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Currently patient education programs and urology practices provide individuals with "lists of foods to avoid" for dietary management of kidney stones. However, "planned diets" that include daily meal plans and recipes provide structure and specificity for diet management and are preferred by many individuals. This article describes the development of planned diets to assist individuals with treatment and prevention of calcium oxalate kidney stones. The literature does not include planned diets available for individuals with kidney stones; the "list of foods to avoid" approach is the standard of practice. Results from studies using the Dietary Approaches to Stop Hypertension (DASH) diet with modifications for patients with kidney stones served as the foundation for the planned diets developed in this study. Foods identified in the literature that reduced the development of kidney stones were included in the meal plans. Nutrient analysis was conducted on all foods to ensure nutrient adequacy and compliance with the dietary management of kidney stones. Foods were grouped for meal planning purposes and two sample one-day 2000 calorie planned diets were distributed to 13 patients in an adult urology practice. Adjustments were made in the diets to accommodate for food preferences and caloric levels. Planned diets can provide a useful alternative for community health education specialists in patient health education programs to assist individuals with diet management to reduce the incidence and recurrence of kidney stones. (Contains 2 tables.)

The objective of this study was to assess the extent of diabetic control and its associated factors among Vietnamese patients with diabetes mellitus (DM). The study was conducted among 652 outpatients who were recruited at a public general hospital (People Hospital 115) and a private clinic (Medic Center) in Ho Chi Minh City, Vietnam. Median age of participants was 57 years from People Hospital 115, and 60 years for participants from Medic Center. Thirty-nine percent of patients at People Hospital 115 and 33% of patients at Medic Center had Hemoglobin A1c (HbA1c) greater than 8%. However, 55% and 45% of these patients from each facility reported they are in good control. There was a high percentage of missing data regarding possible complications at both sites. It was also observed a high proportion of patients with a discrepancy between perception and actual control of diabetic condition. Many of these patients showed less distress and had a high self-rating regarding their adherence to a lifestyle regimen. Furthermore, some of these patients were smokers and had a history of atherosclerotic disease. Overall, Vietnamese diabetic patients in this study exhibited poor plasma glucose control. Physician education designed to improve monitoring of glucose levels and diabetic complications, and patient education aimed at raising awareness about actual diabetic control are indicated in this population. (Contains 5 tables.)

Background: Asthma is one of the most prevalent chronic diseases in the United States and can be life-threatening. There are a rising number of adults with asthma that cannot be prevented or cured but may be controlled. Self-management education is essential for long-term asthma control; however, the most effective type of education is unknown. Purpose: The study examined and compared effects of an individually tailored (n = 44) and a standardized (n = 44) asthma self-management program on adult asthma control. The individually tailored education utilized an andragogical framework. Methods: A comparative, pretest-posttest design was used. Education curricula were based on National Asthma Education Prevention Program guidelines. Asthma Control Test (ACT) and Peak Expiratory Flow readings were pre and post-test measures. Independent t-test, chi-square, and repeated measure general linear model compared groups. Results: A significant difference in ACT scores between pre and post-test (F = 4.43, p = 0.038) and a decrease in mean number episodes of shortness of breath (F =6.22, p = 0.015), regardless of asthma teaching method was found. Over 50% of participants reported not receiving previous asthma education. Physicians were the primary source of education reported. Discussion: Asthma education is needed. Both the standardized and individually tailored education may improve asthma control. Translation to Health Education Practice: Health educators must take an active role in providing asthma education based on the rising number of adults with asthma and reports of those receiving no education. Practitioners can determine the type of education based on the setting and learner needs. (Contains 3 tables and 1 figure.)

Background: Discussing medicines with patients is the responsibility of prescribers and pharmacists. However, it is not well known whether patients are given the information they want or whether information provision continues when medicines are taken long-term. Objective: To determine how often general practitioners (GPs) and pharmacists provide verbal information to patients about their medicines, and compare the information given with what patients want to know. Design: Cross-sectional surveys. Setting: New Zealand primary healthcare. Method: Two questionnaires were developed and sent to a sample of pharmacists and GPs, and chi-squared analysis was carried out. Open responses were analysed qualitatively to detect further ideas. Results: A total of 119 pharmacists and 150 GPs responded. For new medicines, significantly more GPs than pharmacists reported giving verbal information all of the time. Significantly more GPs than pharmacists reported discussing most counselling points all or most of the time. Pharmacists were more likely than GPs to discuss counselling points only when requested to by patients. For repeat medicines, significantly more GPs than pharmacists were likely to consider counselling points very important. Conclusion: Patients may not be receiving the information they want to know about their medicines, and there may be an overall lack of verbal communication about medicines with patients. Some information will only be discussed if the patient actively requests it; the likelihood of this increases with repeat medicines. The use of counselling aids and tools, such as a medicine information leaflet, could help healthcare providers provide patients with the information they need.

