Increase Patient Knowledge Research Articles

How can the detection of AF be improved? Insights from patient journeys and primary care clinicians

Abstract Background Atrial fibrillation (AF) is underdiagnosed and it is estimated that a third of people with AF remain undiagnosed. AF is complex to detect because it can be intermittent and some patients are asymptomatic. When symptoms are present they can be non-specific. In the absence of a screening programme to detect AF it is important to identify ways to improve its detection of AF in order to reduce the risk of AF-related stroke. Purpose We conducted a qualitative study in primary care to explore the patient path to diagnosis of AF and identify ways to improve detection Methods We recruited patients with a recent diagnosis of AF (< 6 months) and interviewed them to understand their path to diagnosis. We interviewed GPs and practice nurses to explore their experience of detecting AF in primary care. The interviews were audio-recorded and transcribed, and the data were analysed using framework analysis. Results Thirty patients and ten primary care clinicians were interviewed. The presence and nature of symptoms experienced by patients and how they interpreted these were significant in the pathways to diagnosis. Patients with acute symptoms presented to A &E and had a quick diagnosis while asymptomatic patients were diagnosed incidentally. Patients with non-specific symptoms generally did not perceive the symptoms as serious, and many delayed seeing a healthcare professional. Their experiences in primary care aligned with findings from interviews with primary care clinicians, who acknowledged AF may not necessarily be the initial suspicion when a patient presents with certain non-specific symptoms. Primary care clinicians described narratives of good practice in the form of opportunistic pulse palpation, as well as challenges of detecting AF in primary care. These included lack of access to 24-hour ambulatory ECG in primary care and limited opportunities to detect AF due to healthcare assistants taking on more responsibilities. Conclusions A number of opportunities to improve the detection of AF can be drawn from these findings. Public education about AF, its signs and symptoms would increase patient knowledge and presentation to healthcare professionals. Standardizing good practice of opportunistic pulse palpation in primary care and training healthcare assistants to perform this is also indicated. Access to 24-hour ambulatory ECG in primary care will reduce delays in diagnosis. Further research on which patients are likely to have undiagnosed AF will facilitate detection in primary care.

Systematic review of barriers, facilitators, and tools to promote shared decision making in the emergency department.

The objective was to systematically review all studies focusing on barriers, facilitators, and tools currently available for shared decision making (SDM) in emergency departments (EDs). Implementing SDM in EDs seems particularly challenging, considering the fast-paced environment and sometimes life-threatening situations. Over 10 years ago, a previous review revealed only a few patient decision aids (PtDAs) available for EDs. Literature searches were conducted in MEDLINE, Embase, and Cochrane library, up to November 2023. Observational and interventional studies were included to address barriers or facilitators for SDM or to investigate effects of PtDAs on the level of SDM for patients visiting an ED. We screened 1946 studies for eligibility, of which 33 were included. PtDAs studied in EDs address chest pain, syncope, analgesics usage, lumbar puncture, ureterolithiasis, vascular access, concussion/brain bleeding, head-CT choice, coaching for elderly people, and activation of patients with appendicitis. Only the primary outcome was meta-analyzed, showing that PtDAs significantly increased the level of SDM (18.8 on the 100-point OPTION scale; 95% CI 12.5-25.0). PtDAs also tended to increase patient knowledge, decrease decisional conflict and decrease health care services usage, with no obvious effect on overall patient satisfaction. Barriers and facilitators were identified on three levels: (1) patient level-emotions, health literacy, and their own proactivity; (2) clinician level-fear of medicolegal consequences, lack of SDM skills or knowledge, and their ideas about treatment superiority; and (3) system level-time constraints, institutional guidelines, and availability of PtDAs. Circumstances in EDs are generally less favorable for SDM. However, PtDAs for conditions seen in EDs are helpful in overcoming barriers to SDM and are welcomed by patients. Even in EDs, SDM is feasible and supported by an increasing number of tools for patients and physicians.

A community health worker–led intervention to improve patient knowledge and receipt of precision medicine: Updated ALCANCE randomized clinical trial findings.

