Tailored Patient Education Research Articles

The effects of self-management education tailored to health literacy on medication adherence and blood pressure control among elderly people with primary hypertension: A randomized controlled trial

ObjectiveTo evaluate the effects of self-management education tailored to health literacy on medication adherence and blood pressure control. MethodThis randomized controlled trial was conducted in 2018 with 118 elderly people with uncontrolled primary hypertension and inadequate health literacy. Self-management education was developed on the basis of the health literacy index. Medication adherence and blood pressure were assessed using 8-items Morisky Medication Adherence Scale and a mercury sphygmomanometer, respectively. ResultsAt baseline, there were no significant between-group differences regarding participants’ demographic characteristics, medical history, and medication adherence. After the intervention, between-group comparisons adjusted for pretest scores showed a significant reduction in the mean score of systolic and diastolic blood pressure and increase adherence to medication due to intervention (P < 0.05). However, the proportions of controlled systolic and diastolic blood pressure were not statistically significant different between-group (P > 0.05). ConclusionSelf-management education tailored to health literacy significantly promotes medication adherence but has no significant effects on control of blood pressure. Practice implicationTo promote adherence to antihypertensive medications, tailored patient education to Health literacy is recommended. Limited pieces of evidence are available on the effectiveness of health literacy index-based interventions, so further studies are required.

Using the Technology Acceptance Model to Develop StartSmart: mHealth for Screening, Brief Intervention, and Referral for Risk and Protective Factors in Pregnancy

Technology decision support with tailored patient education has the potential to improve maternal and child health outcomes. The purpose of this study was to develop StartSmart, a mobile health (mHealth) intervention to support evidence-based prenatal screening, brief intervention, and referral to treatment for risk and protective factors in pregnancy. StartSmart was developed using Davis' Technology Acceptance Model with end users engaged in the technology development from initial concept to clinical testing. The prototype was developed based upon the current guidelines, focus group findings, and consultation with patient and provider experts. The prototype was then alpha tested by clinicians and patients. Clinicians were asked to give feedback on the screening questions, treatment, brief motivational interviewing, referral algorithms, and the individualized education materials. Clinicians were asked about the feasibility of using the materials to provide brief intervention or referral to treatment. Patients were interviewed using the think aloud technique, a cognitive engineering method used to inform the design of mHealth interventions. Interview questions were guided by the Screening, Brief Intervention, Referral to Treatment theory and attention to usefulness and usability. Expert clinicians provided guidance on the screening instruments, resources, and practice guidelines. Clinicians suggested identifying specific prenatal visits for the screening (first prenatal visit, 28-week visit, and 36-week visit). Patients reported that the tablet-based screening was useful to promote adherence to guidelines and provided suggestions for improvement including more information on the diabetic diet and more resources for diabetes. During alpha testing, participants commented on navigability and usability. Patients reported favorable responses about question wording and ease of use. Clinicians reported the use of mHealth to screen and counsel pregnant patients on risk and protective factors facilitated their ability to provide comprehensive care.

