Enduring Power of Print: How Health Information Pamphlets Promote Equity and Trust in Patient Education.

The economic woes of the United States (U.S.) healthcare system have given rise to an unprecedented federal effort to modernize the information systems and promote the adoption of health information technology (HIT). The recent economic stimulus package—the American Recovery and Reinvestment Act of 2009 (ARRA)—has a HIT component (HITECH Act) that will allocate $17 billion in financial incentives intended to persuade doctors and hospitals to adopt meaningful use of an electronic health record (EHR) and $2 billion for support systems and requisite infrastructure [1, 2]. The purpose of the HITECH Act is to encourage health care providers to leverage HIT tools to achieve quality and efficiency goals. Although this primary value proposition for HIT adoption by health care professionals remains a matter of debate, the potential for secondary benefits such as the reuse of clinical data for research and quality improvement is inevitable [8]. The U.S. is not alone in their efforts to adopt HIT. The United Kingdom’s NHS Connecting for Health (http://www.informatics.nhs.uh), Australia’s HealthConnect (www.healthconnect.gov.au) and Canada’s Health Infoway (www.infoway-inforoute.ca) represent three such efforts at different stages of implementation. EHRs, however, are just one of the many tools of health informatics. The tools of informatics encompass clinical guidelines and decision support, formal health languages, information systems (EHRs, PACS, integrated databases and registries) and communication systems (Internet, telemedicine). It is important to remember that these tools are only a means to an end—the delivery of the best possible healthcare. Informatics is the intersection of people, information and technology. Within the field of informatics are several major subcategories, each with their own domain (Fig. 1). Health informatics has been defined broadly as the logic of healthcare [3]. It is a field concerned with the optimal use of information, often aided by technology, to improve individual health, health care, public health, and biomedical research [6]. Fig. 1 Major subcategories of informatics. (Reprinted with courtesy from Hersh W. A stimulus to define informatics and health information technology. BMC Med Inform Decis Mak. 2009;9:24.) Substantial differences have been identified between various clinical fields to justify the creation of areas of “subspecialty” informatics. Certainly there is enough uniqueness in our information needs, those of our patients and the technologies we routinely use to make clinical decisions to warrant the existence of orthopaedic informatics. Orthopaedic informatics is therefore the logic of orthopaedics—the rational study of the way we think about patients: the way we define, select and evolve treatments; how we create, share and apply clinical knowledge; the information needs of our consumers. It is aided by informatics tools to obtain the information we need in the appropriate detail, of the appropriate quality, when we need it, where we need it, to improve the efficiency and effectiveness of patient care, research and education. Informatics skills underpin communicating effectively, structuring information, questioning to find information, searching for knowledge and making decisions. Informatics has been recognized as a core competency for patient-centered care and the requirements of a changing health system [5]. It is important to note that informatics competency is not just computer literacy. Fig. 2 Christian Veillette, MD is shown. The 2009 ABJS Carl T. Brighton Workshop on Health Informatics in Orthopaedic Surgery brought together various stakeholders in health informatics from across the World to present, debate and develop recommendations for advancing the field of orthopaedic informatics. Representatives from health care institutions, surgeons, HIT vendors, researchers, informaticians, regulators and policymakers, and payers participated in the active discussions on the eight major themes covered including (1) patient education and the Internet; (2) Internet-based education and simulation; (3) telemedicine, disparities in utilization, access to information communication technology (ICT); (4) Web 2.0 and publishing; (5) ontologies and search; (6) informatics in orthopaedic training; (7) information systems, databases, registries – aligning data models in orthopaedics; and (8) EHRs in orthopaedics. We asked each of the Workshop participants to provide constructive feedback with the objective to create summary recommendations and answer the three questions originally asked by Dr. Carl Brighton who established these Workshops in 1996: (1) Where are we now? (2) Where do we need to go? and (3) How do we get there?

