were held involving 23 people with IBS out of 147 who responded to a newspaper article asking for help with a study of self-care in IBS. Qualitative analysis of transcripts from these meetings formed the basis of guidebook development. Patients described their experiences, coping strategies, experiences of the healthcare system, treatments and social consequences of the condition. Medical literature searches were made to find answers to identified areas of information need. The book includes direct quotes from patients describing their own experiences. Guided and practical ways of support are required for people with IBS who want to self-manage their condition. [ABSTRACT FROM AUTHOR]

How does the way that information is presented potentially influence patients' consent for health treatments, in a shared decision making process? The goal of this paper is to present an overview of selected recent literature concerning patient health information presentation/use for treatment decision making. Recent work with patient populations has begun to extend early cognitive psychological work showing systematic biases in thinking. Key research findings are organized by type of format (probability, graphic, and qualitative/quantitative dimensions). The applied literature on this topic is amenable to only limited integration in regard to key findings, and relatively few novel approaches to improving information comprehension have been described in the health literature. Promising approaches being proposed, developed, and tested are described, such as enhanced-access computerized patient choice modules, "debiasing" techniques, and tailoring of information. Additional theoretical and practical issues are discussed, as well as selected policy implications of current knowledge. [ABSTRACT FROM AUTHOR]

The birth and early growth of a new discipline from the union of evidence-based medicine (EBM) and the theoretical foundations of human psychology and behaviour has led to a plethora of new terms to define and redefine a paradigm shift in clinical decision making. This paper provides a short glossary of (1) terms to describe the practitioner-patient relationship in decision making and (2) terms describing some of the tools for facilitating evidence-based decision making. In addition, it is proposed that a more acceptable name for this discipline may be 'integrated decision making' (IDM). A case is argued for the fact that this term better addresses many of the concerns raised by practitioners and consumers about barriers to the integration of evidence and patient preferences in clinical practice and the changing nature of the practitioner-patient relationship in healthcare today. [ABSTRACT FROM AUTHOR]

To become active partners in chronic illness management, patients need relevant information which clearly explains treatment choices. This paper describes a method of producing information to feed into production of a guidebook for people with irritable bowel syndrome (IBS). Users were involved throughout the development process. Five focus groups were held involving 23 people with IBS out of 147 who responded to a newspaper article asking for help with a study of self-care in IBS. Qualitative analysis of transcripts from these meetings formed the basis of guidebook development. Patients described their experiences, coping strategies, experiences of the healthcare system, treatments and social consequences of the condition. Medical literature searches were made to find answers to identified areas of information need. The book includes direct quotes from patients describing their own experiences. Guided and practical ways of support are required for people with IBS who want to self-manage their condition. [Copyright &y& Elsevier]

The birth and early growth of a new discipline from the union of evidence-based medicine (EBM) and the theoretical foundations of human psychology and behaviour has led to a plethora of new terms to define and redefine a paradigm shift in clinical decision making. This paper provides a short glossary of (1) terms to describe the practitioner–patient relationship in decision making and (2) terms describing some of the tools for facilitating evidence-based decision making. In addition, it is proposed that a more acceptable name for this discipline may be ‘integrated decision making’ (IDM). A case is argued for the fact that this term better addresses many of the concerns raised by practitioners and consumers about barriers to the integration of evidence and patient preferences in clinical practice and the changing nature of the practitioner–patient relationship in healthcare today. [Copyright &y& Elsevier]

How does the way that information is presented potentially influence patients’ consent for health treatments, in a shared decision making process? The goal of this paper is to present an overview of selected recent literature concerning patient health information presentation/use for treatment decision making. Recent work with patient populations has begun to extend early cognitive psychological work showing systematic biases in thinking. Key research findings are organized by type of format (probability, graphic, and qualitative/quantitative dimensions). The applied literature on this topic is amenable to only limited integration in regard to key findings, and relatively few novel approaches to improving information comprehension have been described in the health literature. Promising approaches being proposed, developed, and tested are described, such as enhanced-access computerized patient choice modules, “debiasing” techniques, and tailoring of information. Additional theoretical and practical issues are discussed, as well as selected policy implications of current knowledge. [Copyright &y& Elsevier]

Teaching patients with rheumatic diseases to cope actively with their problems may increase the social support they receive and, also, the quality of their lives. In this paper, a systematic review of coping interventions for people with rheumatic diseases is described. Fourteen controlled trials were selected. Effects on quality of life have been measured in 13 studies of which 6 found positive effects. Effects on social support have been found in one of four studies investigating this variable. Coping has been measured in three studies with effects found on active coping in one study. There is a need for well-designed research on the effects of active coping in people with rheumatic diseases, as this may open new perspectives in patient education. [ABSTRACT FROM AUTHOR]