Background: People who have an intellectual or developmental disability (IDD) and asthma are at greater risk of poor health outcomes. They often require assistance from caregivers when managing their medicines. The objective of this pilot study was to assess the level of understanding of asthma self-management concepts of family caregivers who provide assistance to people who IDD and asthma. Results will inform future needs assessment and intervention studies. Materials and Methods: Nineteen caregivers of people who have asthma and IDD completed a mailed survey. The survey included scales to measure asthma self-management concepts, inhaler technique knowledge, medication adherence and control of asthma. The caregivers were instructed to complete most of the scales with reference to the person with IDD. Results: Most caregivers had acceptable health literacy, but had low scores on the asthma self-management and inhaler technique tests. The most frequently cited barriers to controlling asthma were inadequate caregiver and patient education about the illness as well as knowing and avoiding asthma triggers. The most frequently cited barriers to medication management were knowing inhaler technique, knowledge of medication and forgetting to use medication. Asthma was controlled in 63.2% of patients, while almost 75% of patients were considered nonadherent to controller therapy. Conclusions: Most caregivers had inadequate understanding of asthma self-management as well as inhaler technique despite having high health literacy. Improving caregiver and patient knowledge and skills may lead to better asthma control.

Background: As pregnant mothers increasingly engage in shared decision making regarding prenatal decisions, such as induction of labor, the patient's level of activation may influence pregnancy outcomes. One potential tool to increase patient activation in the clinical setting is mobile applications. However, research is limited in comparing mobile apps with other modalities of patient education and engagement tools. Aim: This study was designed to test the effectiveness of a mobile app as a replacement for a spiral notebook guide as a patient education and engagement tool in the prenatal clinical setting. Method: This randomized controlled trial was conducted in the Women's Health Clinic and Family Health Clinic of three hospitals. Repeated-measures analysis of covariance was used to test intervention effects in the study sample of 205 patients. Results: Mothers used a mobile app interface to more frequently record information about their pregnancy; however, across time, mothers using a mobile app reported a significant decrease in patient activation. Discussion: The unexpected negative effects in the group of patients randomized to the mobile app prompt these authors to recommend that health systems pause before distributing their own version of mobile apps that may decrease patient activation. Conclusion: Mobile apps can be inherently empowering and engaging, but how a system encourages their use may ultimately determine their adoption and success.

Objective: Perceived self-efficacy (PSE) is considered a foundation for effective self-care in the context of chronic disease and illness. In order to improve patient and caregiver knowledge about self-care in B-cell non-Hodgkin's lymphoma (NHL), we designed and delivered an online, patient-focused education activity. Educational impact on PSE was evaluated using a mixed quantitative/qualitative methodology. We report here on the qualitative characteristics of self-efficacy. Methods: We interviewed participants using open-ended questions based on a semi-structured interview guide. Interviews were audio-recorded and transcribed verbatim, and analysed using constant comparative method with software support (NVivo for Mac 11, QSR International). Results: In all, 12 people diagnosed with B-cell NHL were interviewed. Descriptive analysis showed that participants were able to summarise key education messages about B-cell NHL presented in the programme. Key themes linked to self-care knowledge and practice included normalisation of self-care, learning the hard way, everyone is different and being prepared. Participants described four key strategies linked to the notion of 'being prepared': (1) asking questions, (2) building relationships with oncologists, (3) developing/maintaining a philosophy of life, and (4) connecting with others. These themes provide context for the experience of PSE and may also reflect beliefs that have implications for self-efficacy education. Conclusions: Interview data affirm PSE as a foundation of self-care and identify beliefs underpinning PSE. A dominant belief of 'being prepared' was sustained by four strategies that education content reinforced. Educators can use these insights to strengthen self-efficacy education interventions for patients with B-cell NHL and other types of cancer.