181 Background: Inequitable access to precision medicine limits its impact. To address disparities, we co-developed the Addressing Latinx Cancer Care Equity Study (NCT04843332), a multi-level intervention with community stakeholders. ALCANCE was designed for low-income and Latinx adults with cancer in rural Monterey County, California. We provided annual training for clinicians about testing guidelines and precision medicine disparities. Trained CHWs educated patients about precision medicine and encouraged them to raise the topic with their oncologist. We tested whether the intervention improved patient knowledge and receipt of precision medicine. Methods: Patients with newly diagnosed or recurrent cancer, age ≥ 18 years, able to consent in English or Spanish, and who self-identified as a racial and ethnic minority OR low-income status OR were insured by public or agricultural company insurance OR uninsured and receiving cancer care at Pacific Cancer Care, a rural community oncology practice in Monterey County, were randomized 1:1 to usual care (control group) or usual care augmented with the multi-level intervention for 12 months (intervention group). The primary outcome was whether the multilevel intervention could increase patient knowledge of precision medicine using a validated 6 question survey from time of enrollment (baseline) to 6-months post-enrollment between groups. A secondary outcome was receipt of precision medicine. CHWs and clinicians completed semi-structured interviews. Results: 110 participants were randomized; 70% (n = 67) reported Spanish as their primary language; 81% (n = 89) identified as Hispanic. Median age was 55 years (55.4 ± 14.3, mean± SD); majority had annual household incomes (USD) ≤ $34,999 (59.0%, n = 46); majority obtained a high school diploma/GED or less (67.3%, n = 74). Most had gastrointestinal (35.5%, n = 39) and breast (24.5%, n = 27) cancers and were diagnosed with stage 3 or 4 (64.5%, n = 71) disease. Precision medicine knowledge was low at baseline across both the control and intervention groups (23.5 ± 19.3 versus 23.0 ± 17.7, respectively). Intervention group participants had greater precision medicine knowledge at 6-months (39.2 ± 23.0) than control group participants (24.2 ± 20.0) with greater increase in knowledge overtime than control group participants (p < 0.001). More intervention group participants (n=46, 79.3%) received precision medicine testing than control (n=34, 60.7%). Across both groups, 26 of those tested had an actionable mutation. Of those 26, 66.7% (n=6 of 9) in the control group and 94.1% (n=16 of 17) in the intervention group received targeted therapy (p=0.065). Interviews with the care team indicated the model was acceptable and has been sustained as part of usual care. Conclusions: CHW-facilitated interventions may reduce disparities in precision medicine cancer care. Clinical trial information: NCT04843332

A Parallel-Group, Randomized Trial Examining Impact of Colposcopy Results Delivery by a Nurse Liaison on Patient-Reported Outcomes and Adherence

ObjectivesCervical cancer is on the rise in Canada. Addressing patient anxiety and improving patient understanding of colposcopy and results may improve adherence. This randomized controlled trial examined the impact of colposcopy results delivery by a Nurse Liaison versus the referring primary care provider (PCP) on patient anxiety, and secondary outcomes including patient satisfaction, knowledge of diagnosis, and 9-month adherence to follow-up. MethodsPatients ≥18 years old presenting for initial appointment at the study colposcopy clinic were randomized 1:1 to an intervention group (Nurse Liaison) versus a control group (PCP). After receiving colposcopy results, participants completed online measures of anxiety (State-Trait Anxiety Inventory), health care satisfaction scales (Patient Satisfaction Questionnaire-18, Health Anxiety Inventory, Visit-Specific Satisfaction Questionnaire-9), self-reported colposcopy diagnosis, and demographics. Chart review at 9 months assessed adherence to recommended colposcopy follow-up. Groups were compared on continuous and categorical variables, controlling for diagnosis severity and trait anxiety. ResultsThe intervention group had significantly lower state anxiety with State-Trait Anxiety Inventory-state mean scores of 37.3 versus 40.7 in controls (P = 0.03). Intervention group participants were more likely to correctly report their diagnosis (84% vs. 66.3%, P = 0.003). Questionnaire responders were more likely to be in the intervention group and had a higher proportion of cervical intraepithelial neoplasia 2+ pathology. There were no differences in demographics, patient satisfaction, or adherence to follow-up between groups. ConclusionsDirect delivery of colposcopy results by a trained Nurse Liaison was associated with decreased patient anxiety around colposcopy results, and increased patient knowledge regarding diagnosis. This model may be considered to improve patient-centred care.