We systematically reviewed studies examining information needs of post-myocardial infarction patients and their families. Electronic databases and bibliographies of relevant papers were searched and experts in the field contacted to find relevant studies. A standardised data form was used to extract data on study populations, instruments and results. Of 14 published studies, 6 used the same instrument. Information about risk factors ranked as the most important category overall, followed by information on cardiac anatomy and physiology, medications, and physical activity. Information about miscellaneous items, diet, psychological factors, and the CCU, although ranked lower, were still rated important. Some variation between settings was evident. Patients preferred physicians over nurses as information givers. Differences were found between patient and nurse ratings of information categories. Differences were found in the self-perceived information needs of patients responding to different instruments, indicating a priming effect. Changes in ranking of information categories between CCU, PCCU and PD are congruent with decreasing levels of patient dependency. The information needs of women and other post-MI subgroups, including the elderly, minority ethnic groups, patients with severe coronary disease, and deprived patients, have not been assessed. Patients have not been involved in the design of information needs assessment instruments. [ABSTRACT FROM AUTHOR]

We systematically reviewed studies examining information needs of post-myocardial infarction patients and their families. Electronic databases and bibliographies of relevant papers were searched and experts in the field contacted to find relevant studies. A standardised data form was used to extract data on study populations, instruments and results. Of 14 published studies, 6 used the same instrument. Information about risk factors ranked as the most important category overall, followed by information on cardiac anatomy and physiology, medications, and physical activity. Information about miscellaneous items, diet, psychological factors, and the CCU, although ranked lower, were still rated important. Some variation between settings was evident. Patients preferred physicians over nurses as information givers. Differences were found between patient and nurse ratings of information categories. Differences were found in the self-perceived information needs of patients responding to different instruments, indicating a priming effect. Changes in ranking of information categories between CCU, PCCU and PD are congruent with decreasing levels of patient dependency. The information needs of women and other post-MI subgroups, including the elderly, minority ethnic groups, patients with severe coronary disease, and deprived patients, have not been assessed. Patients have not been involved in the design of information needs assessment instruments. [Copyright &y& Elsevier]

Teaching patients with rheumatic diseases to cope actively with their problems may increase the social support they receive and, also, the quality of their lives. In this paper, a systematic review of coping interventions for people with rheumatic diseases is described. Fourteen controlled trials were selected. Effects on quality of life have been measured in 13 studies of which 6 found positive effects. Effects on social support have been found in one of four studies investigating this variable. Coping has been measured in three studies with effects found on active coping in one study. There is a need for well-designed research on the effects of active coping in people with rheumatic diseases, as this may open new perspectives in patient education. [Copyright &y& Elsevier]

The motivation to learn new skills that improve patient care comes from practical experience. Once motivated, trainees and practitioners alike require excellent content and process to modify approaches that improve outcomes. This paper defines content areas the authors believe are needed to improve communication between cancer patients and their practitioners. Perhaps more importantly, the educational process to achieve improved outcomes is discussed and the importance of the context in which that education occurs is stressed. The linkage between administrative behavior and practitioner behavior is described. Synchronicity between the expectations for practitioner practice and the practice environment is needed for practitioners to successfully incorporate the patient-centered practices patients are demanding. Finally, a research agenda is outlined that encourages evaluation of the model proposed. [ABSTRACT FROM AUTHOR]

This paper presents a comprehensive conceptual model of health care communication involving three key health care partners: patients, physicians, and significant family members (health significant other, HSOs). A unique feature of this model is its focus on proactive roles played by elderly patients in information gathering and communication with health care partners regarding both cancer prevention and cancer care. We outline how proactive initiatives by health care consumers and involvement of their HSOs can enhance patient outcomes (satisfaction with physician, adherence to preventive and corrective practice recommendations, and quality of life). Finally, we also note primary antecedents of health care partner communication in terms of both medical care context and patient characteristics. We hope that this testable causal model will inform future research in the field of health communication. [ABSTRACT FROM AUTHOR]