Providing patient education for a group is an essential practice for all healthcare providers that has been recognized by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), specifically in relation to patients with chronic diseases. This practice requires skills such as adapting communication to meet the needs of a broad audience, understanding the perspective and knowledge gaps of a broad audience, and ensuring engagement of all audience members. These are experiences that pharmacy students do not traditionally encounter until the fourth professional year. This article will present the design of an active-learning, role-playing activity intended to develop group patient education skills in pharmacy students.

Objective: Healthcare educators are usually well-intended in their educational efforts for and with patients. The purpose of this study was to conduct a meta-analysis comparing traditional versus technology-delivered healthcare education. Design: Systematic review with meta-analysis. Methods: Educational technology was operationally defined to include videos, DVDs, websites and other computer-based education programmes. Proquest Health Management, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Proquest Nursing & Allied Health, PubMed, Medline and Academic Search Premier databases were searched. Search limits included articles published between January 2006 and September 2016, authored in English and peer reviewed. There were four search terms: patient education, videos, DVDs and computer-assisted technology (CAT). A total of 5,003 articles were identified. Articles were screened for inclusion by study title, reducing the list to 407. Abstracts were read, reducing the list to 201. The remaining articles were read. Inclusion and exclusion criteria were established, and 24 studies were included in the final analysis. Effect sizes were calculated, and a meta-analysis was performed. Results: Of the 24 studies included, 12 measured improvements in knowledge, with 10 asserting statistically significant improvements with the use of technology compared to traditional delivery. According to the results of the meta-analysis, however, evidence from pooling the data more strongly favours traditional education compared to technology driven interventions. Conclusion: This meta-analysis compared traditional versus technology-delivered healthcare education; the results suggest preference for traditional.

Background: Diabetes self-management education (DSME) is generally considered to be a key determinant of the treatment outcomes and related costs of diabetes mellitus. While DSME programmes generally have positive outcomes, their effects may depend on certain factors, such as the type of programmes provided and patients' level of health literacy (HL). Low HL has been associated with poorer self-management behaviours and poor medication adherence in diabetic patients, but its impact on the effects of DSME has not yet been systematically investigated. This study aimed to investigate the influence of HL on the self-reported effects of DSME programmes while taking the type of programme into consideration. Method: A total of 366 diabetic patients from nine countries completed a questionnaire measuring HL, self-management behaviours, problem perception, coping, perceived general health and well-being, before and after participating in a DSME programme. Results: DSME programmes were found to have positive effects on self-reported self-management behaviours and almost all psychological and health outcomes, regardless of HL level. Patients with high HL scored better on several diabetes outcomes than those with low HL, but all patients described benefiting from DSME. Individual and group-based programmes resulted in more positive effects on several diabetes outcomes than self-help groups, but no interaction with HL was found. Conclusion: Our findings confirm those of previous studies showing that DSME programmes have positive effects and that low HL is associated with lower diabetes outcomes but do not support the assumption that the effects of DSME programmes are influenced by the patient's HL. However, due to the limitations of this study, further investigation is necessary to support these findings and improve our understanding about the impact of HL on DSME programmes' effectiveness.

Background: Adolescents experience numerous barriers to obtaining sexual and reproductive health care (SRHC). Mobile Health Units (MHUs) can remove some barriers by traveling to the community. This pilot study developed Mobile SRHC through an iterative process on an existing MHU and evaluated it among adolescents and providers. Methods: Mobile SRHC was developed through a mixed-method, multiphase study. Three key informant interviews with MHU providers, an adolescent needs assessment survey, and a Youth Model Development Session informed model development. Emergency contraception (EC), oral contraceptive pills (OCPs), and depot-medroxyprogesterone acetate (DMPA) were sequentially incorporated into MHU services. Administrative data assessed method distribution and surveys assessed patient satisfaction. Results: Key informants held positive attitudes toward implementing Mobile SRHC into their practice. Needs assessment surveys (N = 103) indicated a majority was interested in learning about sexual health (66.0%) and obtaining birth control (54.4%) on an MHU. Over 3 months, 123 adolescents participated in Mobile SRHC. Seven packs and 9 prescriptions of EC, 8 3-month packs and 10 prescriptions of OCPs, and 5 injections and 5 prescriptions of DMPA were distributed. Ninety-two percent of adolescent participants reported they would recommend Mobile SRHC to friends. Conclusions: Mobile SRHC is a feasible approach for reproductive health care among adolescents.