Impact of Health Literacy on Eye Health Disparities

The aim of this study was to explore patients' narratives of patient education in physiotherapy after a total hip arthroplasty (THA). The data was collected via open thematic interviews from ten patients who had had a primary THA. The interviews were analysed using a qualitative, narrative method. Three story models of patient education in physiotherapy were identified: Supportive patient education in physiotherapy, Co-operative patient education in physiotherapy and Contradictory patient education in physiotherapy. The emphasis of narration in the first story model was on the trust in the guidance, functioning interaction in the second and insufficient patient education in physiotherapy in the third story model. According to the results of this study, patients with THA experience functioning interaction and trust in the patient education in physiotherapy as enhancing the rehabilitation process. Conversely insufficient patient education about exercising and follow-up physiotherapy made the patients feel insecure and according to them might have slowed down the rehabilitation process. These findings can be utilized in planning and improving patient education in physiotherapy after THA.

1. Miriam E. Bar-on, MD* 1. 2. *Professor of Pediatrics, Ronald McDonald Children’s Hospital, Loyola University Stritch School of Medicine, Maywood, IL Dr Bar-on also is Chair, Committee on Public Education, American Academy of Pediatrics. Objectives After completing this article, readers should be able to: 1. Describe the primary goals of patient handouts. 2. Describe the primary goals of group education for patients who have specific disease processes. 3. Delineate the advantages of pediatrician involvement in the community. 4. Describe quality issues related to patient education on the Internet. 5. List the advantages of developing media contacts and providing information to them. Public or patient education is one means of attaining the optimal physical, mental, and social health and well-being for infants, children, adolescents, and young adults, as stated in the American Academy of Pediatrics’ (AAP) mission statement. By definition, patient education is the process of influencing patient behavior and producing changes in knowledge, attitudes, and skills required to maintain or improve health. This usually is addressed on an individual basis and includes teaching and counseling to enable patients to stay healthy and manage illness better when it occurs. Public education, on the other hand, is a broader term that includes the pediatrician’s role in influencing the health status of the public through involvement with community groups and the media. Both types of education are important and merit pediatrician involvement. Questions arise as to the best and most effective ways to provide this education within the constraints of busy practices or other commitments. Public education can be incorporated into pediatricians’ daily activities in a variety of ways both inside and outside the office. Studies in the medical literature have reviewed the outcomes of public/patient education programs and their effectiveness in practice. This article examines various methods of public/patient education that may enhance pediatricians’ promotion of health and well-being for their patients. Although many of the methods discussed will be familiar, there is evidence in the literature that public/patient education is not adequately provided to patients. The office is the primary …

Colledge et al. suggested a direct-to-patient health information intervention enhances both patient communication and education, and they recommended that physicians consider the Internet a patient educational tool [1]. However, despite the easy availability of accurate medical information on the Internet, the majority of clinical practices have not successfully incorporated Internet education into clinic workflow. McMullen suggested physicians might save time, contribute to patient education, and influence patient information seeking by recommending health information websites tailored to a patient's specific condition [2]. D'Alessandro et al. [3] and Siegel et al. [4] used the term “information prescription” to describe a physician-directed Internet health education intervention. In these studies, physicians provided condition-specific, paper-based information prescriptions for patient education and communication. These prescriptions have been tied, in some cases, to Medline Plus [5], a comprehensive, commercial-free, Internet-based consumer health information resource provided by the US National Library of Medicine [4]. Siegel et al. reported modest improvements in patient health information seeking, increased awareness of MedlinePlus, and increased patient interest when receiving an information prescription from a physician [4]. D'Alessandro et al. also found improvements in Internet health information seeking, although only 32% of patients who were given paper information prescriptions had used them during the follow-up period [3]. Ritterband et al. found that an email reminder increased patient compliance with paper information prescriptions by 45% [6]. While the literature suggests that information prescriptions can modestly enhance patient education, studies to date have relied on paper-based prescriptions or verbal recommendations, which might have resulted in limited compliance. To test this hypothesis, the authors created email information prescriptions for selected medical conditions that were specifically tailored with physician-selected links to MedlinePlus. The authors hypothesized that: (1) a physician-directed, condition-specific, email information prescription (using links to the MedlinePlus website) would be favorably evaluated by patients; and (2) intervention patients would be more likely to use MedlinePlus when compared to a control group. The authors also anticipated that a physician-directed, condition-specific information prescription would be favorably received by internists in an ambulatory and a HIV clinic setting.

