CD-ROM Intervention Research Articles

HIV/AIDS Stigma Attitudes Among Educators in KwaZulu-Natal, South Africa

One hundred and twenty educators from KwaZulu-Natal, South Africa, underwent HIV/AIDS training. The educators were surveyed about their attitudes toward people with HIV. The educators completed self-administered survey questionnaires both before and after 2 interventions. Measures included demographic characteristics, teachers' knowledge about HIV/AIDS, self-efficacy in handling HIV/AIDS situations, and attitudes (stigma and otherwise) toward HIV-related issues. The first intervention was a CD-ROM and the second intervention involved educators receiving a 2-day workshop on HIV transmission, risk factors, and actions that educators should know and undertake. The first step entailed testing the stigma instrument for its internal consistency and developing and testing potential subscales from the instrument. The second step entailed testing for the statistical associations between stigma (as measured by the stigma instrument and its subscales) and various demographic and HIV knowledge-related variables. The overall stigma scale had a Cronbach α coefficient of .66. Educators in the workshop generally had lower baseline levels of stigma than those in the CD-ROM intervention. Following both interventions, the stigma levels of both groups of educators were significantly reduced. Improvements in the general knowledge about HIV as a disease and in the specific knowledge about HIV transmission risks were both statistically significantly associated with reductions in stigma attitudes, having controlled for educators' baseline stigma levels and demographic profiles. The levels of teachers' stigma attitudes were statistically significantly lower after both types of HIV/AIDS training and were also statistically significantly associated with improvements in HIV knowledge.

Facilitating Informed Decisions Regarding Microsatellite Instability Testing Among High-Risk Individuals Diagnosed With Colorectal Cancer

To evaluate the impact of a CD-ROM intervention in the education of patients with suspected Lynch syndrome (LS) about microsatellite instability (MSI) and immunohisochemistry (IHC) testing. Two hundred thirteen patients meeting Bethesda criteria were randomly assigned to receive either a brief educational session with a health educator (n = 105) or a brief educational session plus a CD-ROM (n = 108). Assessments were administered at baseline and 2 weeks post-treatment. Primary outcomes included MSI and IHC knowledge and level of satisfaction with and completeness of the preparation to make the decision for MSI testing. Secondary outcomes included decisional conflict, difficulty making the decision, cancer-specific and global anxiety, and level of discussion about MSI testing with family and friends. Participants in the education plus CD-ROM condition reported significant increases in knowledge about the MSI and IHC tests, greater satisfaction with the preparation to make a decision for testing, lower decisional conflict, and greater decisional self-efficacy. The effects of the education plus CD-ROM on most outcomes were not moderated by preintervention levels of exposure to MSI testing, family support for MSI testing, or the family history of cancer. Incorporation of new media education strategies for individuals at risk for LS may be a valuable component of the informed consent process. As clinical criteria for MSI and IHC testing continue to expand, the need for alternative educational approaches to meet this increased demand could be met by the self-administered computer-based strategy that we described.

Effect of a CD‐ROM‐based educational intervention on resident knowledge and adherence to deep venous thrombosis prophylaxis guidelines

CD-ROM-based educational methods are not new to residency training, yet little is known about how they affect resident knowledge and patient care practices. We evaluated the effects of a CD-ROM-based educational tool on residents' knowledge of anticoagulation and their adherence to anticoagulation guidelines. Residents in the departments of cardiothoracic surgery, emergency medicine, otolaryngology, internal medicine, neurosurgery, dental medicine, neurology, obstetrics and gynecology, orthopedics, surgery, and urology at a university hospital participated in the study. Residents were provided with CD-ROM-based training on the proper use of anticoagulation based on the sixth ACCP guidelines for antithrombotic therapy. Multiple choice testing was carried out before and after the CD-ROM intervention to assess resident knowledge, and resident compliance with venous thromboembolism prophylaxis guidelines was assessed via inpatient chart review by an independent committee. Changes in knowledge were measured via test scores and the rate of compliance with anticoagulation guidelines. Multiple choice test scores of 117 residents increased significantly after reviewing the CD-ROM (from 46.7% +/- 15.1% to 77.8% +/- 15.1%, P < .005). As a control, we administered the same test at the same 2 times at a comparable institution but without the CD-ROM intervention and found that test scores did not significantly increase. Chart review revealed a rate of compliance with anticoagulation guidelines for prophylaxis of venous thromboembolism of 75% before the CD-ROM intervention, which increased to 95% after the intervention, an increase that was sustained for at least 7 months. These findings suggest that CD-ROM-based interventions might be useful not only in enhancing resident knowledge but also in improving the quality of care by favorably affecting clinical practice.