Education with interactif website media on patient compliance levels for implementation of post-odontectomy instructions

Introduction: Patient compliance with post odontectomy instructions is one of the factors that determine postoperative success. Lack of patient knowledge can interfere with the healing process and cause complications. Instructions given verbally often make patients less aware of post-operative care. Interactive website media through gadgets can be used as a tool to increase patient knowledge as an effort to prevent complications. The purpose of the study was to determine the effect of providing education with interactive website media on the level of patient compliance with post-odontectomy instructions. Methods: The type of research used is pre-experiment research with Post Test Only With Control Group Design. Sampling using Accidental Sampling technique obtained as many as 30 people. The variables in the study were interactive website media and compliance. Hypothesis testing using mann whitney U. Results: The results showed a difference in the level of compliance after being given education through interactive website media between the intervention group (80%) and the control group (53.35%). Mann Whitney U analysis showed that there was an effect on the provision of education with interactive website media on the level of patient compliance with the implementation of post odontectomy instructions p value = 0.049 (p < 0.05). Conclusion Interactive website media can improve patient compliance with instructions given at post odontectomy. Odontectomy patients become more aware of the importance of carrying out postoperative instructions to prevent complications

Abstract B110: A community-based educational intervention to improve colorectal cancer screening

Abstract Background: Colorectal cancer (CRC) is the 3rd leading cause of cancer death in the US. Early detection through screening increases survival and decreases mortality. Approximately 59% of eligible adults in the US are up to date on CRC screening with lower rates in minoritized communities. We report on a tailored a CRC screening educational intervention focused on improving CRC screening rates in the Black, Latinx, and Chinese immigrant communities that we serve. Methods: An educational intervention utilizing NCI’s Screen to Save CRC colorectal cancer educational materials was tailored through key contact interviews and focus groups with Black, Latinx, and Chinese immigrant communities and made available in Spanish/English/Mandarin. Invitations to participate were primarily disseminated through weekly email blasts to adults (persons age18+). A pre- and post-intervention survey was used to assess patient knowledge and intentions to screen. Persons completing the post-survey received a FIT test for CRC screening with a FIT. We used McNemar test to compare the results pre- and post-survey. Results: Of the 300 participants who completed the post-survey, 117 (39%) were male, and 183 were female (61%). 231 identified as white non-Latinx (77%), 48 (16%) Black, 3 (9%) Asians. 241 (80.3%) completed college. 186 (62%) had received CRC screening—176 (95%) by colonoscopy, 31 (17%) by fecal immunochemical test FIT prior to enrollment. 240 (80%) were eligible for FIT by age. 137 (83%) were interested in receiving FIT. Primary reasons for not pursuing FIT test included choosing to pursue a colonoscopy or having had a recent normal colonoscopy. 88 expressed interest pursuing FIT; 66 (75%) participants signed FIT consent form, and 41 (62%) completed FIT. Knowledge regarding CRC screening improved for the following questions: CRC starts in liver (p=0.0082), small intestine (p<0.0001) and colon and/or rectum (p=0.0027), “FIT checks the stool for fat (p<0.0001), tumors (p<0.0001) and polyps (p=0.0067),” “Risk factors for CRC are poor diet (p=0.0019), smoking/tobacco use (p=0.0148), lack of physical activity(p=0.0012),” “Lynch syndrome is a disorder that runs in families and increases my chances of developing CRC (p<0.0001)” and “Increasing my physical activity will not lower my chances of developing CRC (p=0.0019).” 153 (60.24%) said the education session was great and 91 (36.25%) said it was good. When asked if they would recommend this education session to family and friends, more than 80% of participants agreed. Conclusions: CRC education video helped increase patient knowledge regarding CRC, specifically about risk factors and improved knowledge regarding FIT as a CRC screening modality. Citation Format: Iqra Siddiqui, FNU Nikita, Ana Maria Lopez. A community-based educational intervention to improve colorectal cancer screening [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B110.

Can patient education initiatives in primary care increase patient knowledge of appropriate antibiotic use and decrease expectations for unnecessary antibiotic prescriptions?

Healthcare globally is increasingly threatened by antibiotic resistance. Misunderstanding of the appropriate use of antibiotics is common within the general population, therefore patient education could be a useful tool to employ against antibiotic resistance. Patient satisfaction with healthcare is important, and antibiotic awareness is crucial to avoid disappointment when antibiotic stewardship is practiced. This review aims to identify whether patient education is an effective tool to improve knowledge and awareness of the appropriate use of antibiotics and whether it has an effect on expectations of or prescription rates of antibiotics. Embase, Medline, Web of Science, PubMed, and Cochrane Library were searched to identify studies examining the impact of various forms of patient education on awareness of appropriate antibiotic use and antibiotic prescription rates. Reference lists of eligible studies were also screened. Three hundred and fourteen unique studies were identified, of which 18 were eligible for inclusion. All studies were of good quality. Three studies examined public health campaigns, five examined leaflets, two examined posters, three examined videos, four used mixed interventions and one study examined a presentation. The results were too heterogenous to perform a meta-analysis. Patient education is an effective tool to increase public knowledge and awareness of the appropriate use of antibiotics, and can reduce the expectation of or prescription rates of antibiotics. The form of patient education matters, as interventions involving active learning and engagement demonstrate significant positive outcomes, whereas passive forms of learning do not appear to have any effect on understanding or prescriptions.