The implementation of Home Blood Pressure Monitoring (HBPM) has improved the diagnosis and treatment of hypertension. Current clinical guidelines advocate the use of validated HBPM devices. However, few studies have examined the current use of validated HBPM devices. We aimed to investigate the current status of the use of validated HBPM devices in real-world hypertensive patients. This study was conducted on Korean patients with hypertension using CareforMe®, a smartphone healthcare application which allows the patients to record their HBPM data which can be shared with their physicians. The validation status of HBPM devices was identified based on four registries: STRIDE BP, Medaval, the Japanese Society of Hypertension, and dabl® Educational Trust. From January 2022 through August 2024, 2731 patients entered the model numbers of their HBPM devices. 56.4% (n = 1539) of the population were male, and the mean age was 53.5 ± 10.8 years old. 110 models from 33 different manufacturers were identified. 97.0% (n = 2649) of the patients used upper-arm devices and 3.0% (n = 82) used wrist devices. Based on the four registries, 32.7% (n = 36) out of 110 devices were validated, and 51.5% (n = 1407) out of 2731 patients used validated devices. Patients using validated devices tend to use more expensive devices than those using non-validated devices (P < 0.0001). Among Korean patients with hypertension undergoing HBPM, 97.0% of the patients used upper-arm devices and 51.5% of the patients used validated devices. Our results proposed the urgent need for patient education and public accessibility to validated devices for the better management of patients with hypertension.The validation status of HBPM devices was identified based on four registries: STRIDE BP, Medaval, the JSH, and dabl® Educational Trust. 51.5% (n = 1,407) out of 2,731 patients used validated devices and 32.7% (n = 36) out of 110 devices were validated. Patient education and public accessibility on validated devices are urgently needed. HBPM home blood pressure monitoring; JSH Japanese Society of Hypertension

With shorter lengths of hospital stay, an increase in the number of persons with chronic disabilities, coupled with the increase in health information on the Internet, there is a need for creating and/or redesigning patient education systems. Through a case review of a quality improvement study, the goal of this paper is to describe the development of the New Patient Education System (NPES) and demonstrate the collaborative system-wide efforts to improve patient education delivery. Objectives are to review the Plan-Do-Study-Act (PDSA) cycles for developing: a) criteria and process for selecting resources; b) the resource collection and website; c) a professional and patient education database for medication and condition information; and d) the method for organizing and customizing patient and family education. Findings show that designing a new patient education system requires an improvement model that promotes change based on incremental and associated steps, creates collaborative structures, such as committees, whose membership changes depending on the goals, seizes the opportunity to respond, uses environmental turbulence as an opportunity to change, and believes that knowledge is a powerful tool. LIST OF COMMON ABBREVIATIONS RF Rehabilitation Facility HRC Health Resource Center PDSA Plan-Study-Do-Act EPM Education Program Manager NPES New Patient Education System CEPM -Clinical Education Program Manager PEAC Patient Education Advisory Committee

In this article, guest writer Ivana Truccolo presents an overview of her work at the Scientific and Patient Library of a Cancer Comprehensive Centre in Italy coordinating the patient education process. She discusses the historical evolution of the concept of patient education and how this has run alongside the role of the health librarian in the provision of consumer health information. Details are provided about various patient education programmes in place at the Centre. In particular, various activities are discussed including patient education classes, the development of patient education handouts and a narrative medicine programme which includes a literary competition. The article concludes with a specific outline of the role the health librarian can play in the provision of consumer health information and patient education. H.S.