Significant conceptual work on shared decision making has taken place but there are still significant challenges in achieving it in routine clinical practice. This paper outlines what research has identified to date that may promote shared decision making, and the further research that is required to enable continuing progress. Greater understanding of the models of decision making and instruments to identify them in practice are still required. Specifying consumer competences, developing instruments to assess these and interventions to enhance them may also be important. Clarifying all these aspects may enable those charged with training professionals to improve the content of professional development programmes. This may be particularly important in the field of cancer treatments where the stakes are high-patients usually desire much information but their desire for involvement in decision making is more variable. The consequences of getting this balance right or wrong are significant with much to be gained or lost. Continued development and evaluation of decision aids and decision explorers that use interactive technology will also be important in identifying how to progress with consumer involvement. If we can learn these lessons, then wider implementation of shared decision making or consumer involvement may become a nearer prospect. [ABSTRACT FROM AUTHOR]

The goal of this paper is to examine emerging issues in consumer-provider communication and patient adherence to cancer prevention, screening, diagnosis, treatment, and coping with survivorship. Many factors that have been shown to affect adherence can be supported or hindered by provider-patient communication, including the provider-patient relationship, patients' beliefs, social and cultural norms, family and social support, mood, and behavioral management. Six research questions are posed, and substantive and methodological recommendations are offered for empirical research on the measurement and achievement of patient adherence. [ABSTRACT FROM AUTHOR]

The motivation to learn new skills that improve patient care comes from practical experience. Once motivated, trainees and practitioners alike require excellent content and process to modify approaches that improve outcomes. This paper defines content areas the authors believe are needed to improve communication between cancer patients and their practitioners. Perhaps more importantly, the educational process to achieve improved outcomes is discussed and the importance of the context in which that education occurs is stressed. The linkage between administrative behavior and practitioner behavior is described. Synchronicity between the expectations for practitioner practice and the practice environment is needed for practitioners to successfully incorporate the patient-centered practices patients are demanding. Finally, a research agenda is outlined that encourages evaluation of the model proposed. [Copyright &y& Elsevier]

This paper presents a comprehensive conceptual model of health care communication involving three key health care partners: patients, physicians, and significant family members (health significant other, HSOs). A unique feature of this model is its focus on proactive roles played by elderly patients in information gathering and communication with health care partners regarding both cancer prevention and cancer care. We outline how proactive initiatives by health care consumers and involvement of their HSOs can enhance patient outcomes (satisfaction with physician, adherence to preventive and corrective practice recommendations, and quality of life). Finally, we also note primary antecedents of health care partner communication in terms of both medical care context and patient characteristics. We hope that this testable causal model will inform future research in the field of health communication. [Copyright &y& Elsevier]

Significant conceptual work on shared decision making has taken place but there are still significant challenges in achieving it in routine clinical practice. This paper outlines what research has identified to date that may promote shared decision making, and the further research that is required to enable continuing progress. Greater understanding of the models of decision making and instruments to identify them in practice are still required. Specifying consumer competences, developing instruments to assess these and interventions to enhance them may also be important. Clarifying all these aspects may enable those charged with training professionals to improve the content of professional development programmes. This may be particularly important in the field of cancer treatments where the stakes are high-patients usually desire much information but their desire for involvement in decision making is more variable. The consequences of getting this balance right or wrong are significant with much to be gained or lost. Continued development and evaluation of decision aids and decision explorers that use interactive technology will also be important in identifying how to progress with consumer involvement. If we can learn these lessons, then wider implementation of shared decision making or consumer involvement may become a nearer prospect. [Copyright &y& Elsevier]

The goal of this paper is to examine emerging issues in consumer–provider communication and patient adherence to cancer prevention, screening, diagnosis, treatment, and coping with survivorship. Many factors that have been shown to affect adherence can be supported or hindered by provider–patient communication, including the provider–patient relationship, patients’ beliefs, social and cultural norms, family and social support, mood, and behavioral management. Six research questions are posed, and substantive and methodological recommendations are offered for empirical research on the measurement and achievement of patient adherence. [Copyright &y& Elsevier]

This paper reports on an evaluation of the reactions of participants in a computer-controlled telephone conversation system (telephone-linked care, TLC) designed to offer nutrition and exercise counseling. After 6 months in the study, subjects were asked a series of questions about their opinions of the TLC system, including overall satisfaction and the system's helpfulness. One hundred and ninety individuals completed the attitude survey. On a scale of 0-100, respondents rated the overall satisfaction and helpfulness of the system at 63.6 and 62.3. Subjects using the nutrition counseling version of TLC rated it significantly higher on satisfaction (73.0 versus 52.4) and helpfulness (70.3 versus 53.7) than did subjects using the exercise version. Satisfaction and helpfulness were correlated with perceived usability, amount of contact, realism, and credibility (P < 0.01). Multivariate analyses showed that treatment group and number of calls made accounted for the greatest amount of variance in ratings of satisfaction and helpfulness. The findings suggest that the amount of contact with this technology, reflected by the number of calls, and the treatment group, nutrition or exercise, were significant predictors of reported satisfaction and perceived helpfulness of the system. [ABSTRACT FROM AUTHOR]