This article describes advances in the behavioral self-management of chronic disease from the perspective of a 25-year trajectory of National Institute of Health-funded research in arthritis and cardiopulmonary diseases that has sought to develop a transdisciplinary understanding of how applied behavioral science can be used to improve health behaviors, functional status, and health outcomes. The article traces the arc of a novel research program--conducted in collaboration with physician-scientists at Columbia, Weill Cornell Medical College, and New York University School of Medicine--that runs through social cognitive theory, behavioral economics, and the emerging science of positive psychology in an effort to develop promising new approaches to fostering the adoption and maintenance of health-related behavioral change. The article concludes with what has been learned and what the implications of the work are for advancing behavioral self-management and patient education to improve patient outcomes and achieve the compression of morbidity. [The Elizabeth Fries Health Education Award Lecture on which this article is based was presented at the 68th Annual Meeting of the Society for Public Health Education (Denver, Colorado, March 31, 2017).]

Simulation in healthcare in an way to train professionals but it is not yet use commonly to train patient or their caregivers. Recently, it has been suggested to extend simulations to patients with chronic conditions. Simulations could help patients and caregivers to acquire psychosocial and self-management skills. This approach proved to be effective for the training of healthcare professionals, but its transferability to patients needs to be evaluated. Already, several questions arise. However, by considering simulations as pretexts for debriefing, they enable patients and professionals to assess a concrete situation, implying voluntary and reflexive learning processes. Thus, video recording should be assessed for its role in patient metacognition, defined as knowing about knowing. A taxonomy for simulations dedicated to patients, like that already developed for healthcare professionals, should be considered. Although practical constraints must be identified and addressed, they should not be the primary issue guiding research. The transferability of simulation as an educational technique from professionals to patients and caregivers should be investigated essentially in order to provide a significant benefit to patients.

Background: Melanoma is a serious skin cancer that has been on the rise in the United States. Some genetic component is apparent. Purpose: The purpose of this study was to identify demographic, clinical, attitudinal, and health belief factors associated with intention to obtain genetic testing for hereditary melanoma among unaffected first-degree relatives of melanoma patients at low to moderate risk for hereditary melanoma. Methods: Using contact information provided by index cases diagnosed with melanoma, 92 unaffected first-degree relatives were asked to complete questionnaires via mail. Results: The average age of respondents was 45.7 (plus or minus 12.8) years, and the majority were female (59%), currently married (80%), and Caucasian (98%). Only 11% of the sample was aware of genetic testing for hereditary melanoma prior to the survey. However, once such a test was described, 48% said they would take the test in the next six months if it were made available to them. Logistic regression analyses revealed that being married, physician recommendation, and helping family members make health care decisions were associated with intention to obtain genetic testing. Discussion: In light of these results, health education efforts for low-to-moderate-risk patients should include information about the clinical utility of genetic testing and the implications of test results for family members. Translation to Health Education Practice: As genetic testing for cancer becomes more widely available, demand for information will increase as well. Health educators will be instrumental in meeting the increased demand for such information and ensuring that those at low risk are appropriately informed and reassured. (Contains 3 tables.)

This randomized controlled trial aimed to test the effectiveness of brief face-to-face patient education in increasing influenza vaccination rate among elderly in the community. Recruitment and intervention were conducted at two general outpatient clinics in Hong Kong. 529 eligible patients were randomly assigned to intervention or control group with 1:1 allocation ratio. Patients in the intervention group received 3-min one-on-one verbal education by medical students and a pamphlet regarding influenza vaccination. Neither verbal health education nor pamphlet was given to the control group. Intention-to-treat analysis showed significantly higher vaccination rate in the intervention group compared with the control group (33.6 versus 25.0%) and the adjusted relative risk was 1.34 (95% CI 1.04-1.72; P = 0.021). Hence, brief face-to-face patient education was effective in increasing influenza vaccine uptake rate of community-dwelling elderly patients. Participants who were undecided whether to receive vaccination seemed to demonstrate larger beneficial effect (RR = 7.84; 95% CI 1.06-57.76) compared with patients who were certain of either receiving (RR = 1.16; 95% CI 0.90-1.48) or not receiving (RR = 2.18; 95% CI 0.68-6.99) the vaccine. The study also revealed that patients' intention for vaccination may not translate into action, reasons for which should be explored in future research.