Reviewed by: Understanding and Reducing College Student Departure Jillian Kinzie Understanding and Reducing College Student Departure John M. Braxton, Amy S. Hirschy, and Shederick A. McClendon San Francisco: Jossey-Bass, ASHE Higher Education Report, Volume 30, Number 3, 2003, 140 pages, $26 (softcover) Nationally, about 63% of high school graduates enroll in postsecondary education the fall after completing high school (National Center for Education Statistics, 2002). The enrollment of traditional college-age students continues at record high levels. However, far too many students who enter the higher education system fail to earn degrees. More than a quarter of students who enter four-year institutions and half of those who enter two-year schools depart at the end of their first years (Adelman, 2004). Moreover, there is a wide gap in graduation rates between low and high income students and among different racial-ethnic groups (The Education Trust, 2004). These statistics have elevated concerns about college completion rates. Although student retention has received considerable attention in higher education literature and research, the completion rate problem remains a central challenge carrying serious implications for the development of human potential, educational equity, and institutional accountability. In Understanding and Reducing College [End Page 213] Student Departure, Braxton, Hirschy and McClendon seek to further understand the completion rate problem by reviewing findings of empirical research on college student departure. They focus attention on the most widely cited student departure theory: Tinto's interactionalist theory. Through a review of empirical evidence, the authors critique Tinto's theory, formulate new models to account for student departure, and make recommendations for further scholarship on the topic. The authors also move beyond theory and into an examination of practice by reviewing exemplary institutional student retention programs. This dual focus on theory and practice is intended to further the use of research-based approaches to understanding and reducing college student departure. Chapter one introduces Tinto's theory, and then dedicates considerable attention to reviewing empirical appraisals of the validity of the theory. The robustness of the theory is first examined by institutional type, including residential commuter and liberal arts institutions, and two-year colleges. After discussing the mixed patterns of support for the theory across institutional types, the authors conclude that a serious revision to Tinto's theory is needed. In chapters two and three, the authors discuss new theoretical frameworks for residential and commuter institutions. Although the revised theory for residential colleges and universities maintains the original thrust of Tinto's concepts, the authors enhance the theory by identifying major factors that influence departure and specify six forces that foster or impede social integration in residential institutions. Because Tinto's theory lacks explanatory power in commuter institutions, the authors propose a new conceptual model of student departure for commuter colleges and universities. Sixteen propositions are advanced to form the foundation of this new theory. These chapters specify the unique contextual conditions at these institutional types, such as student entry characteristics, the external environment, the campus environment, and academic communities, and how these elements directly influence subsequent commitment to the institution or the departure decisions of students. In addition, both chapters discuss implications for racial and ethnic minority students at these institutional types. The formulation of new theories of student departure has immediate implications for practice. In chapters four and five, the authors discuss these implications and put forth recommendations for implementation. Brief descriptions of exemplary student retention programs are provided to demonstrate the promise of using research-based approaches to reduce institutional rates of departure. The final chapter returns to a discussion of research and offers specific recommendations for further scholarship on the topic. This publication offers a novel and practical approach to understanding the complex and ill-structured problem of college student departure. By providing concise reviews of the research findings that give rise to their theoretical propositions and new models, the authors present a well-organized case. Greater specification of student departure theory for residential colleges is helpful, but the generation of a new model for commuter institutions is particularly valuable given the paucity of empirical evidence for Tinto's theory at this institutional type. These new models demonstrate greater sensitivity to the unique characteristics of students...

A central plank of health care reform is an expanded role for educated consumers interacting with responsive health care teams. However, for individuals to realize the benefits of health education also requires a high level of engagement. Population studies have documented a gap between expectations and the actual performance of behaviours related to participation in health care and prevention. Interventions to improve self-care have shown improvements in self-efficacy, patient satisfaction, coping skills, and perceptions of social support. Significant clinical benefits have been seen from trials of self-management or lifestyle interventions across conditions such as diabetes, coronary heart disease, heart failure and rheumatoid arthritis. However, the focus of many studies has been on short-term outcomes rather that long term effects. There is also some evidence that participation in patient education programs is not spread evenly across socio economic groups. This review considers three other issues that may be important in increasing the public health impact of patient education. The first is health literacy, which is the capacity to seek, understand and act on health information. Although health literacy involves an individual’s competencies, the health system has a primary responsibility in setting the parameters of the health interaction and the style, content and mode of information. Secondly, much patient education work has focused on factors such as attitudes and beliefs. That small changes in physical environments can have large effects on behavior and can be utilized in self-management and chronic disease research. Choice architecture involves reconfiguring the context or physical environment in a way that makes it more likely that people will choose certain behaviours. Thirdly, better means of evaluating the impact of programs on public health is needed. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework has been promoted as one such potential approach.