This paper reports on an evaluation of the reactions of participants in a computer-controlled telephone conversation system (telephone-linked care, TLC) designed to offer nutrition and exercise counseling. After 6 months in the study, subjects were asked a series of questions about their opinions of the TLC system, including overall satisfaction and the system’s helpfulness. One hundred and ninety individuals completed the attitude survey. On a scale of 0–100, respondents rated the overall satisfaction and helpfulness of the system at 63.6 and 62.3. Subjects using the nutrition counseling version of TLC rated it significantly higher on satisfaction (73.0 versus 52.4) and helpfulness (70.3 versus 53.7) than did subjects using the exercise version. Satisfaction and helpfulness were correlated with perceived usability, amount of contact, realism, and credibility (P<0.01). Multivariate analyses showed that treatment group and number of calls made accounted for the greatest amount of variance in ratings of satisfaction and helpfulness. The findings suggest that the amount of contact with this technology, reflected by the number of calls, and the treatment group, nutrition or exercise, were significant predictors of reported satisfaction and perceived helpfulness of the system. [Copyright &y& Elsevier]

This paper describes a compilation and further analysis of three qualitative studies, conducted independently, on women's health care decisions. Key areas regarding women's health, which span the life cycle, were examined including prenatal genetic screening, hormone replacement therapy and the use of complementary/alternative medicine in the treatment of breast cancer. Common themes were evident across all the focus groups in each of the three studies including: women's information seeking behavior; reliance on trusted information sources; the desire for information sharing; active involvement in the decision-making process; and accepting the consequences of the final decision. The findings have important implications for health care professionals as they engage women in the decision-making process about health concerns. [ABSTRACT FROM AUTHOR]

Although empathy in the physician-patient relationship is often advocated, a theoretically based and empirically derived measure of a physician's empathic communication to a patient has been missing. This paper describes the development and initial validation of such a measure, the Empathic Communication Coding System (ECCS), which includes a method for identifying patient-created empathic opportunities. To determine the extent to which empathic communication varies with physician and patient gender, we used the ECCS to code 100 videotaped office visits between patients and general internists. While male and female patients created a comparable number of empathic opportunities, those created by females tended to exhibit more emotional intensity than those created by males. However, female patients were no more likely than male patients to name an emotion in their empathic opportunities. Physician communication behavior was consistent with the literature on gender differences: female physicians tended to communicate higher degrees of empathy in response to the empathic opportunities created by patients. The ECCS appears to be a viable and sensitive tool for better understanding empathy in medical encounters, and for detecting modest gender differences in patients' creation of empathic opportunities and in physicians' empathic communication. [ABSTRACT FROM AUTHOR]

This paper describes a compilation and further analysis of three qualitative studies, conducted independently, on women’s health care decisions. Key areas regarding women’s health, which span the life cycle, were examined including prenatal genetic screening, hormone replacement therapy and the use of complementary/alternative medicine in the treatment of breast cancer. Common themes were evident across all the focus groups in each of the three studies including: women’s information seeking behavior; reliance on trusted information sources; the desire for information sharing; active involvement in the decision-making process; and accepting the consequences of the final decision. The findings have important implications for health care professionals as they engage women in the decision-making process about health concerns. [Copyright &y& Elsevier]

Although empathy in the physician–patient relationship is often advocated, a theoretically based and empirically derived measure of a physician’s empathic communication to a patient has been missing. This paper describes the development and initial validation of such a measure, the Empathic Communication Coding System (ECCS), which includes a method for identifying patient-created empathic opportunities. To determine the extent to which empathic communication varies with physician and patient gender, we used the ECCS to code 100 videotaped office visits between patients and general internists. While male and female patients created a comparable number of empathic opportunities, those created by females tended to exhibit more emotional intensity than those created by males. However, female patients were no more likely than male patients to name an emotion in their empathic opportunities. Physician communication behavior was consistent with the literature on gender differences: female physicians tended to communicate higher degrees of empathy in response to the empathic opportunities created by patients. The ECCS appears to be a viable and sensitive tool for better understanding empathy in medical encounters, and for detecting modest gender differences in patients’ creation of empathic opportunities and in physicians’ empathic communication. [Copyright &y& Elsevier]

