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Although video is increasingly used in public health education, studies generally do not implement randomized trials of multiple video segments in clinical environments. Therefore, the specific configurations of educational videos that will have the greatest impact on outcome measures ranging from increased knowledge of important public health issues, to acceptance of a voluntary HIV test, remain largely unknown. Interventions can be developed to run on affordable handheld computers, including inexpensive tablets or netbooks that each patient can use individually, and to integrate video delivery with automated data collection. These video interventions can then be used not only to educate patients who otherwise might not be reached, but to examine how content can be optimized for greater effectiveness as measured by cognitive and behavioral outcomes. This approach may prove especially valuable in high volume urban facilities, such as hospital emergency departments, that provide points of contact for lower income, lower literacy, and high-risk populations who may not otherwise interact with healthcare providers or researchers. This article describes the development and evaluation of an intervention that educates emergency department patients about HIV prevention and testing while comparatively examining a set of videos, each based upon competing educational theories. The computer-based video intervention and methodology are both highly replicable and can be applied to subject areas and settings far beyond HIV or the emergency department.

Objective: The authors quantitatively examined differences in psychiatric residents' and attending physicians' communication profiles and voice tones. Methods: Audiotaped recordings of 49 resident-patient and 35 attending-patient medication-management appointments at four ambulatory sites were analyzed with the Roter Interaction Analysis System (RIAS). Nonparametric tests were used to compare differences in proportions of speech devoted to relationship-building, activating, and partnering in decision-making processes, and data-gathering/counseling/patient education. Differences in affect expressed by psychiatrists' voice tones were also examined. Results: Residents' visits were twice as long as Attendings' visits (28.2 versus 14.1 minutes), and residents devoted a significantly greater proportion of their talk to relationship-building (23% versus 20%) and activating/partnering (36% versus 28%) aspects of communication, whereas Attendings devoted a greater proportion to biomedically-related data-gathering/counseling/patient education (31% versus 20%). Analysis of voice tones revealed that residents were perceived as sounding significantly friendlier and more sympathetic, versus Attendings, who were rated as sounding more dominant and rushed. Conclusion: These findings show distinct communication profiles and voice-tone differences. Future psychiatric communication research should address the influence of appointment length, psychiatrist/patient characteristics, and other potential confounders on psychiatrist-patient communication. (Contains 1 figure and 2 tables.)

Objective: While access to health education information has become easier, the quality of information retrieved from the Internet varies considerably. In response to the need for accessible, quality health information that is tailored to meet individual patient needs, a patient education website, called PEPTalk, was developed. The site houses text and video material that has been validated by practicing clinicians. A study was conducted to examine patient and community members' satisfaction with PEPTalk and the impact of the health education materials on their health behaviour. Community staff and health providers' experiences with the new technology were also examined. Design and method: A descriptive study using surveys and interviews was conducted with 57 patients, community participants and clinicians living in a large Canadian city and First Nations communities in Northern Ontario. Results: Participants' PEPTalk Satisfaction scores ranged from moderately to highly satisfied. Participants found the information presented on PEPTalk useful and relevant, had improved their knowledge of health, and in most cases, altered health behaviour. Clinicians and community staff who referred participants to the PEPTalk website reported that the site provided reliable, evidence-based information that they were comfortable sharing with their patients and community members. Conclusion: There is an emerging role for tools that provide tailored health education. The health provider's role regarding interpretation, discussion and follow-up remains essential, and tools such as PEPTalk need to be part of an overall health education strategy. (Contains 2 tables.)

Objective: Adherence to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA) is poor. We assessed the effectiveness of a motivational interviewing intervention (motivational interview nurse therapy [MINT]) in addition to best practice standard care to improve acceptance and adherence to CPAP therapy in people with a new diagnosis of OSA. Method: One hundred six Australian adults (69% male) with a new diagnosis of OSA and a clinical recommendation for CPAP treatment were recruited from a tertiary sleep disorders center. Participants were randomly assigned to receive either 3 sessions of a motivational interviewing intervention (MINT; n = 53; mean age = 55.4 years) or no intervention (control; n = 53; mean age = 57.74 years). The primary outcome was the difference between the groups in objective CPAP adherence at 1-month, 2-month, 3-month, and 12-month follow-ups. Results: Fifty (94%) participants in the MINT group and 50 (94%) participants in the control group met all inclusion and exclusion criteria and were included in the primary analysis. The number of hours of CPAP use per night in the MINT group at 3 months was 4.63 hr and was 3.16 hr in the control group (p = 0.005). This represents almost 50% better adherence in the MINT group relative to the control group. Patients in the MINT group were substantially more likely to accept CPAP treatment. Conclusions: MINT is a brief, manualized, effective intervention that improves CPAP acceptance and objective adherence rates compared to standard care alone. (Contains 4 tables and 2 figures.)

This article is intended as a clear and practical introduction to use of a scientific perspective on embodied learning. It looks to embodied cognition and embodied cognitive science to explore education for self-care. The author presents a neurobiologic understanding of embodied learning to bridge adult education to the science-driven world of health care. She shares a well-studied pedagogy of embodied education that can be applied to develop embodied patient education. Finally, she suggests a vision of patient education sourced in personal embodied awareness as a most appropriate means of achieving truly empowered patients capable of self-care. (Contains 1 figure.)