Knowledge, attitudes, and perceptions of infertility: a national survey

The negative psychosocial impact from infertility on patients and couples is well-established; however, little is known about the general public’s knowledge and perception of infertility. The purpose of this study was to assess the knowledge and attitudes of the general U.S. population regarding the causes, prevalence, and emotional effect of infertility, and to investigate the relationships between prior infertility history, obstetric history, birth control use, and race on these beliefs. Internet survey. A 46-question survey was developed by the authors in Qualtrics. One-thousand respondents were recruited for a small monetary incentive to complete the survey via Amazon’s Mechanical Turk (MTurk) in February 2018. Individuals were eligible if they were American residents and aged 18 to 69 years at the time of the survey. Responses were analyzed with Chi-squared test, Fisher exact test, and logistic regression where appropriate, using SAS software, Version 9.4. Nine-hundred ninety-three (99.3%) respondents completed the survey. Respondents predominantly identified as non-Hispanic White (79%), followed by Black or African American (7.8%), Hispanic White (6.8%), and Asian (6.6%). 73% of respondents were between age 21 and 40 years. 68% of the respondents were female, and of those, 67% had previously been pregnant, 44% had experienced a miscarriage, and 19% had a history of pregnancy termination. 24% of respondents reported that they and/or their partner had a history of infertility. 53% of respondents believed more than 20% of individuals will experience infertility in their lifetime, with individuals with a history infertility estimating a higher incidence of infertility in the population than those without that history (OR 2.0, 95% CI 1.5-2.7). The majority of respondents feel that infertility treatment should be covered by insurance (70%) and that women undergoing fertility treatment should have paid time off to for those appointments (54%). Commonly believed causes of infertility included past use of birth control pills (48%), alcohol and/or drug use (75%), having had an abortion (45%), and prior use of an intrauterine device (48%). 45% of respondents felt that race had an effect on fertility. Respondents were more likely to identify their own race as having the highest rate of infertility (OR 8.0, 95% CI 4.9-12.8) and to identify a different race as having the lowest rate of infertility (OR 0.5, 95% CI 0.3-0.8). Among a national sample of adults in the United States, knowledge and perceptions about the causes and incidence of infertility vary. Misperceptions about the causes of infertility are common, and this diminished health literacy may predispose individuals to inequity in access to fertility care. Providers may benefit from learning of these common misperceptions and the associated risk factors in order to tailor patient education and community outreach programs to improve health literacy, eliminate misperceptions around the diagnosis of infertility, and improve access to care.

The Chinese version of the Coronary Artery Disease Education Questionnaire-II (CADEQ-II): translation and validation.

ObjectivesIt is necessary to assess disease-related knowledge in patients with coronary artery disease (CAD) for tailored patient education; however there is a lack of a well-validated measurement in China. The objective of this study was to translate and validate a Chinese version of the Coronary Artery Disease Education Questionnaire-II (CADEQ-II).MethodsThe Chinese version of CADEQ-II was translated and culturally adapted. Then, it was tested for psychometric properties through a convenient sampling. Content validity was examined based on a panel of five experts. The item difficulty index and item discrimination index were calculated to assess the item difficulty and item discrimination. Internal consistency reliability was measured with the Cronbach’s alpha coefficient. Criterion-related validity was established through comparing scores in patients with different education levels. Construct validity was assessed through confirmatory factor analysis (CFA).ResultsThe Chinese version of the CADEQ-II was finalized after deleting three items and modifying two items from the original version. Three hundred and sixteen participants completed the whole questionnaire. Content validity index of the whole questionnaire was 0.87. The Cronbach’s alpha coefficient of the overall questionnaire was 0.907. The significant difference of the knowledge scores among patients with different education levels supported criterion-related validity. CFA confirmed the proposed four-factorial structure of the questionnaire.ConclusionThe Chinese version of CADEQ-II had an acceptable reliability and validity among Chinese patients with CAD. It could be used to develop individualized health education for Chinese patients with CAD. Also, it could serve as a suitable outcome measurement to evaluate the effectiveness of education interventions related to CAD.