There is no sinus without "us": A randomized controlled study assessing the efficacy of shared decision-making in the surgical management of chronic rhinosinusitis.

CRS patients exhibit little decision conflict in their choice of pursuing surgery. Standard counseling alone appears to suffice once patients express an interest in surgery. Decision aids may increase patient knowledge and improve postoperative care understanding.

(131) EFFECTIVENESS OF AN INTERACTIVE PATIENT LEARNING MODULE: INTIMACY IN PREGNANCY

Abstract Introduction Two-thirds of women experience negative sexual symptoms during their pregnancy. Women suffer with dyspareunia, arousal issues, decreased libido, and anorgasmia frequently throughout pregnancy, with a significant worsening of symptoms during the third trimester. Also, many women restrict their sexual activity due to fear and misconceptions of inducing preterm labor or harming the fetus and social parameters of sexual conduct during pregnancy. Due to the lack of readily available medical education regarding sexual function in pregnancy, many women of various religious backgrounds may feel lack of trusting asking family members or medical professionals regarding sexual wellness. Objective Patient education given during pregnancy will increase patient knowledge of intimacy during pregnancy as well as improve sexual satisfaction and relationship quality and mental health in pregnancy. Moreover, this module will address gaps in common misconceptions by introducing supportive literature findings regarding benefits of intercourse during pregnancy dispensing the social stigma. Methods This prospective study is a single group before and after pilot study. This study recruited 25 patients beyond 12 weeks’ gestation. We approached 34 of patients and 25 agreed to participate in review an educational module titled “Sexual Intimacy and Pregnancy” build from ACOG guidelines. This module was created at an 8th grade reading level. Patients completed a presurvey, used the module on an electronic device and then completed a post-module assessment. Results 68% of women currently experience sexual dysfunction as either one of more of the following: pain with sex, decreased libido, anorgasmia, or vaginal dryness. Compared to their pre-module response, more women correctly answered the items “What percentage of pregnant women experience sexual dysfunction?” (28.0% versus 76.0%; p = .001) and “Having sex will cause labor” (28.0% versus 4.0%; p = .03). Additionally, women were more comfortable asking their doctor about sex while pregnant following the module (OR = 2.26, 95% CI: 1.06 – 4.83; p = .04). Through the recruitment process, we noticed that patients more likely to participate based on age, level of education received and most significant gravidity. The key for this recruitment was to create an environment in the exam room where both parents were able to see and engage with the module. During the module, partners spoke about current sexual dysfunction initially followed by confirmation by the pregnant patient. Prior to viewing this module, most participants predicted a much smaller percentage of women would be afflicted by sexual dysfunction in pregnancy which illustrating the broad deficits in sexual health education. Conclusions All participants would recommend this educational module to fellow pregnant women and all participants rated the completion and content of this module at easy or very easy to follow. This education module demonstrates baseline improvement in knowledge of sexual function in pregnancy and increases comfort level of discussing sexual function during prenatal care. Future direction of this study aims to target education in various socioeconomic cultures where intimacy education is not discussed in the clinical setting. Disclosure No.

Telehealth pada Kepatuhan Diet Pasien Penyakit Ginjal Kronis

This study aims to identify the effect of telehealth on diet compliance in CKD patients. The research method used systematic review sought relevant articles using MeSH-based keywords. Relevant full-text articles were retrieved from four databases: Scopus, PubMed, Science Direct, and ProQuest. Research guidelines followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The results showed that Telehealth programs can increase patient knowledge about the disease, treatment, laboratory results that show better results, and compliance. Telehealth interventions are promising avenues for CKD treatment delivery due to advances in technology and information. Telehealth programs may represent windows of opportunity, diet education, counselling with dieticians, sharing experience with others resulted improving patient’s knowledge on the disease, treatment, and compliance. Future telehealth programs that focus on developing the contents of telehealth modules based on evidence from this study. Keywords: Telehealth, Chronic Kidney Disease, Compliance, Health Service

The effect of a multilevel community health worker-led intervention on patient knowledge and receipt of precision medicine: Updated findings from a randomized clinical trial.