The purpose of this paper is to provide an overview of self-management approaches for people with chronic conditions. The literature reviewed was assessed in terms of the nature of the self-management approach and the effectiveness. Findings are discussed under the headings of: chronic conditions targeted, country where intervention was based, type of approach (e.g. format, content, tutor, setting), outcomes and effectiveness. The last of these focused on reports of randomised controlled studies. [ABSTRACT FROM AUTHOR]

This paper presents the development process of a health education program to promote adherence to a pelvic floor muscle exercise (PFME) therapy for women with urinary incontinence (UI). The development process started with a needs assessment phase in which the health problem, health-related quality of life, and behavioral and environmental determinants were assessed. Guided by the intervention mapping (IM) approach, program objectives were formulated and, on the basis of both empirical and theoretical data, intervention methods for influencing determinants of adherence to PFME therapy were chosen and translated into practical strategies. This information was assimilated to a transparent description of the program design. The theoretical rationale of the program was based on the transtheoretical model, the self-regulation theory and principles of targeted communication and sex-specific health care. [ABSTRACT FROM AUTHOR]

This paper describes recruitment and participation of physicians and patients in a randomized study to evaluate the effects of a moderately intensive (2-year) lifestyle management intervention for post-menopausal women with type 2 diabetes at risk for coronary heart disease (CHD). The purpose of this report is to answer two practical public health questions: (1) "Will physicians refer their patients with type 2 diabetes to such an intensive lifestyle change program?" and, if so, (2) "Will these patients participate?" Results showed high (70%) acceptance among physicians. About 51% of eligible patients agreed to participate, which was encouraging given the substantial time commitment involved. Main reasons for refusal were lack of eligible patients (among physicians) and lack of time (among patients). Patient participants and non-participants did not differ significantly on age, body mass, and other demographic and medical variables. Based on these results, it appears that appropriate recruitment procedures will yield a representative sample of women willing to participate in intensive lifestyle management programs. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to provide an overview of self-management approaches for people with chronic conditions. The literature reviewed was assessed in terms of the nature of the self-management approach and the effectiveness. Findings are discussed under the headings of: chronic conditions targeted, country where intervention was based, type of approach (e.g. format, content, tutor, setting), outcomes and effectiveness. The last of these focused on reports of randomised controlled studies. [Copyright &y& Elsevier]

This paper presents the development process of a health education program to promote adherence to a pelvic floor muscle exercise (PFME) therapy for women with urinary incontinence (UI). The development process started with a needs assessment phase in which the health problem, health-related quality of life, and behavioral and environmental determinants were assessed. Guided by the intervention mapping (IM) approach, program objectives were formulated and, on the basis of both empirical and theoretical data, intervention methods for influencing determinants of adherence to PFME therapy were chosen and translated into practical strategies. This information was assimilated to a transparent description of the program design. The theoretical rationale of the program was based on the transtheoretical model, the self-regulation theory and principles of targeted communication and sex-specific health care. [Copyright &y& Elsevier]

This paper describes recruitment and participation of physicians and patients in a randomized study to evaluate the effects of a moderately intensive (2-year) lifestyle management intervention for post-menopausal women with type 2 diabetes at risk for coronary heart disease (CHD). The purpose of this report is to answer two practical public health questions: (1) “Will physicians refer their patients with type 2 diabetes to such an intensive lifestyle change program?” and, if so, (2) “Will these patients participate?” Results showed high (70%) acceptance among physicians. About 51% of eligible patients agreed to participate, which was encouraging given the substantial time commitment involved. Main reasons for refusal were lack of eligible patients (among physicians) and lack of time (among patients). Patient participants and non-participants did not differ significantly on age, body mass, and other demographic and medical variables. Based on these results, it appears that appropriate recruitment procedures will yield a representative sample of women willing to participate in intensive lifestyle management programs. [Copyright &y& Elsevier]

The aim of this paper is to assess whether patient-centred consultations are more effective than the usual style of consultations used by general practitioners with patients suffering from benign chronic musculoskeletal pain and fibromyalgia. It also seeks to evaluate the differential characteristics of these two clinical groups of symptoms. The study was designed as a cluster randomised and simple blind trial. Twenty general practitioners took part and 110 patients were recruited. Compared with patients who received the usual treatment from their family physician, those who received a patient-centred approach showed greater improvement after 1 year in terms of psychological distress (anxiety) and number of tender points, as well as showing positive trends in some important outcomes such as pain intensity. Significantly better results were observed in those patients suffering chronic pain than in those with fibromyalgia, particularly as regards associated symptoms, self-rated pain and physical mobility as measured by the Nottingham health profile. [ABSTRACT FROM AUTHOR]