Video Education Improves Heart Failure Knowledge and Self-Care

Background Patient education is recommended to enhance self-care in all heart failure (HF) guidelines. The optimal method of educating HF patients is not known, but video education (VE) can provide a standardized and cost-effective method to deliver HF patient education. In addition, mobile technology can be an efficient and convenient way to deliver patient education as patients transition from hospital to home. Purpose The purpose of this study was twofold: 1) Evaluate whether HF knowledge, self-efficacy, self-care skills, and readmission rates improved after adding VE to usual care, and 2) Evaluate patient satisfaction with VE. Methods A convenience sample of adult HF inpatients was recruited over 11 weeks at an academic medical center. Participants received access via tablet, smartphone, or computer to 26 videos, each between 2-4 minutes in length, and lasting a total of 1.5 hours. The first video was shown while inpatient and subsequent videos were viewed at participants’ discretion while inpatient as well as after discharge. Participants received a “Managing Your Heart Failure With Video Education” booklet to aid accessing the videos. HF knowledge and self-care were measured before and after VE using the Atlanta Heart Failure Knowledge Test and the Self-care of Heart Failure Index. A patient log and satisfaction with each video was collected. Seventy participants enrolled and 30 completed the questionnaires. All-cause 30-day readmission data were compared to a randomly selected historical group from the previous months and year. Results Participants’ mean age was 66 years, 70% (21) were female, 67% (20) were Caucasian, 63% (19) high school educated or less, 83% (25) had hypertension, 73% (22) were New York Heart Association Class III-IV, and 43% (13) had HF with reduced ejection fraction. Mean Charlson Comorbidity Index scores was 6.2 ± 2.3. HF knowledge and self-maintenance scores increased (mean 1.7, + 3.2, p =.008, mean 13.96 + 20.99, p =.001 respectively). Participants’ scores improved by at least 5% on 20 of the 30 questions on the HF knowledge test. Self-efficacy (self-care confidence) and self-care management did not significantly improve (mean 1.67, SD 26.69, p = .735; mean 9.4, SD 22.7, p =.073 respectively). All-cause 30-day hospital readmissions did not significantly decrease (9 to 7, p= .276). HF patients were satisfied with the VE information (96%) and all would recommend the videos (100%). The videos rated most helpful were: Heart Failure Medications: Diuretics (71.4%), Managing Heart Failure: Limiting Sodium (65%), and Taking Your Heart Failure Medications (61.9%). Conclusion VE was associated with improved HF knowledge and self-maintenance with high patient satisfaction. HF Knowledge scores may further be used to tailor patient education based on identified knowledge gaps. Future work is needed to investigate whether self-efficacy and self-management improves with continued follow-up.

Health literacy in pressure injury: Findings from a mixed-methods study of community-based patients and carers.

The present study, drawn from a larger mixed-methods case study, provides insights into the health literacy of community-based patients with pressure injuries, and their carers, and critically analyzes the patient information resources available; crucial because health literacy is associated with patient care and outcomes for patients. Two datasets were used to better understand patient literacy in relation to pressure injury: (i) narratives from patients and carers; and (ii) analysis of patient education resources. Narratives were subject to content analysis and patient education resources available to the patients were analyzed drawing on the Simplified Measure of Gobbledygook, the National Health Service Toolkit for Producing Patient Resources, and compared to an internationally-advocated pressure injury leaflet. The study findings indicated that despite leaflets broadly meeting required production and content guidelines, patients appeared to poorly engage with these materials and demonstrated limited health literacy in relation to pressure injury. Although improvements in leaflet production and readability might be advantageous, emphasis should remain on quality patient-health-care professional relationships to enable tailored patient education that can enhance awareness and engagement with treatment and prevention interventions.

Clinical analysis for the death of 127 patients with acute myocardial infarction and nursing strategies

How to give the corresponding nursing strategies for the risk factors of death is the focus of the current clinical nursing of AMI. Therefore, this study aims to determine causes of death in patients with Acute Myocardial Infarction (AMI) and the nursing strategies. The clinical data of 127 AMI patients treated in our center from January 1st, 2010 to December 31st, 2014, categorized into observed group and control group according to psychological counselling, were retrospectively analysed. Total of 68 patients were enrolled in observed group with 59 patients enrolled in control group. 48 (70.6%) of observed group had complicated infection and 43 (72.9%) of control group, respectively. The mortality of observed group was 17.65%, lower than 33.90% of control group (p=0.035). Multivariate logistic regression analysis indicated that age (≥ 70 y), less-awareness, complicated infection and accompanying conditions such as cardiogenic shock might be high-risk factors of AMI-induced death. In conclusion, AMI deaths are associated with diverse causes. Active and effective nursing approaches, such as psychological counselling, may help to decrease the risk of AMI deaths. The corresponding nursing strategies for these death-related factors included tailored patient education, psychological counselling, concentrated nursing care, reasonable nursing resource planning, continuous ECG monitoring and close observation.