1609 Background: Inequitable access to precision medicine limits its impact. To address disparities, we co-developed a 2-part multi-level intervention with community stakeholders, called the Addressing Latinx CANcer Care Equity Study (NCT04843332). The intervention was designed for low-income and Latinx adults with cancer in rural Monterey County, California. We provided annual training for clinicians about testing guidelines and precision medicine disparities. Trained community health workers educated patients about precision medicine and encouraged them to raise the topic with their oncologist. We tested whether the intervention improved patient knowledge and receipt of precision medicine. Methods: Patients with newly diagnosed or recurrent cancer, age ≥ 18 years, able to consent in English or Spanish, and who self-identified as a racial and ethnic minority OR low-income status OR were insured by public or agricultural company insurance OR uninsured and receiving cancer care at Pacific Cancer Care, a rural community oncology practice in Monterey County, were randomized 1:1 to usual care (control group) or usual care augmented with the multi-level intervention for 12 months (intervention group). The primary outcome was whether the multilevel intervention could increase patient knowledge of precision medicine using a validated 6-question survey from the time of enrollment (baseline) to 6 months post-enrollment between groups. A secondary outcome was the receipt of precision medicine. Patients were followed for 12 months. Results: 110 participants were randomized; 70% (n = 67) reported Spanish as their primary language; 81% (n = 89) identified as Hispanic. The median age was 55 years (55.4 ± 14.3, mean± SD); the majority had annual household incomes (USD) ≤ $34,999 (59.0%, n = 46); the majority obtained a high school diploma/GED or less (67.3%, n = 74). Most had gastrointestinal (35.5%, n = 39) and breast (24.5%, n = 27) cancers and were diagnosed with stage 3 or 4 (64.5%, n = 71) disease. Precision medicine knowledge was low at baseline across both the control and intervention groups (23.5 ± 19.3 versus 23.0 ± 17.7, respectively). Intervention group participants had greater precision medicine knowledge at 6 months (39.2 ± 23.0) than control group participants (24.2 ± 20.0) with a greater increase in knowledge over time than control group participants (p < 0.001).More intervention group participants (n=46, 79.3%) received precision medicine testing than control (n=34, 60.7%). Across both groups, 26 of those tested had an actionable mutation. Of those 26, 66.7% (n=6 of 9) in the control group and 94.1% (n=16 of 17) in the intervention group received targeted therapy (p=0.065). Conclusions: CHW-facilitated interventions may reduce disparities in precision medicine cancer care. Clinical trial information: NCT04843332 .

Appropriateness of ChatGPT in Answering Heart Failure Related Questions

Heart failure requires complex management, and increased patient knowledge has been shown to improve outcomes. This study assessed the knowledge of Chat Generative Pre-trained Transformer (ChatGPT) and its appropriateness as a supplemental resource of information for patients with heart failure. A total of 107 frequently asked heart failure-related questions were included in 3 categories: "basic knowledge" (49), "management" (41) and "other" (17). Two responses per question were generated using both GPT-3.5 and GPT-4 (i.e., two responses per question per model). The accuracy and reproducibility of responses were graded by two reviewers, board-certified in cardiology, with differences resolved by a third reviewer, board-certified in cardiology and advanced heart failure. Accuracy was graded using a four-point scale: (1) comprehensive, (2) correct but inadequate, (3) some correct and some incorrect, and (4) completely incorrect. GPT-4 provided 107/107 (100%) responses with correct information. Further, GPT-4 displayed a greater proportion of comprehensive knowledge for the categories of "basic knowledge" and "management" (89.8% and 82.9%, respectively). For GPT-3, there were two total responses (1.9%) graded as "some correct and incorrect" for GPT-3.5, while no "completely incorrect" responses were produced. With respect to comprehensive knowledge, GPT-3.5 performed best in the"management"category and"other"category (prognosis, procedures, and support) (78.1%, 94.1%). The models also provided highly reproducible responses, with GPT-3.5 scoring above 94% in every category and GPT-4 with 100% for all answers. GPT-3.5 and GPT-4 answered the majority of heart failure-related questions accurately and reliably. If validated in future studies, ChatGPT may serve as a useful tool in the future by providing accessible health-related information and education to patients living with heart failure. In its current state, ChatGPT necessitates further rigorous testing and validation to ensure patient safety and equity across all patient demographics.