Objective: Free clinics provide free or reduced fee healthcare to individuals who lack access to primary care and are socio-economically disadvantaged in the USA. Free clinic patients may have health education needs, but experience barriers to attending health education programmes. In an attempt to reach out to free clinic patients who might not otherwise attend health education classes, this project examined the efficacy of student-led health education classes conducted in the waiting room prior to a patient's appointment with a provider. Design: The classes had two areas of focus: women's health and health information. Health educators and Spanish interpreters were graduate and undergraduate students. Setting: This study was conducted in the waiting room of a free clinic in the Intermountain West region of the USA. Method: The health education classes were held 22 times in total from late August to early December 2014. Results: While the survey-based assessment of the programme did not show a difference in levels of health consciousness, health information seeking and health attitudes, the programme potentially increased interest in attending the health education classes. Conclusion: There were some challenges associated with the implementation of a health education class in the waiting room setting, particularly in regards to environments, evaluation and interpretation services. Future projects are needed to address challenges associated with conducting a health education class in a waiting room setting. In addition, a variety of health topics, evidence-based evaluation and interpreter services are key for future success.

Objective. In a randomized controlled trial we compared two models of community health worker-led diabetes medication decision support for low-income Latino and African American adults with diabetes. Most outcomes were improved when community health workers used either an interactive e-Health tool or print materials. This article investigates mediators and moderators of improved medication adherence in these two models. Method. Because both programs significantly improved satisfaction with medication information, medication knowledge, and decisional conflict, we examined whether improvements in each of these outcomes in turn were associated with improvements in self-reported medication adherence, and if so, whether these improvements were mediated by improvements in diabetes self-efficacy or diabetes distress. Potential moderators of improvement included gender, race/ethnicity, age, education, insulin use, health literacy, and baseline self-efficacy, diabetes distress, and A1c. Results. A total of 176 participants (94%) completed all assessments. After adjusting for potential confounders, only increased satisfaction with medication information was correlated with improved medication adherence (p = 0.024). Improved self-efficacy, but not diabetes distress, was associated with improvements in both satisfaction with medication information and medication adherence. However, the Sobel-Goodman Mediation test did not support improvements in self-efficacy as a mechanism by which improved satisfaction led to better adherence. None of the examined variables achieved statistical significance as moderators. Conclusions. Improvements in satisfaction with medication information but not in medication knowledge or decision conflict were associated with improvements in medication adherence. Interventions that target low-income ethnic and racial minorities may need to focus on increasing participants' satisfaction with information provided on diabetes medications and not just improving their knowledge about medications. Future research should explore in more depth other possible mediators and moderators of improvements in medication adherence in low-income minority populations.

Despite the evidence indicating that decision aids (DA) improve informed treatment decision making for prostate cancer (PCa), physicians do not routinely recommend DAs to their patients. We conducted semi-structured interviews with urologists (n = 11), radiation oncologists (n = 12) and primary care physicians (n = 10) about their methods of educating low-risk PCa patients regarding the treatment decision, their concerns about recommending DAs, and the essential content and format considerations that need to be addressed. Physicians stressed the need for providing comprehensive patient education before the treatment decision is made and expressed concern about the current unevaluated information available on the Internet. They made recommendations for a DA that is brief, applicable to diverse populations, and that fully discloses all treatment options (including active surveillance) and their potential side effects. Echoing previous studies showing that low-risk PCa patients are making rapid and potentially uninformed treatment decisions, these results highlight the importance of providing patient education early in the decision-making process. This need may be fulfilled by a treatment DA, should physicians systematically recommend DAs to their patients. Physicians' recommendations for the inclusion of particular content and presentation methods will be important for designing a high quality DA that will be used in clinical practice.

Recent advances in communication technologies enable potential provision of remote education for patients using computer-generated environments known as virtual worlds. Previous research has revealed highly variable levels of patient receptiveness to using information technologies for healthcare-related purposes. This preliminary study involved implementing a questionnaire investigating attitudes and access to computer technologies of respiratory outpatients in order to assess potential for use of virtual worlds to facilitate health-related education for this sample. Ninety-four patients with a chronic respiratory condition completed surveys, which were distributed at a Chest Clinic. In accordance with our prediction, younger participants were more likely to be able to use and have access to a computer, and some patients were keen to explore use virtual worlds for healthcare-related purposes: Of those with access to computer facilities, 14.50% expressed a willingness to attend a virtual world focus group. Results indicate that future virtual world health education facilities should be designed to cater to younger patients because this group is most likely to accept and use such facilities. Within the study sample, this is likely to comprise of people diagnosed with asthma. Future work could investigate the potential of creating a virtual world asthma education facility.