Pilot testing of the effectiveness of nurse-guided, patient-centered heart failure education for older adults

Heart failure (HF) is the most common cause of hospitalization and rehospitalization among those 65 years and older. Effective HF self-management is recommended for reducing readmissions. This pilot study, through a one-group, pretest-posttest design, examines the effects of nurse-guided, patient-centered HF education on readmissions among older adults (n = 26) in a post-acute care unit. All selected participants received 3 sessions of tailored patient education. Their knowledge and self-care skills were measured pre- and post-intervention with the Atlanta Heart Failure Knowledge Test (A-HFKT) and the Self-Care of Heart Failure Index (SCHFI). Patients' HF-related knowledge and self-care skills showed statistically significant improvements, and only 1 patient was rehospitalized for any HF-related reason within 30 days post-discharge. These results suggest that HF rehabilitation teams could support better patient outcomes by assigning nursing staff to provide individualized patient education, as this can help ensure that patients understand discharge instructions for effective self-care.

Effectiveness of patient-centered interventions on falls in the acute care setting compared to usual care: a systematic review.

Unintentional falls during hospitalization remain a concern for healthcare institutions globally despite implementation of various improvement strategies. Although the incidence of falls has been of heightened focus for many years and numerous studies have been done evaluating different approaches for fall prevention, fall rates remain high in acute care settings. Patient fall risk scales tend to address only particular intrinsic and extrinsic factors but do not adequately assess a patient's current fall risk status, subsequently warranting more patient-centered risk assessments and interventions. To evaluate the effectiveness of patient-centered interventions on falls in the acute care setting. All adult patients admitted to medical or surgical acute care units for any condition or illness. Patient-centered intervention strategies to reduce falls compared to usual care. Randomized control trials. Primary outcome: fall rates or number of falls. Secondary outcome: fall-related injuries. A comprehensive search strategy aimed to find relevant published and unpublished quantitative, English language studies from the inception of databases through July 30, 2016 was undertaken. Databases searched included: PubMed, CINAHL, Embase and Health Source: Nursing/Academic Edition. A search for unpublished studies was also performed using ProQuest Dissertations and Theses, the New York Academy of Medicine and the Virginia Henderson e-Repository. Reviewers evaluated the included studies for methodological quality using the standardized critical appraisal instrument form from the Joanna Briggs Institute. Quantitative data were extracted from papers included in the review using the standardized data extraction form from the Joanna Briggs Institute. Due to clinical and methodological heterogeneity among the included studies, a meta-analysis was not possible. The findings of this review have been presented in narrative form. Five randomized control trials were included. Three studies demonstrated statistically significant reductions in fall rates (p < 0.04) while two studies showed no difference in fall rates between groups (p > 0.5). In the three studies that demonstrated reduced fall rates, personalized care plans and patient-centered education based on patients' fall risk results were utilized. Three studies measured the secondary outcome of fall-related injuries; however, results demonstrated no difference in fall-related injuries between groups (p > 0.5). Evidence of this review indicates patient-centered interventions in addition to tailored patient education may have the potential to be effective in reducing falls and fall rates in acute care hospitals. There is limited high quality evidence demonstrating the effectiveness of patient-centered fall prevention interventions so novel solutions are urgently needed and warrant more rigorous, larger scale randomized trials for more robust estimates of effect.

Educational needs in patients with spondyloarthritis in Sweden \u2013 a mixed-methods study

BackgroundThere is a demand for a flexible and individually tailored patient education to meet patients’ specific needs and priorities, but this area has seldom been studied in patients with spondyloarthritis (SpA), a family of inflammatory rheumatic diseases. The aim of the present study was to identify needs and priorities in patient education in patients with SpA. A second aim was to investigate patients’ experiences and preferences of receiving patient education.MethodsData collection included a questionnaire survey with the Educational Needs Assessment Tool (ENAT) and interviews, using a mixed-methods design. Patients were identified through a specialist clinic register. Descriptive data are presented as mean with standard deviation, or frequencies. Chi-square test and independent-samples t-test were used for group comparisons. A manifest qualitative conventional content analysis was conducted to explore patients’ experiences and needs in patient education, based on two focus groups (n = 6) and five individual interviews.ResultsAlmost half (43%) of the 183 SpA patients had educational needs, particularly regarding aspects of self-help, feelings, and the disease process. More educational needs were reported by women and in patients with higher disease activity, while duration of disease did not affect the needs. The qualitative analysis highlighted the importance of obtaining a guiding, reliable, and easily available patient education for management of SpA. Individual contacts with healthcare professionals were of importance, but newer media were also requested.ConclusionThere are considerable educational needs in patients with SpA, and education concerning self-help, feelings, and the diseases process were raised as important issues. Healthcare professionals need to consider the importance of presenting varied formats of education based on the experiences and preferences of patients with SpA.