Patient education is a crucial aspect of nursing practice, but much of the research about it is quantitative and has been conducted in urban medical centers. These urban-based studies have limited utility for nurses working in rural hospitals where the populations they serve often have unique and challenging health contexts and cultures. Since rural residents value knowledge that comes from within their own culture, we used phenomenology and hermeneutics to learn from patients about their experiences of receiving patient education in rural hospitals. Fifteen patients, 7 females and 8 males from 4 rural hospitals participated in non-structured, audio-recorded interviews where we asked them to describe their experiences of receiving patient education. The findings emphasize the need for patients to receive patient education in ways that help them be self-reliant. The findings also suggest the need to involve family members as co-educators when providing patient education to patients hospitalized for familial chronic illnesses. (Contains 3 tables.)

Purpose: The aim of this study was to describe nurses' and other health care professionals' views about their patient education skills and how to develop them. Design/methodology/approach: The data for the study were collected from the participants of the online education course on patient education. The data were analyzed using qualitative content analysis. Findings: The results show that, in the experience of health care professionals, it is important to make a shift from the professional-led education and counselling towards an education relationship in which the professional and the patient are equals and represent different kinds of expertise and to develop patient education towards patient-centredness supporting the patients' self-management. Research limitations/implications: The sample used in the research is small. Practical implications: The participants in this study experienced that, as patient educators, it is necessary for them to acknowledge their own abilities, beliefs and values in order to be able to develop their patient education skills. This is noteworthy because appreciating and acknowledging the importance of reflection is one prerequisite for the paradigm shift from the traditional patient education model towards patient-centred education. Consequently, it is important to investigate further the best ways of facilitating the development of health care professionals' skills with regard to patient-centred education. Originality/value: The study showed that, through education and training, health care professionals can recognize the need to develop their patient education towards patient-centredness. (Contains 1 figure.)

The authors developed and delivered a brief patient activation intervention (PAI) that sought to facilitate physician-patient communication. The intervention was designed to assist low-income, racial/ethnic minority users of community health centers in building skills and confidence asking questions. The PAI takes 8 to 10 minutes to deliver and consists of five steps that can be carried out by individuals with minimal formal medical training. A total of 252 patients waiting to see their physician participated in the intervention and completed the follow-up semistructured interview after their health care visit. The authors describe the intervention and the results of their qualitative evaluation of patient's responses. Overall, the PAI was valued by patients, appeared to add to patients' satisfaction with the health care they received, and was feasible to implement in the primary care setting. Furthermore, findings from this study provide indirect insight regarding factors that influence minority patient's question-asking behavior that include patient's attitudes, social factors, and patient's self-efficacy in question formulation. (Contains 4 tables and 1 figure.)

Purpose: The aim of this study was to examine whether older people are prepared to engage in appropriate falls prevention strategies after discharge from hospital. Design and Methods: We used a semi-structured interview to survey older patients about to be discharged from hospital and examined their knowledge regarding falls prevention strategies to utilize in the post-discharge period. The study was part of a prospective cohort study, nested within a larger, randomized controlled trial. Participants (n = 333) were asked to suggest strategies to reduce their falls risk at home after discharge, and their responses were compared with current reported research evidence for falls prevention interventions. Results: Participants' strategies (n = 629) were classified into 7 categories: behavioral, support while mobilizing, approach to movement, physical environment, visual, medical, and activities or exercise. Although exercise has been identified as an effective falls risk reduction strategy, only 2.9% of participants suggested engaging in exercises. Falls prevention was most often conceptualized by participants as requiring 1 (35.4%) or 2 (40.8%) strategies for avoiding an accidental event, rather than engaging in sustained multiple risk reduction behaviors. Implications: Results demonstrate that older patients have low levels of knowledge about appropriate falls prevention strategies that could be used after discharge in spite of their increased falls risk during this period. Findings suggest that health care workers should design and deliver falls prevention education programs specifically targeted to older people who are to be discharged from hospital.

Objective: The purpose of this study was to develop guidelines and recommendations on patient education programmes of any type, targeted specially to individuals with OA and which were designed to improve the clinical effectiveness of managing OA. Methods: The Ottawa Methods Group contacted specialized organizations that focus on management for individuals diagnosed with OA to nominate nine experienced clinicians specializing in various fields--rheumatology, physiatry, medicine, occupational therapy, physical therapy--and a patient with OA. The EBCPGs in this report were created based on the Appraisal of Guidelines Research and Evaluation (AGREE) criteria. The Ottawa Panel graded the recommendations according to levels (I for randomized controlled trials [RCTs], II for non-randomized studies) and strength of evidence (A, B, C, C+, D, D+, or D-). Results: Using a systematic approach to our literature search, a total of over 1000 articles was found on the efficacy of patient education for OA, and 57 articles were recognized as potentially relevant. Based on the inclusion and exclusion selection criteria, 20 studies were ultimately included. Results from the Jadad scale illustrated that seven of the 20 studies included were considered of high methodological quality ([greater than or equal to] 3). The remaining studies received low scores, therefore they were categorized as poor methodological quality trials. Conclusion: This review of the studies to date seems to indicate the potential of patient education for OA to positively affect pain, at least in the short-term, and exercise compliance in the longer term. While the programmes reviewed varied widely in the focus and approach of education, a number of promising "effective ingredients" seem to be suggested by this review. The Ottawa Panel recommendations are in concordances with other clinical practice guidelines related to the efficacy of patient education for the management of OA, especially to improve pain, physical activity level, self-efficacy and quality of life. (Contains 3 tables and 2 figures.)