Patient Experiences With a Multidisciplinary Fibroid Program

Study ObjectiveAlthough medical, interventional, and surgical treatment options for fibroids have expanded over the last decade, many patients are not thoroughly counseled about all available therapies. Patients desire a more comprehensive approach with shared decision-making tailored to their health goals. The aim of this study is to assess patient knowledge regarding treatment options before and after consultation with a multidisciplinary fibroid center. DesignProspective survey study. SettingAcademic medical center in New York, NY. Patients and ParticipantsPatients who presented for initial consultation with a multidisciplinary fibroid program from July 2021 through January 2022. InterventionsPatients were offered same-day office consultation with a minimally invasive gynecologic surgeon (MIGS) followed by a telemedicine visit with an interventional radiologist (IR) within 3 weeks of the appointment request. Collaborative discussions were held between providers regarding patient care. Patients were asked to complete the survey following both appointments. Data was collected regarding demographics, prior evaluation of fibroids, knowledge about treatment options, and overall experience. ResultsA total of 102 patients completed the survey (response rate 77%). A majority (55.9%) had known about their fibroids for at least 2 years. Most patients sought out the fibroid program for a 2nd (28.4%), 3rd (22.5%) or 4th (7.8%) opinion. Notably, 35.3% of patients who had previously been seen by an obstetrician-gynecologist (OB/GYN) were not offered any treatment. Of those who had been offered treatment, 24.5% were counseled on medical management with oral contraceptives, 28.4% on surgical options, and 5.9% on uterine artery embolization. Nearly all patients (86.3%) endorsed that they would not have sought 2 separate consultations had it not been for the program. Patients were overall well-informed after their experience, with 95.1% reporting they were more knowledgeable about their options and none reporting the 2 separate consults created more confusion for them. ConclusionMany patients with symptomatic fibroids seeking secondary opinions have not been adequately counseled on fibroid management options. A collaborative approach to fibroid management better educates patients, provides an opportunity to be thoroughly counseled by the specialists performing either surgical or interventional procedures, and increases patient knowledge about fibroid treatment options.

Factors Influencing the Occurrence of Cataracts In Hospital

This study aimed to determine the factors that influence the occurrence of cataracts in the Sheikh Yusuf Hospital, Gowa Regency. The research design used was analytic with a Cross-Sectional Study approach. The study results were obtained using the Observation sheet with a sample of 55 respondents. After conducting research, sampling is done by accidental sampling, and then the data is processed using computer software. The results of the bivariate analysis showed that there was an effect of age on the incidence of cataracts by regression test with t-test obtained a Significant value of 0.001 < 0.05 and Occupational Effect on the incidence of cataracts with t-test obtained a Significant value of 0.000 < 0.05 this study concludes that there is an effect of age on the incidence of cataracts. Cataracts and there is an effect of work on the incidence of cataracts in the Sheikh Yusuf Hospital, Gowa Regency. It is recommended that the hospital be able to provide information to patients to increase patient knowledge about cataracts and cataract surgery.

Does coping style mediate the relationship between knowledge and psychosocial outcomes in women with atrial fibrillation?

In patients affected by atrial fibrillation (AF) disease-specific knowledge and coping style may be associated with psychosocial well-being. This study aimed to determine if coping style (problem-focused, emotion-focused, avoidance-focused) mediated the relationship between patient knowledge and three psychosocial outcomes (anxiety, depression and life satisfaction). In 2021a total of 188 women with reported AF, and ages ranging from 18 to 83 years (mean 48.7, sd 15.5 years), completed an online questionnaire consisting of sociodemographic, clinical and AF knowledge questions and psychosocial instruments (Anxiety and depression, the Hospital Anxiety and Depression (HADS) scale; life satisfaction, Satisfaction With Life Scale (SWLS); and coping style (Brief COPE). Using Jamovi statistical software three individual mediational models (for anxiety, depression and life satisfaction) were constructed assessing the direct and indirect relationships between knowledge, coping style and each psychosocial outcome. Age was a covariate in each model. The mediation analyses demonstrated significant direct negative associations between AF knowledge and HADS anxiety and depression and positive associations with SWLS. There were also direct associations between each of the three coping styles and the three psychosocial outcomes. There were significant indirect effects of coping style between AF knowledge and each of the three outcomes confirming partial mediation effects. These findings highlight the crucial role of coping style in mediating the association between AF knowledge and psychosocial outcomes. As such, interventions aimed at increasing patient knowledge of AF may be more effective if adaptive problem-solving coping strategies are also demonstrated to these patients. Additionally, modification of maladaptive coping strategies as part of the psychological management of patients with AF is highly recommended.