Studying communication in oncologist-patient encounters: The SCOPE Trial

Study objective: Most oncologists have not received adequate training in physician-patient communication, and existing effective courses tend to be time and resource intensive. We are developing and testing a tailored CD-ROM educational intervention that includes feedback on oncologists’ own audio-recorded conversations with their advanced cancer patients. In this report, we describe the study methods and identify challenges to implementation and how these were overcome. Study design: A three-phase, randomized, controlled trial. In Phase 1, we audio-recorded oncologist-patient clinic encounters. In Phase 2, oncologists were randomly assigned to a communication CD-ROM intervention or control. Phase 3 consisted of audio-recording all participating oncologists conversing with a new sample of patients, two to 12 months after the intervention, to assess its effectiveness. Setting: Oncology clinics at Duke University Medical Center (DUMC) and the Durham Veterans Affairs Medical Center (DVAMC) in Durham, NC, and the University of Pittsburgh Medical Center (UPMC) in Pittsburgh, PA. Participants: Medical, radiation and gynecological oncologists and their patients with advanced cancer. Intervention: A tailored CD-ROM that contains an interactive educational interface with reference materials and video-clips of model conversations, along with the oncologists’ own Phase 1 audio-recorded conversations. Conclusion: We present challenges and solutions to oncologist recruitment, identifying appropriate patients with advanced cancer, adapting to clinic flow, and developing a self-administered communications intervention.

Distress in Pediatric Hematology-Oncology Patients Undergoing Intravenous Procedures: Evaluation of a CD-ROM Intervention

This study assessed the influence of a developmentally specific CD-ROM intervention on cognitive appraisals, fear, behavioral distress, and pain in pediatric hematology-oncology patients scheduled for intravenous (IV) procedures. Thirty children, 7 to 18 years of age, were randomly assigned either to a standard medical care group or a standard medical care plus CD-ROM intervention group. It was hypothesized that using the CD-ROM would decrease threat appraisals of the IV procedure, causing decreased fear of the IV, less behavioral distress, and less pain during the IV. It was also hypothesized that intervention-enhanced secondary appraisal would be seen in children in the CD-ROM intervention group and that they would cope more effectively with the IV procedure. Self-report and observational ratings were used to assess the following dependent variables: primary and secondary appraisal, fear, behavioral distress, and pain. Results indicated significant effects for the reduction of threat appraisals following CD-ROM intervention (p ??.05). Children in the CD-ROM intervention group used cognitive restructuring coping more effectively than did the control group (p ??.05). No significant effects were found for fear, behavioral distress, or pain.

“Withdrawal symptoms” in adolescents: A comparison of former smokers and never‐smokers