Effective management of chronic diseases (e.g., diabetes) can depend on the extent to which patients can learn and remember disease-relevant information. In two experiments, we explored a technique motivated by theories of self-regulated learning for improving people's learning of information relevant to managing a chronic disease. Materials were passages from patient education booklets on diabetes from NIDDK. Session 1 included an initial study trial, Session 2 included self-regulated restudy, and Session 3 included a final memory test. The key manipulation concerned the kind of support provided for self-regulated learning during Session 2. In Experiment 1, participants either were prompted to self-test and then evaluate their learning before selecting passages to restudy, were shown the prompt questions but did not overtly self-test or evaluate learning prior to selecting passages, or were not shown any prompts and were simply given the menu for selecting passages to restudy. Participants who self-tested and evaluated learning during Session 2 had a small but significant advantage over the other groups on the final test. Secondary analyses provided evidence that the performance advantage may have been modest because of inaccurate monitoring. Experiment 2 included a group who also self-tested but who evaluated their learning using idea-unit judgments (i.e., by checking their responses against a list of key ideas from the correct response). Participants who self-tested and made idea-unit judgments exhibited a sizable advantage on final test performance. Secondary analyses indicated that the performance advantage was attributable in part to more accurate monitoring and more effective self-regulated learning. An important practical implication is that learning of patient education materials can be enhanced by including appropriate support for learners' self-regulatory processes. (Contains 2 footnotes, 3 tables, and 8 figures.)

Introduction: To identify health website recommendation trends by Gold Coast (Australia) general practitioners (GPs) to their patients. Method: A mixed method approach to data collection and analysis was employed. Quantitative data were collected using a prepaid postal survey, consisting of 17 questions, mailed to 250 (61 per cent) of 410 GPs on the Gold Coast (Australia). The resulting empirical data and resulting themes were further used to design semi-structured interview questions. A total of 15 (8 male, 7 female) GPs volunteered to be interviewed. Results: Fifty-nine per cent of participating GPs recommend health websites to their patients during consultations. Male GPs (63 per cent), those aged 41-50 years (55 per cent), and those practising for less than 10 years (60 per cent) were more inclined to recommend a health website to a patient. From the survey data, eight principle categories presented themselves as to GPs' recommendation trends, these including; "Do not recommend websites"--(1) Limited time, (2) Prefer to personally discuss, (3) Reliability issues, (4) Biased information--and "Do recommend health websites"--(5) Helps to educate patient, (6) Enhances the doctor-patient relationship, (7) Age-appropriate technology, (8) Treatment orientated. The semi-structured interviews presented a further eight sub-categories and have been identified as: (1) Fewer female GPs than male GPs recommend health websites, (2) Age and years of experience of GPs affect internet prescription trends, (3) Patients more knowledgeable, (4) "Sweeteners" offered by pharmaceutical companies, (5) A high influence by pharmaceutical companies on the WWW/internet, (6) A lack of knowledge pertaining to reliability issues--issues of trust, (7) Limited knowledge pertaining to interactivity and usability components, and (8) A need for further medical education for GPs. Conclusion: More than half of the surveyed GPs actively recommend websites to their patients, with a GP's sex, age and years of experience influencing his or her recommendation decisions. There are numerous and varied reasons as to why GPs "do" or "do not" recommend health websites to their patients. Web-based continuing medical education courses or programmes in medical schools may help GPs develop the skills necessary for the delivery of effective e-health care. (Contains 6 tables.)

Despite extensive patient education, few heart failure (HF) patients master self-care. Impaired cognitive function may explain why patient education is ineffective. A concurrent triangulation mixed methods design was used to explore how knowledge and cognitive function influence HF self-care. A total of 41 adults with HF participated in interviews about self-care and completed standardized instruments measuring knowledge, cognitive function, and self-care. Content analysis uncovered themes suggesting that lack of understanding, not lack of knowledge, contributes to poor self-care. Linear regression tested the relative influence of knowledge and cognitive function on self-care. Cognitive function was a stronger determinant of self-care than knowledge. Poorer cognitive function was related to better self-care and explained in part by mixed methodology and the qualitative narratives. (Contains 7 tables and 1 figure.)

Despite cervical cancer being one of the leading causes of cancer-related deaths among women in Peru, cervical Pap smear coverage is low. This article uses findings from 185 direct clinician observations in four cities of Peru (representing the capital and each of the three main geographic regions of the country) to assess missed opportunities for health education on Pap smears and other preventive women's health behaviors during women's visits to a health care provider. Various types of health establishments, provider settings, and provider types were observed. Opportunities for patient education on the importance of prevention were rarely exploited. In fact, health education provided was minimal. Policy and programmatic implications are discussed. (Contains 3 tables.)