Development of Nurse-led Self-Management Education Instruments for Type 2 Diabetes Mellitus Patients

Purpose: The purpose of this study is to develop and outline the Nurse-Led Diabetes Mellitus Self-Management Education (Nu-DiMENTION) program, aimed at improving knowledge and behavior change among type 2 diabetes mellitus (DM) patients. Given the challenges faced by these patients in managing their disease effectively, including risks of complications such as diabetic foot ulcers, retinopathy, and ketoacidosis, there is a pressing need for tailored self-management education programs. The study seeks to address this need by creating a web-based nurse-led educational intervention that has demonstrated efficacy in increasing patient knowledge and promoting positive behavior change. Methods: The research adopts a research and development (R&D) approach to outline the development process of Nu-DiMENTION. Drawing upon theory, existing research evidence, international guidelines, and qualitative data from target users, the study identifies determinants of self-management and defines the content to be included in the program. The development process involves multiple stages, including evaluating existing educational instruments, conducting focus groups with relevant stakeholders (e.g., healthcare professionals and type 2 DM patients), and assessing item validity through expert evaluation. Results and discussion: The initial evaluation of 19 diabetes mellitus educational instruments revealed inadequacies in terms of goals, targets, content, methods, media, time, and evaluation. Subsequent focus groups involving healthcare professionals and type 2 DM patients provided valuable insights into strategic issues and innovation plans for the Nu-DiMENTION program. The assessment of item validity conducted by diabetes mellitus education experts confirmed the validity and reliability of the developed instruments, with a Cronbach's alpha value of 0.834 indicating good internal consistency. Implications of the research: The development of Nu-DiMENTION holds significant implications for improving the self-management capabilities of type 2 DM patients and reducing the risk of diabetes-related complications. By providing accessible, web-based nurse-led education, the program has the potential to empower patients with the knowledge and skills necessary to effectively manage their condition. Moreover, the rigorous development process, including expert validation, ensures the quality and reliability of the program, enhancing its suitability for implementation in clinical settings. Originality/value: This study contributes to the literature by outlining the development process and subject matter of Nu-DiMENTION, a novel web-based nurse-led self-management education program for type 2 DM patients. By synthesizing theory, existing evidence, and stakeholder insights, the program offers a comprehensive approach to addressing the educational needs of this patient population. Furthermore, the emphasis on item validity assessment ensures the program's reliability and effectiveness, adding to its value as a practical intervention for improving diabetes self-management. Overall, Nu-DiMENTION represents an innovative and valuable contribution to diabetes care and patient education.

Gambaran Kepatuhan Pasien dengan Penyakit Ginjal Kronis dalam Menjalani Hemodialisis di RSUD Prof.Dr.W.Z. Johanes

Hemodialysis is a tool that patients with chronic kidney disease (CKD) need to replace damaged kidney function. Compliance with hemodialysis plays an important role in the patient's health condition. Since 2021, the number of hemodialysis patients at RSUD Prof.DR.W.Z. Johanes, from 108 patients to around 85 patients remaining in 2022. This study aims to provide an overview of CKD patients' compliance in undergoing hemodialysis at RSUD Prof.DR.W.Z. John. This type of research is qualitative with a case study approach. Eight key informants and two supporting informants using purposive sampling. The research results showed that generally, hemodialysis compliance among informants was good. Predisposing factors, knowledge about hemodialysis and its risks, motivation to comply with hemodialysis such as the hope of health, not wanting to give up, want to work, and also the desire to still live with the family as well as belief in the benefits of hemodialysis encouraging informants to be more compliant. Supporting factors such as completeness of facilities and affordability of access to services encourage more optimal hemodialysis. Reinforcing factors such as emotional, instrumental, and information support provided by family and health workers increase informants' compliance with hemodialysis. Hemodialysis units can improve and maintain the quality of hemodialysis facilities and services. Existing health workers can increase patient knowledge and motivation by maintaining positive communication during the hemodialysis process. The family can be a positive companion for the fulfillment of hemodialysis patients. Hemodialysis patients must maintain and improve their physical and mental condition.