What Demographic and Clinical Characteristics Correlate With Expectations With Trapeziometacarpal Arthritis?

Pretreatment variables have been shown to be associated with the fulfillment of patient expectations, yet in treating thumb trapeziometacarpal osteoarthritis (OA) it remains unclear how patient expectations correlate with the effectiveness of treatment. An increased understanding of the variables that affect patient expectations enables tailored patient education and patient-provider communication. (1) Is there a correlation between patient demographics and clinical characteristics, and the expectations the patients have when seeking treatment for trapeziometacarpal OA? (2) What factors are independently associated with the total expectations score and frequency of expecting "back to normal" among patients treated for trapeziometacarpal OA? Between March 2011 and October 2013, 89 patients of all 96 eligible patients seeking treatment for trapeziometacarpal OA were approached and agreed to participate in this study. Participants completed a validated expectations survey measuring the number of expectations and the degree of improvement expected. Comparative analysis of demographic and clinical characteristics and multivariate regression analysis against patients' expectations were performed to assess and identify factors that correlate with the number and degree of expectations. Sample size was determined with an a priori power analysis (with 80% power and statistical significance set at p<0.05), which showed that 88 patients were needed to detect the minimal clinical difference of 12 points in the Michigan Hand Questionnaire; we then increased this by 10% to allow for potential dropouts. After controlling for potential confounding variables such as age, hand dominance, and work status, the following factors were associated with a higher expectations score: choice of surgery (β=11.5; 95% CI, 0.7-23.8; p=0.044), female gender (β=19.0; 95% CI, 5.3-32.7; p=0.007), and dominant side affected (β=-41.6; 95% CI, -63.7 to -19.5; p<0.001). For the frequency of "back to normal" responses, surgical treatment (β=7.4; 95% CI, 2.3-12.4; p=0.005) and history of previous injury (β=8.2; 95% CI, 0.1-16.3; p=0.047) were independently associated factors after controlling for confounding variables. There were no independent associations with age, marital status, work status, depression or anxiety, or prior contralateral surgery. Patients whose dominant side was affected, were female, and chose surgical treatment, had higher total expectations. Patients who reported an antecedent injury and chose surgical treatment more frequently expected a return to normal. With identification of these factors, orthopaedic surgeons can recognize patients who are prone to higher expectations, and, thus, have the opportunity to implement efficient pretreatment education. In addition, identification of specific factors enables a focused measure of the effect of these factors on the fulfillment of expectations. Level II, prognostic study.

Technology to Support Motivational Interviewing

PurposeThis paper reports the findings of motivational interviewing (MI) training with and without technology support on school-based health center (SBHC) providers' satisfaction with MI training, providers' self-report of behavioral counseling related to childhood overweight/obesity, and parents' perception of care after training. Design and MethodsThe effects of training and technology on MI is part of a larger comparative effectiveness, cluster randomized trial. Twenty-four SBHCs in six states received virtual training on MI. Half the sites received HeartSmartKids™, a bilingual (English/Spanish), decision-support technology. The technology generated tailored patient education materials. Standard growth charts were plotted and health risks were highlighted to support MI counseling. The results of the MI training included provider satisfaction with MI training and parent assessment of the components of MI in their child's care. Providers and parents were surveyed at baseline, after training, and six months after training. ResultsProviders were satisfied with training and reported improvements in counseling proficiency (p<0.0007) and psychological/emotional assessment (p=0.0004) after training. Parents in the technology group reported significant improvement in provider support for healthy eating (p=0.04). ConclusionVirtual training has the potential of preparing providers to use MI to address childhood obesity. Technology improved parent support for healthy eating. Future research should evaluate the impact of technology to support MI on patient outcomes. Practice ImplicationsChildhood obesity guidelines emphasize that MI should be used to promote healthy weight in children. Training providers on MI may help more providers incorporate obesity guidelines in their practice.