Large increases in the need for long-term care (LTC) services are expected as baby boomers age. Little has been published about patient and caregiver preferences for information about LTC. However, our qualitative research findings suggest that potential consumers may find it difficult to obtain accurate and timely information about LTC programs and services. In-person, semistructured interviews were conducted with 47 subjects, including patients (n = 25) within 90 days of their referral to a LTC placement (including NH, assisted living, home care, and community) and their caregivers (n = 22). Interview questions addressed the events that seemed to trigger their need for a LTC referral, the resources they used to become more informed about LTC options and the issues they confronted with the LTC referral process. Qualitative analyses identified a number of patient and informal caregiver-reported barriers to making decisions about LTC services, including insufficient information about LTC programs and community resources, unclear funding requirements and inadequate funding, and difficulty knowing how to plan for LTC or make LTC decisions. A potential solution may be an online LTC Guide designed to provide accurate information about the range of LTC services, with an emphasis on home and community-based services. This Guide was developed to address the gap in comprehensive LTC information identified in the findings of this study. (Contains 1 table.)

This paper reflects on the challenges and benefits of multidimensional collaboration in an action research study to evaluate and improve preoperative education for patients awaiting colorectal surgery. Three cycles of planning, acting, observing and reflecting were designed to evaluate practice and implement change in this interactive setting, calling for specific and distinct collaborations. Data collection includes: observing educational interactions; administering patient evaluation questionnaires; interviewing healthcare staff, patients and carers; patient and carer focus groups; and examining written and audiovisual educational materials. The study revolves around and depends on multi-dimensional collaborations. Reflecting on these collaborations highlights the diversity of perspectives held by all those engaged in the study and enhances the action research lessons. Successfully maintaining the collaborations recognises the need for negotiation, inclusivity, comprehension, brokerage, and problem-solving. Managing the potential tensions is crucial to the successful implementation of changes introduced to practice and thus has important implications for patients' well-being. This paper describes the experiences from an action research project involving new and specific collaborations, focusing on a particular healthcare setting. It exemplifies the challenges of the collaborative action research process and examines how both researchers and practitioners might reflect on the translation of theory into educational practices within a hospital colorectal department. Despite its context-specific features, the reflections on the types of challenges faced and lessons learned provide implications for action researchers in diverse healthcare settings across the world. (Contains 3 figures.)

Nearly half the U.S. population copes with a chronic disease or condition. A chronic disease is "one lasting three months or more that generally cannot be prevented by vaccines or cured by medication." Heart disease, cancer, diabetes, and obesity are the most common chronic diseases in developed countries. By 2030, it is estimated that one hundred seventy-one million U.S. citizens will have been affected by at least one chronic illness. Learning is integral to coping with chronic illness. The purpose of this chapter is to demonstrate the role of adult learning in coping with chronic disease. The author reviews select studies that discuss learning related to chronic illness. An investigation of patient education studies follows. Last, the author provides recommendations for health educators.

Objective: To determine health care provider needs related to pediatric obesity management in rural California and to explore strategies to improve care through telehealth. Methods: Cross-sectional survey of health care providers who treated children and adolescents at 41 rural clinics with existing telehealth connectivity. Results: Most of the 135 respondents were family physicians at designated rural health clinics serving low-income families. Respondents had practiced in rural areas for an average of 10 years. Most providers rated their self-efficacy in managing pediatric obesity as 2 or 3 on a 5-point scale. The barriers most frequently reported by health care providers were lack of local weight management programs, lack of patient motivation, and lack of family involvement in treatment. Providers reported that the resources they would find most helpful were readily accessible patient education materials, strategies to link patients with community treatment programs and training in brief, focused counseling skills. Three-quarters of providers already used telehealth for distance learning. Providers reported very high interest in participating in continuing education on pediatric obesity delivered by telehealth, specifically Internet communication with specialists, web-based education, and interactive video case-conferencing. Conclusions: Rural health care providers face several barriers related to pediatric obesity management. Targeted interventions provided via telehealth to rural health care providers may enhance the care of obese children and adolescents. The results of this study provide directions and priorities for the design of appropriate interventions.

Objective: To examine older adults' beliefs about osteoporosis and osteoporosis screening to identify barriers to screening. Design: Cross-sectional mailed survey. Setting: Western Pennsylvania. Methods: Surveys were mailed to 1,830 women and men aged 60 years and older. The survey assessed socio-demographic characteristics, osteoporosis and general health-related characteristics, and beliefs about osteoporosis severity, susceptibility, screening self-efficacy, and screening response efficacy. Analyses included Wilcoxon rank-sum tests to compare belief dimension scores, and multivariable ordinal logistic regression analyses to evaluate association between osteoporosis beliefs and potential explanatory variables. Results: Surveys were completed by 1,268 individuals (69.3 per cent). Mean age of respondents was 73.3 years, and most were female (58.7 per cent). Individuals demonstrated greatest belief in the severity of osteoporosis and least belief in personal susceptibility (P less than 0.001). Older individuals believed less strongly than younger individuals in osteoporosis severity (OR, 0.95 per one year increase in age; 95 per cent CI, 0.92-0.97) and response efficacy (OR, 0.97 per one year increase in age; 95 per cent CI, 0.95-0.99). Women believed more strongly than men in osteoporosis susceptibility (OR, 1.87; 95 per cent CI, 1.38-2.53) and screening self-efficacy (OR, 2.87; 95 per cent CI, 1.17-7.07). Individuals with high self-rated health status had greater belief than those with low self-rated health status in screening self-efficacy (OR, 3.59; 95 per cent CI, 1.89-6.83). Conclusion: Older adults demonstrate several beliefs that may be barriers to osteoporosis screening, including low belief in susceptibility to osteoporosis. These beliefs should be targeted with patient education to improve screening rates. (Contains 2 tables and 1 figure.)