Pendidikan Kesehatan tentang Tuberkulosis terhadap Peningkatan Pengetahuan dan Sikap Penderita dalam Pencegahan Penularan Tuberkulosis

This study aims to evaluate the effect of health education on increasing patient knowledge and attitudes to prevent tuberculosis transmission at the Nabire District Health Center, Nabire Regency. This research method uses a Quasi-Experimental Pre-Post design with case and control groups. The research showed that the experimental group experienced a significant increase in their knowledge (an average of 50.48 on the pre-test to 77.14 on the post-test). The control group also experienced a rise, although smaller (an average of 49.02 on the pre-test to an average of 50.40 on the post-test). Changes in the attitudes of respondents in both groups also occurred, with a significant increase in the experimental group (average of 47.72 in the pre-test to 72.70 in the post-test) and a minor increase in the control group (average of 47.96 in the pre-test to 51.60 on post-test). Based on the results of the bivariate analysis, it was found that the P-value was 0.000, which means that there was an influence of health education about tuberculosis on increasing the knowledge and attitudes of sufferers in preventing the transmission of tuberculosis. In conclusion, the health education approach effectively increases patient knowledge and attitudes toward avoiding tuberculosis. These results indicate the need to integrate health education to control tuberculosis in the Nabire District Health Center and similar areas.
 Keywords: Health Education, Knowledge, Attitude, Tuberculosis

Patient decision aids for aortic stenosis and chronic coronary artery disease: a systematic review and meta-analysis.

Shared decision-making is recommended for patients considering treatment options for severe aortic stenosis (AS) and chronic coronary artery disease (CAD). This review aims to systematically identify and assess patient decision aids (PtDAs) for chronic CAD and AS and evaluate the international evidence on their effectiveness for improving the quality of decision-making. Five databases (Cochrane, CINAHL, Embase, MEDLINE, and PsycInfo), clinical trial registers, and 30 PtDA repositories/websites were searched from 2006 to March 2023. Screening, data extraction, and quality assessments were completed independently by multiple reviewers. Meta-analyses were conducted using Stata statistical software. Eleven AS and 10 CAD PtDAs were identified; seven were less than 5 years old. Over half of the PtDAs were web based and the remainder paper based. One AS and two CAD PtDAs fully/partially achieved international PtDA quality criteria. Ten studies were included in the review; four reported on the development/evaluation of AS PtDAs and six on CAD PtDAs. Most studies were conducted in the USA with White, well-educated, English-speaking participants. No studies fulfilled all quality criteria for reporting PtDA development and evaluation. Meta-analyses found that PtDAs significantly increased patient knowledge compared with 'usual care' (mean difference: 0.620; 95% confidence interval 0.396-0.845, P < 0.001) but did not change decisional conflict. Patients who use PtDAs when considering treatments for AS or chronic CAD are likely to be better informed than those who do not. Existing PtDAs may not meet the needs of people with low health literacy levels as they are rarely involved in their development. PROSPERO: CRD42021264700.

Effectiveness of Educational Interventions to Improve Knowledge and Medication Adherence for People with Schizophrenia: A Systematic Review

Not only antipsychotics but additional interventions such as education for people with schizophrenia are also needed to support optimal therapy. Studies with educational interventions have been conducted and show varied outcomes. The systematic review aimed to summarize and evaluate the effectiveness of studies regarding educational interventions for people with schizophrenia. Two electronic databases (PubMed and Science Direct) were used to find studies with criteria that were educational interventions for people with schizophrenia and focused on outcome measures related to improving knowledge, medication adherence, and other outcomes as an effect of educational interventions, randomized or randomized controlled trial studies, published between 2012 and 2022. The manual search of referenced articles was also applied. A literature search was conducted using the terms ("people with schizophrenia" OR "patients with schizophrenia") AND ("education" OR "knowledge") AND ("medication adherence" OR "medication compliance" OR "medication persistence"). Of the 666 studies, seven were eligible. Some educational interventions are part of a therapy program, while others are full psychoeducational programs that target not only the patient but also the patient's family. There was only one study that used counseling supported by leaflets delivered by a pharmacist. Another intervention used face-to-face interviews and discussions supplemented by modules or booklets, or giving booklets to patients and then following up by phone. Only one of the seven studies was effective in increasing patient knowledge. The rest did not measure knowledge but assessed other parameters, i.e., stigma and insight, symptoms, social functioning, relapse rate, or quality of life as the effect of educational intervention. Three studies showed a significant difference in improvement in medication adherence between the intervention and control groups; two studies were not significant, and the rest were unmeasured. It can be concluded that educational intervention had a positive effect on PwS and their families’ knowledge, improved medication adherence, and other outcomes as an effect of the educational intervention.