Utilizing patient navigators to enhance oral chemotherapy education and safety for at-risk patients.

43 Background: Oral anticancer drugs are increasingly being used as standard therapy. At Tufts Medical Center Cancer Center, 10% of patients on active cancer treatment are receiving oral chemotherapy. To address barriers to medication education and timely management of treatment effects, we began an initiative involving our pharmacy specialist who reviews newly-started oral chemotherapy treatments for safety concerns, dose appropriateness, and drug interactions. In response to the cultural-linguistic needs of our Chinese patients (20% of our patients, largest minority group) and unique challenges of our patients of lower SES (40% of our patients), we are also leveraging patient navigators (PN) to improve timely care and understanding of and adherence to oral cancer medications for our most vulnerable patients. Methods: PN regularly interact with patients and work closely with the care team to address patients’ concerns. Formal PN visits with patients in clinic are documented in the EMR. To assess the scope of issues related to oral chemotherapy and/or supportive care drugs (e.g. anti-nausea, anti-constipation) and the potential impact in using PN, we reviewed PN encounter notes from the first 6 months of 2016 to identify patient-reported issues. Results: In reviewing 492 PN encounter notes from the first 6 months of 2016 (111 patients were navigated), 138 (28%) of all patient encounters involved assistance related to oral chemotherapy, supportive care drugs, and/or comorbidities medications. Examples of patient-reported issues include confusion about purpose and/or type of drug, dosing scheduling, side effects management, and logistical challenges (e.g. refills, copays, specialty pharmacy orders). Conclusions: From the PN encounter notes, we identified a need for more formalized patient-centered interventions to enhance education, monitoring, and patient-provider communication about oral chemotherapy to proactively resolve medication-related issues. We are piloting an evidence-based approach involving pharmacist-PN-patient teaching sessions, tailored patient education tools, and scheduled check-ins between PN and patients adapted from the MASCC Oral Agent Teaching Tool model.

Breast Cancer Patients' Perceptions of a Virtual Learning Environment for Pretreatment Education.

The process and technicalities of radiation therapy (RT) for cancer treatment can be challenging for patients to understand as RT involves complex procedures, highly specialised equipment, and radiation itself has limited sensory characteristics. Hence, it is imperative that education programs are specifically planned and developed to suit the needs of patients, address radiation as an entity and include salient visual aids. In this context, the Virtual Environment for Radiotherapy Training (VERT) system, primarily created for RT practitioner simulation, may provide unique opportunities for patient education. This article reports on patient feedback of a newly developed breast cancer patient education program, which integrates the VERT system as the focal education tool. The education program content included RT immobilisation, simulation, planning and treatment components, along with an introduction to the VERT system. Nineteen breast cancer patients (n=19) completed an evaluation questionnaire at the completion of their VERT education program. Open-ended questions were used to detect the least and most useful aspects of the education session. Patient feedback indicated a high regard for the comprehensiveness of the education program, with particular acknowledgement of the three dimensional visual features of the VERT system. It is proposed that VERT's high visual impact should be exploited in tailored patient education programs in order to obtain maximum patient engagement and make significant gains in effective knowledge transfer.