The aim of this paper is to assess whether patient-centred consultations are more effective than the usual style of consultations used by general practitioners with patients suffering from benign chronic musculoskeletal pain and fibromyalgia. It also seeks to evaluate the differential characteristics of these two clinical groups of symptoms. The study was designed as a cluster randomised and simple blind trial. Twenty general practitioners took part and 110 patients were recruited. Compared with patients who received the usual treatment from their family physician, those who received a patient-centred approach showed greater improvement after 1 year in terms of psychological distress (anxiety) and number of tender points, as well as showing positive trends in some important outcomes such as pain intensity. Significantly better results were observed in those patients suffering chronic pain than in those with fibromyalgia, particularly as regards associated symptoms, self-rated pain and physical mobility as measured by the Nottingham health profile. [Copyright &y& Elsevier]

This paper studies the effects of patient education, tailored to individual needs of patients as part of an asthma self-management program. A tailored education program was designed which took into account individual information needs of patients by using a feedback instrument. Totally 98 steroid dependent asthmatics entered the tailored education program, 95 patients received usual care. Outcome measures were information exchanged and patient satisfaction. Study duration was 6 months. Patients in the tailored education group showed a significant reduction in information need (P=0.005). Patient satisfaction increased from 87.9 to 93.7 in this group while this did not change in the usual care group (P=0.000). Use of this tailored education program improved the GP-patient interaction within the context of a clinically effective asthma self-management program. Findings from this study may be applicable to other chronic conditions as well. [ABSTRACT FROM AUTHOR]

This paper describes the results of a detailed evaluation of the intervention process of a multifactorial home visit programme aimed at preventing falls and mobility impairments among elderly persons living in the community. The aim of the study is to provide insight in factors related to the intervention process that may have influenced the effectiveness of this home visit programme. The programme consisted of five home visits performed by a community nurse over a period of 1 year. During the home visits the participants were screened for risk factors potentially influencing falls and mobility. The screening was followed by recommendations, referrals, and other actions aimed at dealing with the hazards observed. Data regarding the intervention process were gathered by means of interviews with nurses and participants, and by means of structured forms and questionnaires administered by the nurses during the intervention period. We conclude that our 1-year multifactorial home visit programme consisting of five home visits is feasible for nurses and participants. Despite this, it seems to be an unsuitable intervention technique to reduce falls and mobility impairments among elderly people at risk. [ABSTRACT FROM AUTHOR]

This paper describes the results of a detailed evaluation of the intervention process of a multifactorial home visit programme aimed at preventing falls and mobility impairments among elderly persons living in the community. The aim of the study is to provide insight in factors related to the intervention process that may have influenced the effectiveness of this home visit programme. The programme consisted of five home visits performed by a community nurse over a period of 1 year. During the home visits the participants were screened for risk factors potentially influencing falls and mobility. The screening was followed by recommendations, referrals, and other actions aimed at dealing with the hazards observed. Data regarding the intervention process were gathered by means of interviews with nurses and participants, and by means of structured forms and questionnaires administered by the nurses during the intervention period. We conclude that our 1-year multifactorial home visit programme consisting of five home visits is feasible for nurses and participants. Despite this, it seems to be an unsuitable intervention technique to reduce falls and mobility impairments among elderly people at risk. [Copyright &y& Elsevier]

This paper studies the effects of patient education, tailored to individual needs of patients as part of an asthma self-management program. A tailored education program was designed which took into account individual information needs of patients by using a feedback instrument. Totally 98 steroid dependent asthmatics entered the tailored education program, 95 patients received usual care. Outcome measures were information exchanged and patient satisfaction. Study duration was 6 months. Patients in the tailored education group showed a significant reduction in information need (P=0.005). Patient satisfaction increased from 87.9 to 93.7 in this group while this did not change in the usual care group (P=0.000). Use of this tailored education program improved the GP–patient interaction within the context of a clinically effective asthma self-management program. Findings from this study may be applicable to other chronic conditions as well. [Copyright &y& Elsevier]

Formative evaluation of multimedia programs can prevent costly and time-consuming revisions and result in more effective programs. Yet systematic formative evaluation is seldom conducted. This paper reviews the basic principles of formative evaluation and describes how we applied those principles to the formative evaluation of a multimedia program for patients about the side effects of cancer treatment. It discusses the challenges of developing multimedia programs for patients and provides guidance to other health professionals interested in developing programs on other topics. [ABSTRACT FROM AUTHOR]

Formative evaluation of multimedia programs can prevent costly and time-consuming revisions and result in more effective programs. Yet systematic formative evaluation is seldom conducted. This paper reviews the basic principles of formative evaluation and describes how we applied those principles to the formative evaluation of a multimedia program for patients about the side effects of cancer treatment. It discusses the challenges of developing multimedia programs for patients and provides guidance to other health professionals interested in developing programs on other topics. [Copyright &y& Elsevier]