Medical students at Mount Sinai School of Medicine participated in an intervention designed to promote knowledge and improved communication skills related to cadaveric organ donation. The intervention required students to interact with a standardized patient for approximately 10 minutes and respond to questions posed about organ donation in a primary care context. A coding scheme for communication content was developed based upon students' accuracy and missed opportunities for educating patients. Data are presented for 2007 and 2008 first-year medical students (N=170) and results indicate several areas of students' missed opportunities for patient education including: (1) logistics of the state health care proxy, (2) timing of funeral arrangements, and (3) ability to choose organs for transplantation. The value of using standardized patients for communication training and health education/promotion is discussed. (Contains 7 notes and 1 table.)

Climate change is a threat to wildlife and the environment, but it also one of the most pervasive threats to human health. The goal of this study was to examine the relationships among dimensions of health literacy, patient education about global warming and climate change (GWCC), and health behaviors. Results reveal that patients who have higher levels of health literacy are more likely to engage in mitigation behaviors. An empirically based set of recommendations for providers to educate patients about the health risks of global warming and climate change is proposed. (Contains 2 tables.)

In recent years, communication education has been used as a means of improving the clinician-patient relationship and promoting health. The focus of these interventions has primarily centered on clinician training. An area that has received less focus, although equally important, is training patients to be good communicators. The purpose of the paper is to first introduce clinician-patient "concordance" as a conceptual framework for patient communication education. Second, we provide a review and critique of the literature on existing patient communication interventions. Finally, we conclude with a discussion of two specific patient populations that face challenges and obstacles in clinician-patient communication and preliminary work we are doing in these areas: complementary and alternative medicine users and the medically underserved. (Contains 1 note and 1 table.)

Patients with diabetes who experience low-health literacy often struggle in their roles as health consumers. A multi-disciplinary group of educators and researchers collaborated to develop a video intervention to help these patients better understand their disease and communicate more effectively with their physician. We describe the assessment study and report preliminary patient perception outcome data regarding the utility of the videos as a communication and health education intervention. Generally, the participants found the intervention to be helpful and informative. For many, the intervention led them to consider behavior changes. For others, the intervention was a prompt for diabetes-related conversations with their physicians. Participant responses also provided empirical support that the intervention was consistent with key principles of message design for patients with low-health literacy. (Contains 5 notes.)

Aim: Children with congenital heart disease (CHD) are at risk of developing neurocognitive problems. However, as these problems are usually identified after cardiac surgery, it is unclear whether they resulted from the surgery or whether they pre-existed and hence might be explained by complications and events associated with the heart disease itself. The purpose of this study was to examine whether neurocognitive deficits commonly reported after cardiac surgery are present before surgery. Method: Forty-five children (22 males, 23 females; mean age 11y 6mo, SD 3y 0mo) with cyanotic and acyanotic heart diseases scheduled for elective cardiac surgery were compared with 41 healthy peers (17 males, 24 females; mean age 11y 10mo, SD 2y 10mo) for attention and processing speed, construction, motor speed, motor planning and fluency, and visual memory. Twenty-three children in the patient group were awaiting their first cardiac surgery and 22 were awaiting follow-up surgery. Results: The patients showed manifest neurocognitive difficulties. Their performance was inferior to that of the healthy comparison group for motor planning (p = 0.02) and visual memory (p = 0.01). The same neurocognitive profile was found in the group of patients awaiting their first cardiac operation. Interpretation: School-age children with various forms of CHD are at risk of neurocognitive impairments before cardiac surgery.

Health literacy, the ability to obtain and understand information and services to make good health decisions, has received much attention recently. Literacy is a stronger predictor of health status than age, income, race, ethnicity, employment status, or educational level. Inadequate health literacy costs the United States an estimated $100-$236 billion every year (Howard, Gazmararian, & Parker, 2005). Improving health literacy is critical to health care access and patient safety. Efforts to increase patients' health literacy have only begun. One of the obstacles to advancing health literacy is a lack of communication between the literacy and health care fields. In this article, the authors share their experiences to help other literacy professionals find ways to work with health care professionals toward the shared goal of improving health literacy. They offer communication strategies that can be used with patients if low literacy skills are suspected. They also share some lessons they have learned as they built bridges between literacy providers and health care providers.