Predictors of physical and mental health in persons with morbid obesity attending a patient education course \u2013 a two-year follow-up study

BackgroundPeople with morbid obesity (body mass index ≥40) may experience changes in their health after participating in a tailored patient education course. The aims of this study were to assess the changes in physical and mental health in persons with morbid obesity during the 2 years following an educational course and to explore possible socio-demographic, treatment, and personal predictors of physical and mental health outcomes.MethodsIn this prospective longitudinal cohort study, self-report questionnaire data were collected from people with morbid obesity at the beginning of mandatory educational courses while on a waiting list for gastric surgery and at two-year follow-up. Of the 185 who attended the courses, 142 (77%) volunteered to participate in the study, and the 59 with complete data at the two-year follow-up were included in the analysis. Physical and mental health were measured with the physical and mental component summary scores from the Short Form 12v2. Self-esteem was measured by the Rosenberg Self-Esteem Scale, and self-efficacy by the General Self-Efficacy Scale.ResultsThe participants reported better physical health at two-year follow-up than at baseline. Mental health did not change significantly over time. Receiving surgical treatment during the study period predicted better physical health at two-year follow-up, even after controlling for physical health at baseline. Mental health at baseline was the only significant baseline predictor of mental health at follow-up. However, increasing self-esteem and self-efficacy over the two-year study period independently predicted better mental health at follow up after controlling for mental health at baseline.ConclusionOur study showed that people with morbid obesity on a waiting list for bariatric surgery improved their physical health during the 2 years after attending a tailored patient educational course. Improving self-esteem and self-efficacy may be important personal factors for maintaining mental health during this period.Trial RegistrationNCT01336725. Registered 14 April 2011.

Adherence to Analgesics in Oncology Outpatients: Focus on Taking Analgesics on Time.

Inadequate adherence to prescribed analgesics may be one of the reasons why patients with cancer experience unrelieved pain. Adherence is directly influenced by patients' barriers about pain management. Patient pain education programs (PEPs) have been developed to reduce patients' barriers and increase patients' adherence to their analgesics. The purpose of this article was to evaluate patients' adherence in patients receiving a pain consult and patient pain education in comparison with patients receiving standard pain treatment (standard care [SC]), to better explore the difficulties in medication adherence in cancer-related pain and the effects of PEP. In 54 adult outpatients with cancer-related pain, patients' adherence to the prescribed around-the-clock analgesics was measured with a Medication Event Monitoring System, in the following time intervals: weeks 1 and 2, weeks 3 and 4, and weeks 7 and 8 after randomization. Adherence was differentiated into taking adherence, taking the correct dose, and taking analgesics at the right time intervals. Taking adherence increased in the intervention group compared to baseline (from 91% to 93%) and decreased in the SC group (from 85% to 78%; P < 0.05). At the end of the study, more patients in the intervention group took their analgesics at the right intervals (78%) than did patients in the SC group (64%, P < 0.05). During the study, patients were more adherent to opioids than to World Health Organization step 1 analgesics. The combined intervention can increase adherence. The true problem in pain management is that patients do not take their prescribed analgesics at the right time intervals. With the detailed adherence information from this study, it is possible to further tailor patient education to the individual patient.

Knowledge gaps in patients with atrial fibrillation revealed by a new validated knowledge questionnaire

ObjectiveThe aim of this study was to develop and validate a new questionnaire, the Jessa Atrial fibrillation Knowledge Questionnaire (JAKQ), to test the knowledge of patients with atrial fibrillation (AF) about the arrhythmia, its treatment and their ability for self-management. MethodsThe JAKQ was developed based on other questionnaires, two educational checklists and patient information support websites. The JAKQ was validated based on content validity, face validity, response process, discriminatory potential and sensitivity of the questionnaire, construct validity and reliability. It was presented to both outpatients and hospitalised patients. ResultsA total of 466 AF patients completed the JAKQ. The final 16-item JAKQ consists of 8 questions about AF in general, 5 questions about oral anticoagulation (OAC) therapy and either 3 questions about vitamin K antagonists (VKA) or non-vitamin K antagonist oral anticoagulants (NOAC). The questionnaire is completed in 6.5±2.4min. The mean score on the JAKQ is 55.8±18.6% with a wide discriminatory span of scores. The JAKQ reveals important knowledge gaps, like 28.8% of the patients not being aware of their medical condition named ‘atrial fibrillation’, 33.7% being unaware that AF can cause thromboembolism and stroke, and 78.6% of the patients taking VKA and 57.0% of the patients on NOACs not knowing what to do when missing an OAC dose. ConclusionsThe JAKQ is a brief, complete and valid AF-specific knowledge questionnaire that can be used in daily practice to assess patients' insight into their condition. It could be used as a tool for individually tailored patient education.