Since the early 1980s, investigators have been reporting that adolescent smokers felt "dependent" on cigarettes and that adolescents trying to quit smoking experienced the same withdrawal symptoms observed in adult quitters, including restlessness, insomnia, increased appetite and weight gain, irritability or anger, depression, craving for cigarettes, and trouble concentrating. We hypothesized that most of these symptoms might be attributed to adolescence itself. To investigate this hypothesis, we examined the prevalence of these seven "adult" withdrawal symptoms in a population of adolescent former smokers and never-smokers. Participants were high school students in Houston, Texas, participating in a nested, group-randomized control group study designed to estimate the impact of a CD-ROM intervention for smoking prevention and cessation. We measured differences in symptoms frequency between never-smokers and former smokers, matched in a 2:1 ratio on sex and race/ethnicity, and differences in symptoms among former smokers as a function of time since final quit attempt and prior level of smoking. Only former heavy smokers have shown significantly higher prevalence of withdrawal symptoms compared with never-smokers. Of the seven symptoms assessed, only craving incrementally increased with the intensity of smoking. Overall the individual withdrawal symptoms did not effectively differentiate between 112 never-smokers and 34 former lighter smokers (persons who used to smoke less than "a few cigarettes on most days"). Withdrawal symptoms can reliably differentiate former heavy smokers from light smokers and never-smokers, among adolescents. Because most adolescents tend to be lighter smokers, future tobacco use and cessation studies should interpret adult withdrawal symptoms among adolescents with caution.

Headstrong: A Pilot Study of a CD-ROM Intervention for Recurrent Pediatric Headache

To empirically evaluate a minimal therapist contact CD-ROM pain management program for recurrent pediatric headache developed as part of this study. Participants were 37 children aged 7-12 attending a pediatric neurology clinic for evaluation of recurrent headache. Children who were randomly assigned to the treatment group worked through the CD-ROM program on home computers for 4 weeks following baseline assessment, whereas those assigned to the wait-list group continued following the prescriptions of their neurologist. Data on daily headache activity and headache-related disability were collected at baseline and up to 3 months after treatment. Children who received the adjunctive CD-ROM program had significant improvements in headache activity above and beyond those in the control group. Results provide initial support for the utility of adding an adjunctive CD-ROM psychological intervention to standard medical care for recurrent pediatric headache and potentially other chronic pain conditions in children.

Alcohol Abuse Prevention Among High-Risk Youth

This study examined the feasibility of a CD-ROM intervention to prevent alcohol abuse among high-risk youths. Youths from 41 community-based agencies in greater New York City participated in a randomized trial of a skills-based interactive CD-ROM. Outcome data were collected on 489 early adolescents in these agencies before and after a randomized subset of youths interacted with a 10-session alcohol abuse prevention program on CD-ROM. Compared to control participants, youths in the intervention arm had a positive increase in perceived harm of alcohol use and increased assertiveness skills. At posttest, drinking rates for control and intervention participants were equal and unchanged from pretest. These findings suggest that CD-ROM technology offers a new and promising medium for engaging high-risk youth in an alcohol abuse prevention program. Study implications and future applications of the present approach are discussed.

Efficacy of a Drug Prevention CD-ROM Intervention for Adolescents

The purpose of the present study was to examine the efficacy of a substance abuse–preventive intervention using CD-ROM technology among adolescents in the sixth and seventh grades (12- to 13-years-old). The CD-ROM program used interactive audio and video content to teach social resistance skills, general personal and social competence skills, and normative education. Rates of substance-use behavior, attitudes, knowledge, normative expectations, and related variables were examined. From approximately 23 schools, students (n = 123) were randomly assigned to either receive the CD-ROM preventive intervention (n = 61) or to serve as a control group (n = 62). Study participants were 50% male, predominantly white (75%), and 94% came from two-parent families. Self-report data were collected using a self-administered web-based survey. Findings indicated that there were significant intervention effects on pro-drug attitudes, normative expectations for peer and adult substance use, anxiety reduction skills, and relaxation skills knowledge, with intervention students reporting improved scores on these outcomes at the posttest relative to control students. Findings indicate that a substance abuse–preventive intervention derived from an effective, school-based prevention approach is efficacious when delivered using CD-ROM technology. Research is needed to determine potential differences in the efficacy of CD-ROM prevention tools delivered in schools compared to home settings.

Does therapist guidance improve uptake, adherence and outcome from a CD-ROM based cognitive-behavioral intervention for the treatment of bulimia nervosa?