The purpose of this study was to investigate how Canadian adults living with limited literacy and chronic illness made meaning of their patient education experiences. The study used a hermeneutic phenomenological research design and employed three data sources over a nine-month period. Data was interpreted and analyzed as it was collected, following common procedures for phenomenological studies. Five themes emerged from the data: roles and relationships, language and health care interactions, living between worlds, mismatched expectations, and powerlessness. Findings suggest that the participants transformed their understanding of their patient education experiences because their literacy abilities improved through work in their literacy classrooms. The article closes with a discussion of the implications of the study for adult literacy practitioners and policy makers. (Contains 1 figure.)

Purpose: This study investigated the effectiveness of interventions to improve medication adherence (MA) in older adults. Design and Methods: Meta-analysis was used to synthesize results of 33 published and unpublished randomized controlled trials. Random-effects models were used to estimate overall mean effect sizes (ESs) for MA, knowledge, health outcomes, and health services utilization. Results: Data were synthesized across 11,827 participants. Interventions significantly improved MA (ES = 0.33), knowledge (ES = 0.48), and diastolic blood pressure (ES = 0.19). Nonsignificant effects were found for systolic blood pressure (ES = 0.21), other health outcomes (ES = 0.04), and health services utilization (ES = 0.16). Moderator analyses showed larger adherence ESs for interventions employing special medication packaging, dose modification, participant monitoring of medication effects and side effects, succinct written instructions, and standardized (not tailored) interventions. Larger effects were found when a moderate proportion of participants were women, for participants taking 3-5 medications, and when pill count adherence was measured. Implications: The findings document that interventions increase MA in older adults. The considerable heterogeneity in the magnitude of effects across studies and results of the moderator analyses demonstrate the need for additional empirical research to optimize interventions.

In this research, 300 doctors in Victoria were asked to make decisions about a hypothetical patient's competence and confidentiality. It appears that assumptions embedded in relevant law, the vague nature of existing legal criteria and the diversity in assessment practices all have the potential to act as obstacles to young people's claim to rights in the medical context. (Contains 4 notes and 2 tables.)

The purpose of the patient education system described here was to distribute patient education material to and within medical practices managed by a small medical practice management company. The belief was that patient education opportunities improved health care outcomes and increased patient participation in health care decisions and compliance with health care plans. This tool reinforced medical practices' commitment to having patients participate actively in their treatment, differentiated them from other practices, and contributed to the generation of new patients.

Objective: To systematically review definitions and descriptions of computer literacy as related to preventive health education programs. Method: A systematic review of the concept of computer literacy as related to preventive health education was conducted. Empirical studies published between 1994 and 2007 on prevention education programs with a computer literacy component were found using medical/health, communication, information science and education databases. Results: A total of 464 citations were retrieved from 12 databases using specific search terms. Six articles met the inclusion criteria of: search terms in title, abstract and/or key words; peer-reviewed; original empirical research; and written in English. Conclusion: Findings show limited and inconsistent definitions of computer literacy in the literature on computer-based prevention interventions. Without a clear construct of computer literacy, it will be difficult to determine the impact of such programs on health information seeking and, ultimately, health status. (Contains 3 tables.)

Objective: To examine whether the communication process between diabetes health professionals and people intensively self-managing their type 1 diabetes influenced behavioural change. Design: Telephone interviews to provide insight into the communication process and its influence on diabetes intensive self-management behaviour. Setting: Interviewees' own homes. Method: A sub-group of 10 people from a questionnaire survey were contacted to participate in a telephone interview. The taped interviews were transcribed verbatim and analysed thematically, both manually and using computer software, to identify common themes in the texts. Results: The process of change and maintenance of diabetes self-management behaviours for the majority of participants was enabled by current available intensive treatments and information, education and support from health professionals in primary care, rather than diabetes health professionals specifically. Conclusions: Individuals intensively self-managing their diabetes have a high degree of motivation to improve glycaemic control, but also require the assistance of health professionals in primary and secondary care to enable this to take place. (Contains 1 table.)

Patient education in asthma management is important; however, there is little known about the characteristics of patients receiving asthma education or how often primary care physicians provide it. The objective of the study was to identify the characteristics of patients receiving asthma education. It was a cross-sectional study using 2001 National Ambulatory Medical Care Survey data. The study included 1230 physicians providing office-based ambulatory medical care in the United States. Patients in the study (weighted n = 11 279 952) were those diagnosed with asthma based on International Classification of Diseases, 9th Revision code receiving care from a pediatrician, internist or a family physician. Main and secondary outcome measures were asthma education ordered or provided. Multivariate analysis indicated that asthma patients receiving education were more likely to have office visits greater than 20 min [odds ratio (OR) = 3.934], be seen for an acute reason (OR = 2.268), be seen in follow-up rather than an initial visit (OR = 1.780), live in rural rather than metropolitan areas (OR = 1.507), have public rather than private insurance (OR = 1.276) and be seen in privately owned practices (OR = 1.248). Bivariate analyses indicated that patients seeing family physicians were more likely than those seeing internists or pediatricians to receive education. Patient education was not uniformly provided. Family physicians provided more asthma education than either pediatricians or internists. Future research should investigate the quality of education provided. (Contains 4 tables.)