Impact of tailored patient education on adherence of patients with chronic myeloid leukaemia to tyrosine kinase inhibitors: a randomized multicentre intervention study

The aim of this study was to evaluate the influence of tailored patient education on adherence to tyrosine kinase inhibitor medication among patients with chronic myeloid leukaemia. Management of chronic myeloid leukaemia has changed dramatically during the last decade. While medication adherence is crucial to clinical response, little is known about how to improve patients' adherence. Randomized multicentre intervention study. The study was conducted between June 2012-August 2014. Eighty-six patients with chronic myeloid leukaemia who had been on tyrosine kinase inhibitor medication for at least six months from eight hospitals were randomized into intervention and control groups. Intervention combined nurse-conducted medication counselling, an information booklet, video and website and text message reminders. Patients were interviewed to assess medication adherence using Morisky's 8-Item Medication Adherence Scale at baseline and nine months. Medication adherence improved with the adherence aids used. At nine months, 51% of patients were highly adherent in the intervention group, compared with 21% in the control group. Adherence improved for a higher proportion of patients in the intervention group than the control group (49% vs. 18%). Morisky's score decreased in almost half of control group cases. Patients were most satisfied with face-to-face counselling (86%) and the information booklet (83%) and least satisfied with text messages (9%). Tailored patient education improved the medication adherence of patients with chronic myeloid leukaemia. Without this, adherence behaviour tended to decline. Personal communication with a nurse proved to be an essential part of adherence support and should not be ignored.

Patient Centered Approach and Health Related Quality of Life in Essential Hypertensive Patients

Hypertension is a common chronic disease amenable to control by adopting relevant lifestyle modifications and/or appropriate medication. The aim of the study was to assess the effect of patient centered approach on self-reported health related quality of life (HRQoL) in patients with essential hypertension attending Internal Medicine outpatient clinic in Zagazig University hospital. This single blinded randomized controlled clinical trial was conducted in Zagazig university internal medicine outpatient clinic on 112 non complicated apparently healthy essential hypertensive patients without comorbidities from 45 to 65 years old randomly allocated into two groups (intervention and control 1:1). Data for this study was collected by social, biological and SF-12v2 questionnaire for both groups. Then management of the intervention group according to the patient centered approach for nine months while patients within control group received classic disease centered approach. The patients within intervention group were given an individualized medical care and tailored patient education program about essential hypertension. The outcome of disease was assessed by measuring change in blood pressure control and health related quality of life within the two groups. It has been found that patients with essential hypertension within both groups reported deteriorated HRQoL yet there was no statistically significant difference between both groups regarding HRQoL at the start of the study. By the end of the study, there was a statistically significant difference between the two study groups regarding blood pressure control and self reported health related quality of life where patients within intervention group reported statistically significant improvement in both variables. In conclusion, the patient centered approach is better than the disease centered approach in management of patients with essential hypertension.

Simplicity, flexibility, and respect: preferences related to patient education in hardly reached people with type 2 diabetes

Individuals with lower income and less education are two to four times more likely to develop diabetes than more advantaged individuals. In response to this, there is a need for developing health promotion activities targeting hardly reached populations. The aim of this study was to examine the perspectives of hardly reached people with type 2 diabetes on patient education, focusing on their wishes and needs regarding format and approach. Data were collected through qualitative interviews with nine individuals with type 2 diabetes with little or no education and characterized as hardly reached patients by health professionals. Interviews were transcribed verbatim and analyzed according to systematic text condensation. We identified four main categories of preferences for patient education: 1) flexibility related to start time, duration, and intensity; 2) simple and concrete education tools, with regard to design and extent; 3) being together, related to meeting people in a similar situation; and 4) respectful educators, related to constructive patient–educator relationships. Insights into the preferences of hardly reached people with diabetes can contribute to the development of appropriately tailored patient education for this patient group.