This paper reports the results of a qualitative study that examined the experiences of cancer patients with the intention of incorporating consumer perspectives into the development of quality cancer care in Hong Kong. Altogether, eight focus group interviews were conducted with a total of 41 cancer patients. The results indicate that patients lack clear guidance and support regarding the management of sequelae and surveillance against recurrence. Patients also raised concerns about the lack of access to information, and the lack of health care provider accountability. Any understanding of the scope and goals of follow-up cancer care is obscured when the healthcare environment is not conducive to good doctor-patient communication. Patients are calling for more explicit goals and clinical practice guidelines to serve as frames of reference for both patients and doctors. [ABSTRACT FROM AUTHOR]

This paper reports the results of a qualitative study that examined the experiences of cancer patients with the intention of incorporating consumer perspectives into the development of quality cancer care in Hong Kong. Altogether, eight focus group interviews were conducted with a total of 41 cancer patients. The results indicate that patients lack clear guidance and support regarding the management of sequelae and surveillance against recurrence. Patients also raised concerns about the lack of access to information, and the lack of health care provider accountability. Any understanding of the scope and goals of follow-up cancer care is obscured when the healthcare environment is not conducive to good doctor–patient communication. Patients are calling for more explicit goals and clinical practice guidelines to serve as frames of reference for both patients and doctors. [Copyright &y& Elsevier]

Providing psychosocial counseling services to cancer patients and their significant others by telephone is emerging as an alternative to traditional (in-person) counseling programs in psychooncology. In this paper, data are reported describing the clients of such a program that has been in continuous operation since 1981: the Cancer Information and Counseling Line (CICL) of the AMC Cancer Research Center. An examination of call record forms completed between 1 June 1998 and 30 May 1999 (N = 1627) revealed that the vast majority of callers were female (77%), non-Hispanic White (77%), with at least some college education (62%). Only 27% were cancer patients/survivors, compared to 43% who were spouses, other relatives and friends of cancer patients/survivors, and 16% who were symptomatic callers. Breast cancer was by far the most frequently mentioned cancer site (30%). Although initial topics of inquiry were dominated by requests for medical information (77%), with only a small percentage of callers initially requesting psychosocial support and counseling (12%), by the time, the call was completed, 67% had received some form of psychosocial support and/or counseling. Recommendations for future research are discussed within the context of this review. [ABSTRACT FROM AUTHOR]

Providing psychosocial counseling services to cancer patients and their significant others by telephone is emerging as an alternative to traditional (in-person) counseling programs in psychooncology. In this paper, data are reported describing the clients of such a program that has been in continuous operation since 1981: the Cancer Information and Counseling Line (CICL) of the AMC Cancer Research Center. An examination of call record forms completed between 1 June 1998 and 30 May 1999 (N=1627) revealed that the vast majority of callers were female (77%), non-Hispanic White (77%), with at least some college education (62%). Only 27% were cancer patients/survivors, compared to 43% who were spouses, other relatives and friends of cancer patients/survivors, and 16% who were symptomatic callers. Breast cancer was by far the most frequently mentioned cancer site (30%). Although initial topics of inquiry were dominated by requests for medical information (77%), with only a small percentage of callers initially requesting psychosocial support and counseling (12%), by the time, the call was completed, 67% had received some form of psychosocial support and/or counseling. Recommendations for future research are discussed within the context of this review. [Copyright &y& Elsevier]

Participation in youth sports has steadily grown over the past 30 years and continues to rise. During the 1998-1999 school year over 360,000 collegiate athletes and almost 6.5 million high school athletes participated in sports. This expansion has been accompanied by an increased awareness of the injury problem associated with participation in youth sports. Estimates are that one-third of high school athletes will sustain an injury during a sports season serious enough to result in time lost from participation. While there may always be some risk associated with sports participation, health professionals can actively encourage injury prevention. In this paper, we describe the benefits of sport participation, the injury problem associated with sports, injury prevention frameworks, and conclude by discussing the changing role of the team physician in youth sports. [ABSTRACT FROM AUTHOR]