Purpose: Remembering medical treatment information may be particularly taxing for older cancer patients, but to our knowledge this ability has never been assessed in this specific age group only. Our purpose in this study was to investigate older cancer patients' recall of information after patient education preceding chemotherapy. Design and Methods: We constructed a recall questionnaire consisting of multiple-choice questions, completion items, and open-ended questions related to information about treatment and recommendations on how to handle side effects. Immediately after a nursing consultation preceding chemotherapy treatment, 69 older patients (M = 71.8 years, SD = 4.1) completed the questionnaire. We checked recall against the actual communication in video recordings of the consultations. Results: On average, 82.2 items were discussed during the consultations. The mean percentage of information recalled correctly was 23.2% for open-ended questions, 68.0% for completion items, and 80.2% for multiple-choice questions. Implications: Older cancer patients are confronted with a lot of information. Recall of information strongly depended on question format; especially active reproduction appeared to be poor. To improve treatment outcomes, it is important that cancer patients are able to actively retrieve knowledge about how to prevent and recognize adverse side effects and that this is checked by the health professional. We make suggestions on how to make information more memorable for older cancer patients.

Objective: The aim of the study was to analyse how parents of Turkish and Turkish/Kurdish children with diabetes and health care professionals perceived the education and support provided, and to assess what was required to improve the collaboration between the families and the team in order to optimize selfcare and metabolic control. Design: A case study including semi-structured interviews, participant observation and information from medical records. Setting: The study was carried out in Copenhagen, Denmark. Method: The study included 11 children aged 4-17 years of Turkish and Kurdish origin, their parents, the Turkish interpreter and the paediatric diabetes team. Results: The study identified the following factors that might contribute to improve the outcome: 1) Adjusted educational initiatives to promote a better understanding of concepts like chronic disease and selfcare, and to ensure that the content of the education is understood, implemented and maintained; 2) special support to enable parents to deal with practical and emotional problems and conflicts related to diabetes management; 3) closer contact and psychosocial support in order to promote learning and motivation for selfcare as well as promoting attendance at the clinics. Conclusion: Non-western immigrants have a considerable need for special support to help them learn to manage a chronic disease. Health education should aim at bridging the gap between differences related to culture and traditions.

Objective: To elicit the level of knowledge, training and preferences of men in relation to Testicular Self Examination (TSE). Setting: The Genito Urinary Medicine (GUM) department of a large teaching hospital in the North East of England. The open access clinic serves patients from Newcastle upon Tyne, Northumberland, Gateshead and surrounding areas. Newcastle is a city with two universities and therefore a large student population. We sought to estimate the current knowledge and practice of Testicular Self Examination amongst men attending a large Genito Urinary Medicine Clinic and ascertain whether they performed TSE, if they could articulate the signs or symptoms of testicular cancer, whether they felt instruction on TSE was necessary and who, if anyone, should provide training. This information was obtained using a simple questionnaire distributed to all new male patients attending GUM at Newcastle General Hospital, during a 12-week period in early 2006. Results demonstrated that only 67 (8%) of the men performed TSE as recommended in health education leaflets (monthly) with 576 (67%) carrying it out on a random basis. In total, 980 (98%) of the men felt that all men should be given instruction on TSE, with 59 per cent stating that school was the most appropriate place to receive the training. Whilst almost all men were aware that testicular lumps may be a sign of testicular cancer, few were able to identify any other potential signs or symptoms. (Contains 1 figure and 3 tables.)

Background: Quality measurement and improvement in practice are requirements for Maintenance of Certification by the American Board of Medical Specialties boards and a component of many pay for performance programs. Objective: To describe the development of the American Board of Internal Medicine (ABIM) Practice Improvement Module (PIM[superscript SM]) and the average performance of ABIM diplomates who have completed the Preventive Cardiology PIM[superscript SM]. Design: Observational study of self-administered practice quality improvement. Setting: Office practices through the United States. Participants: A total of 179 cardiologists and general internists completing requirements for ABIM Maintenance of Certification from 2004 through 2005. Measurements: Physicians self-audited at least 25 charts to obtain performance measures, patient demographics, and coronary heart disease risk factors. At least 25 patients completed surveys regarding their experience of care in the physician's practice. Physicians completed a self-assessment survey detailing the presence of various practice systems. Results: The mean rate for systolic blood pressure control was 48%, for diastolic blood pressure 84%, and for low-density lipoprotein (LDL) cholesterol at goal 65%. Of patients 61% rated the quality of care as excellent and 58% rated the practices excellent at encouraging questions and answering them clearly. More than 85% of patients reported "no problem" obtaining a prescription refill, scheduling an appointment, reaching someone in the practice with a question, or obtaining lab results. Targets for improvement were increasing the rates for LDL cholesterol or systolic blood pressure at goal, improving patients' physical activity, patient education, and accuracy of risk assessment. Improvement strategies included implementing chart forms, patient education, or care management processes. Limitations: Patients and charts were selected by physicians reporting their performance for the purpose of MOC. Conclusions: The Preventive Cardiology PIM[superscript SM] successfully provides a self-assessment of practice performance and provides guidance in helping physicians initiate a cycle of quality improvement in their practices. (Contains 1 figure and 4 tables.)