BackgroundConsumer health informatics (CHI) originated in the 1990s. With the rapid development of computer and information technology for health decision making, an increasing number of consumers have obtained health-related information through the internet, and CHI has also attracted the attention of an increasing number of scholars.ObjectiveThe aim of this study was to analyze the research themes and evolution characteristics of different study periods and to discuss the dynamic evolution path and research theme rules in a time-series framework from the perspective of a strategy map and a data flow in CHI.MethodsThe Web of Science core collection database of the Institute for Scientific Information was used as the data source to retrieve relevant articles in the field of CHI. SciMAT was used to preprocess the literature data and construct the overlapping map, evolution map, strategic diagram, and cluster network characterized by keywords. Besides, a bibliometric analysis of the general characteristics, the evolutionary characteristics of the theme, and the evolutionary path of the theme was conducted.ResultsA total of 986 articles were obtained after the retrieval, and 931 articles met the document-type requirement. In the past 21 years, the number of articles increased every year, with a remarkable growth after 2015. The research content in 4 different study periods formed the following 38 themes: patient education, medicine, needs, and bibliographic database in the 1999-2003 study period; world wide web, patient education, eHealth, patients, medication, terminology, behavior, technology, and disease in the 2004-2008 study period; websites, information seeking, physicians, attitudes, technology, risk, food labeling, patient, strategies, patient education, and eHealth in the 2009-2014 study period; and electronic medical records, health information seeking, attitudes, health communication, breast cancer, health literacy, technology, natural language processing, user-centered design, pharmacy, academic libraries, costs, internet utilization, and online health information in the 2015-2019 study period. Besides, these themes formed 10 evolution paths in 3 research directions: patient education and intervention, consumer demand attitude and behavior, and internet information technology application.ConclusionsAveraging 93 publications every year since 2015, CHI research is in a rapid growth period. The research themes mainly focus on patient education, health information needs, health information search behavior, health behavior intervention, health literacy, health information technology, eHealth, and other aspects. Patient education and intervention research, consumer demand, attitude, and behavior research comprise the main theme evolution path, whose evolution process has been relatively stable. This evolution path will continue to become the research hotspot in this field. Research on the internet and information technology application is a secondary theme evolution path with development potential.

ObjectivesUtilizing social network analysis, this study aimed to analyze the main keywords in the literature regarding the health literacy of and the use of online health information by aged persons over 65.MethodsMedical Subject Heading keywords were extracted from articles on the PubMed database of the National Library of Medicine. For health literacy, 110 articles out of 361 were initially extracted. Seventy-one keywords out of 1,021 were finally selected after removing repeated keywords and applying pruning. Regarding the use of online health information, 19 articles out of 26 were selected. One hundred forty-four keywords were initially extracted. After removing the repeated keywords, 74 keywords were finally selected.ResultsHealth literacy was found to be strongly connected with 'Health knowledge, attitudes, practices' and 'Patient education as topic.' 'Computer literacy' had strong connections with 'Internet' and 'Attitude towards computers.' 'Computer literacy' was connected to 'Health literacy,' and was studied according to the parameters 'Attitude towards health' and 'Patient education as topic.' The use of online health information was strongly connected with 'Health knowledge, attitudes, practices,' 'Consumer health information,' 'Patient education as topic,' etc. In the network, 'Computer literacy' was connected with 'Health education,' 'Patient satisfaction,' 'Self-efficacy,' 'Attitude to computer,' etc.ConclusionsResearch on older citizens' health literacy and their use of online health information was conducted together with study of computer literacy, patient education, attitude towards health, health education, patient satisfaction, etc. In particular, self-efficacy was noted as an important keyword. Further research should be conducted to identify the effective outcomes of self-efficacy in the area of interest.

Use and effectiveness of video-based resources by pharmacists for patient education and counselling: A systematic review.

Assessing the Quality of YouTube Content on Laryngoplasty: A Resource for Patient Education.

Several recent works have highlighted hospital discharge as a good opportunity to deliver patient education (PE). Despite its constraints (overcrowding and unpredictable workload, in particular), the emergency department (ED) should be viewed as an opportune place for improving patient satisfaction and adherence to recommendations, and thus for preventing complications and early readmission, suggesting that better PE and health information could be one way to enhance patient safety. Building evidence on how best to organise and deliver effective PE poses many challenges, however. This paper gives an overview of the main issues (what we already know and prospects for research/clinical approaches) concerning PE in the ED: improving provider skills, ensuring PE continuity, developing educational materials, interprofessional collaboration, identifying specific educational needs for certain subgroups of patients, evaluating PE delivery, and identifying the most effective interventions. Future research will be needed to develop evidence-based guidelines for a comprehensive approach to PE.