Objectives: This paper contributes to the growing literature on help-seeking among women who experience violence.Methods: We interviewed 390 low-income women who reported experiencing physical or sexual violence during adulthood, half of whom were infected with HIV. We obtained information on actions taken in response to episodes of violence and for leaving abusive relationships.Results: A substantial proportion of women could predict an oncoming episode of violence; although the majority took some action either before or during the violent episode, almost 20% took no action at that time to protect themselves. Although family and friends were the greatest source of help for leaving violent relationships, the majority of women who left their abusers, 70%, did not receive assistance. Jobs and education were identified services that would help women leave abusive relationships.Conclusions: There is need for more services for low-income women experiencing violence that focus on safety and on supporting and promoting financial independence. [ABSTRACT FROM AUTHOR]

Bicycle helmet purchase, use, consistent use, and correct use are determined by a complex set of factors. Behavioral theory suggests that they are influenced by the reciprocal association between individual characteristics such as, expectations, skills, attitudes, and beliefs; social influences such as social norms and peer pressure; and environmental factors such as availability, accessibility, and cost. These factors can be influenced through counseling and other interventions. While a review of the literature suggests that many bicycle helmet programs have not been planned using behavioral models and knowledge from the behavioral sciences, many studies include information that supports behavioral principles. This paper describes the behavioral principles and their application to the problem of increasing bicycle helmet use. Recommendations for practitioners are included. [ABSTRACT FROM AUTHOR]

Objectives: This paper contributes to the growing literature on help-seeking among women who experience violence. Methods: We interviewed 390 low-income women who reported experiencing physical or sexual violence during adulthood, half of whom were infected with HIV. We obtained information on actions taken in response to episodes of violence and for leaving abusive relationships. Results: A substantial proportion of women could predict an oncoming episode of violence; although the majority took some action either before or during the violent episode, almost 20% took no action at that time to protect themselves. Although family and friends were the greatest source of help for leaving violent relationships, the majority of women who left their abusers, 70%, did not receive assistance. Jobs and education were identified services that would help women leave abusive relationships. Conclusions: There is need for more services for low-income women experiencing violence that focus on safety and on supporting and promoting financial independence. [Copyright &y& Elsevier]

Participation in youth sports has steadily grown over the past 30 years and continues to rise. During the 1998–1999 school year over 360,000 collegiate athletes and almost 6.5 million high school athletes participated in sports. This expansion has been accompanied by an increased awareness of the injury problem associated with participation in youth sports. Estimates are that one-third of high school athletes will sustain an injury during a sports season serious enough to result in time lost from participation. While there may always be some risk associated with sports participation, health professionals can actively encourage injury prevention. In this paper, we describe the benefits of sport participation, the injury problem associated with sports, injury prevention frameworks, and conclude by discussing the changing role of the team physician in youth sports. [Copyright &y& Elsevier]

Bicycle helmet purchase, use, consistent use, and correct use are determined by a complex set of factors. Behavioral theory suggests that they are influenced by the reciprocal association between individual characteristics such as, expectations, skills, attitudes, and beliefs; social influences such as social norms and peer pressure; and environmental factors such as availability, accessibility, and cost. These factors can be influenced through counseling and other interventions. While a review of the literature suggests that many bicycle helmet programs have not been planned using behavioral models and knowledge from the behavioral sciences, many studies include information that supports behavioral principles. This paper describes the behavioral principles and their application to the problem of increasing bicycle helmet use. Recommendations for practitioners are included. [Copyright &y& Elsevier]

Unintentional and intentional injuries cause a great deal of human suffering throughout the world. They exact a huge toll on societies in terms of mortality, years of potential life lost, disability, and health care costs. The good news is that great strides have been made in understanding the causes of injuries and how to prevent them. Using seat belts and car seats, installing air bags in cars, replacing dangerous playground equipment, enforcing drinking and driving laws are but a few examples of modifying behavior, products, and environments to reduce injury risk. This paper provides an overview of the science of injury control and selected examples of how professionals in the field of patient education and counseling can contribute to enhancing the safety of the public. [Copyright &y& Elsevier]

The incidence and prevalence of tuberculosis are far more common among third world populations immigrating to the United States than among US-born citizens. Immigrants' failure to comply with an anti-tuberculosis treatment can impede completion of care and further confound this public health problem. Barriers to patient--provider communication can negatively influence adherence to a medical regimen. Patients who are unable to comprehend medical advice and do not see it as personally salient are less likely to follow their provider's medical advice. In this paper, the authors focus on efforts to develop a patient education tool targeting Spanish-speaking Latino immigrant patients to facilitate communication with tuberculosis clinicians. A description of the multi-stage developmental processes is presented including conducting a needs assessment, development of visual and written messages, review/critique by tuberculosis experts, field-testing, revisions, and distribution. Formative evaluation and field testing indicates promise for improving communication using this tool. [ABSTRACT FROM AUTHOR]