Objectives: To explore factors underlying African Americans' perceptions of oral cancer and the oral cancer exam. Study findings were used to guide development of oral cancer messages designed to increase oral cancer exams among African Americans. Methods: Focus groups were conducted to understand African Americans' attitudes and expectations regarding oral cancer and oral cancer exams. Results: Respondents lacked knowledge of personal susceptibility to and the severity of a late-stage oral cancer diagnosis. Participants had limited knowledge of risk factors. Discussion: Findings point to the need for improved patient education and communication between the public and dental providers.

Purpose: Secondary prevention programmes have traditionally employed mass screening approaches to assess for asymptomatic signs of cancer. It has been suggested that early detection strategies involving public education and self-referral may prove more cost-effective with low risk populations for cancers with symptomatic presentation. This study, which was commissioned to inform the development of a cancer awareness campaign, aims to examine public perceptions of the early detection of cancer, the psycho-social barriers to self-referral amongst a key at-risk population and the implications for patient education. Design/methodology/approach: An exploratory study using qualitative focus groups with an at-risk population of older people living in deprived communities in west-central Scotland. Findings: The findings reveal broad support for initiatives designed to raise symptom awareness. However, fear of cancer can lead to apparently irrational responses to symptoms and subsequent delay, particularly amongst men who are less likely to seek support from lay networks. Originality/value: Early detection messages need to take account tone and symptom description to allay fears and ensure appropriate presentation. Consideration also needs to be given to the role played by lay and professional opinion formers to informing and supporting patients' decision to present with suspicious symptoms, particularly when targeting harder to reach patients of men, older people, and people living in deprived communities. (Contains 1 table.)

This study compares the effect of an acceptance-based protocol (ACT) and a cognitive control-based (CONT) protocol on three measures of pain coping: tolerance, self-report, and believability. Specific methodological controls were employed to further isolate the role of the value of participating in a pain task, compared to previous investigations on the alteration of the function of aversive stimulation. Twenty participants were randomly assigned to one of the conditions (ACT vs. CONT), and a pre-post design was used. In the ACT condition, the protocol established a relation of coordination between the pain-related thoughts and the actions in the valued direction. In the CONT condition, the protocol established a relation of opposition between the same aspects. Results show an increase in pain tolerance and a reduction of self-reported pain at posttest for both conditions. However, ACT participants showed significantly lower believability of pain than did CONT participants. Conceptual and clinical implications are discussed. (Contains 2 tables and 1 figure.)

The innovative practical course was developed to improve the students' ability to acquire pharmaceutical care skills. The primary components of the course were in-school training using small group discussions and hospital experience including identification, analysis, prevention and resolution of drug-therapy problems, patient counseling on their medications and diseases, and interaction with medical team. Specific objectives of the research were to (1) compare students' performance before and after the course, (2) measure students' perceptions of their pharmaceutical care skills before and after the course, (3) determine students' perception of the value of the course. Statistical comparison of pre-test and post-test grades indicated both a retention and acquiring pharmaceutical care skills. A pre-course and post-course survey instrument was designed to measure students' perception of their pharmaceutical care skills. Perception of most of the items of the survey was significantly improved at the end of the course. Overall, the majority of students were highly satisfied with the course. In conclusion, the present study demonstrates that the innovative pharmaceutical care practical course was successfully introduced.

In this article, we discuss the findings of a study about how patients who have been diagnosed with cancer learn about their disease. This is a form of learning that is not often thought of as learning, within the practices in which it takes place. It involves learners who neither possess specific forms of knowledge, nor are sure about what knowledge there is to possess. In medical practice, this form of learning is often referred to in terms such as "information seeking," and the implemented practices of providing information do not always seem to take account of current understandings of teaching and learning amongst educational and psychological researchers. Here we report the findings of a U.K. Department of Health project concerned with the acceptability and usefulness of the Internet as a cancer information source. Post-Vygotskian theory is deployed in the interpretation of the data and the development of a model of the learning. (Contains 1 table.)

We developed eight heavily illustrated booklets covering patients' rights and responsibilities, antiepileptic medicines, and most psychotropic medicines. The language level was very basic but covered a wide range of information. We distributed free copies of the booklets, together with standardized questionnaires, to consumers with and without intellectual disabilities or other developmental disabilities; 604 questionnaires were returned. The majority of consumers indicated that they read the booklets, learned more about their rights/responsibilities and the medicines described, and found the booklets helpful. Consumers with intellectual disability experienced more difficulty than "average" consumers in understanding the materials, but satisfaction and understanding were reportedly high overall. Female and minority respondents indicated somewhat higher satisfaction with the booklets than did their counterparts.

Objective: To describe a process for developing low-literacy health education materials that increase knowledge and activate patients toward healthier behaviors. Methods: We developed a theoretically informed process for developing educational materials. This process included convening a multidisciplinary creative team, soliciting stakeholder input, identifying key concepts to be communicated, mapping concepts to a behavioral theory, creating a supporting behavioral intervention, designing and refining materials, and assessing efficacy. Results: We describe the use of this process to develop a diabetes self-management guide. Conclusions: Developing low-literacy health education materials that will activate patients toward healthier behaviors requires attention to factors beyond reading level.