Abstract Background We recently demonstrated the efficacy and feasibility of a novel CD-ROM based cognitive-behavioral multi-media self-help intervention for the treatment of bulimia nervosa. What is not known in CD-ROM treatments is how to best to deliver and support such packages in clinical practice. In particular, it is of great importance to identify to what extent such packages can be offered stand alone, and to what extent additional support from a practitioner is required. Objective The aim of the present study was to examine whether the addition of therapist support to the CD-ROM intervention would improve treatment uptake, adherence and outcome. Method Two cohorts of patients with full or partial bulimia nervosa referred to a catchment area based eating disorder service were offered an eight session CD-ROM-based cognitive-behavioral self-help treatment (“Overcoming Bulimia”). The first cohort received minimal guidance only and the second cohort were offered three brief focused support sessions with a therapist. The two cohorts were compared on treatment uptake, adherence and outcome. Results Patients in both groups improved significantly. There were no significant differences between the two groups in terms of treatment uptake, adherence or outcome, except that the therapist guidance group more often achieved remission from excessive exercise at follow-up. Discussion These findings provide further support for the acceptability and efficacy of the CD-ROM intervention for bulimia nervosa. Brief focused therapist guidance did not confer any significant additional benefits. This result has important implications for the widespread adoption of such approaches.

A Randomized, Prospective, Multisite Comparison of Pediatric Prehospital Training Methods

Results of prehospital pediatric continuing education using train-the-trainer and CD-ROM training methods were compared to each other and to a control group. The null hypothesis was that no differences would be found in pretraining and posttraining measurements of knowledge and performance by either training method. This was a prospective trial involving 12 sites. Random selections were made from ambulance service lists provided by 3-state emergency medical services (EMS) agencies. Preintervention and postintervention (12-month) measurements included a written examination and 2 performance scenarios videotaped for independent panel evaluation. Training was either an interactive CD-ROM or standard classroom instruction using a train-the-trainer model. Mean differences in written, performance, and combined scores were analyzed. Differences were noted in the combined and performance scores for the CD-ROM intervention group. No differences were noted in written measurements between or among the groups. In this small sample, interactive CD-ROM training shows promise for improving performance. The research design, with additional guards against sample size attrition, may provide a model for multisite EMS education research.

A Cervical Cancer CD-ROM Intervention for College-Age Women: Lessons Learned from Development and Formative Evaluation

Despite the decline of incidence rates of cervical cancer over the past 50 years, data suggest an increase of precervical cancer among college women. This increase may be the result of the high prevalence of the Human Papillomavirus (HPV) among this population. To increase cervical cancer prevention behaviors, we developed a computer-based intervention targeting women ages 18 to 24. Through the use of story scripts, role models, and demonstrations (both animated and videotaped procedures), women learn the importance of regular Pap smear screenings, personal risks for developing cervical cancer, the meaning of and dealing with abnormal Pap smears, communication with health care providers, and sexual practices that impact the transmission of HPV. Results from the formative evaluation support the viability of CD-ROM interventions in health education and emphasize the importance of addressing women’s cognitive and affective perceptions surrounding cancer, sexual health, and gynecological exams. Lessons learned from the development process are presented.

An educational intervention for advance directives.

In spite of the passage of the Patient Self-Determination Act in 1991, research indicates that providing information alone has not brought about a significant increase in the completion rates of advance directive (AD) documents. The purpose of this pilot study was to design, implement, and evaluate an interactive multimedia CD-ROM educational program on AD. Study subjects consisted of 31 volunteer elderly men and women in a senior citizens center. An interactive multimedia CD-ROM program was developed in phase I of the study. Subjects were administered on-line pretests and posttests. The effectiveness of the CD-ROM intervention was measured by AD attitude and knowledge changes. A program satisfaction scale was used, and an observer rated the subjects' use of the computer program. Subjects had a statistically significant change in posttest knowledge scores and a high degree of satisfaction and ease in using the computer program. The use of an interactive multimedia CD-ROM program with a touch-sensitive monitor to operate a computer-based AD program for senior citizens shows future promise.