Web-based Educational Materials Research Articles

1819-LB: A Health Communication Assessment of Oral Self-Care Contents in Web-Based Education Materials for People with Diabetes

1819-LB: A Health Communication Assessment of Oral Self-Care Contents in Web-Based Education Materials for People with Diabetes

Assessing readability and comprehension of web-based patient education materials by American Heart Association (AHA) and CardioSmart online platform by American College of Cardiology (ACC): How useful are these websites for patient understanding?

Cardiovascular diseases (CVD) are a leading cause of morbidity & mortality worldwide. Patient education materials help patients understand the disease and its management. Health literacy is an important challenge that may contribute to health inequities and disparities. The National Institute of Health and American Medical Association recommend patient education materials to be ≤6th-grade reading level. ObjectiveTo evaluate readability and comprehension of patient education materials related to CVD, available at the American Heart Association (AHA) & CardioSmart web platform by the American College of Cardiology (ACC) websites. MethodWe examined the readability and comprehension of 63 patient education materials (accessed June 2022) using: (a) Flesch Kincaid Readability Ease (FKRE): measures readability (0–100, goal > 70), (b) Flesch Kincaid Grade Level (FKGL) (goal = grade 7). We compared the AHA and ACC scores using descriptive and t-tests. P-value ≤ 0.05 was significant. ResultsSixty-three web pages of patient education materials (AHA 24, ACC 39) were reviewed in June 2022. Mean ± standard deviation (SD) FKRE was 54.9 ± 6.8 for all the web pages. FKRE 50–60 equates to “fairly difficult to read.” Mean ± SD FKGL was 10.0 ± 1.3. AHA patient education materials content was significantly more difficult to read and comprehend, were longer, and had more complex words than ACC patient education materials. ConclusionsCVD-related patient education materials available online through leading national organizations are not congruent with the recommendations from national healthcare organizations. They are not as user-friendly as they can be. Urgent recognition of the gaps and unmet needs are indicated to optimize patient health literacy.

Web-based patient educational material on chimeric antigen receptor T-cell therapy: Quantitative assessment of readability.

11040 Background: Chimeric antigen receptor (CAR) T-cell therapy is another paradigm-shifting advancement for hematologic malignancies, creating unprecedented treatment options. However, there is still a lack of knowledge and understanding among patients regarding this novel therapy. Most patients turn to online resources, ranging from social media to federal websites, to gather health information to supplement decision-making. Given that the average American adult reads between the sixth- and eighth-grade levels, national organizations recommend that patient resources be written at the sixth-grade level or below. The purpose of this study was to evaluate web-based patient educational material on CAR -T cell therapy resources using measures of readability and compare it to national guidelines. Methods: Online patient information on CAR-T cell therapy from the top 20 U.S Cancer center as per US news ranking was collected. We analyzed the content by six of the most common readability tests- Flesch Reading Ease score (FRE), Gunning Fog (GF), Flesch-Kincaid Grade Level (FKGL), Coleman-Liau Index (CLI), Simple Measure of Gobbledygook (SMOG) Index, and the Automated Readability Index (ARI). The text from each article was carefully reviewed and analyzed using the software Readable, and the readability scores with standard deviation (SD) were obtained. Results: The mean score FRE score was 48.5 (SD: 6.7), which corresponds to college level and is difficult to read. The mean GF score was 8.7(SD: 1.5), which represents the writing of an 8th grader. The FKGL score was 8.6 (SD: 1.1), which represents a level of 8th grade or above. The mean CLI score was 11.5(SD: 1.3), which is the text level for high school juniors. The mean SMOG index was 10.9 (SD: 1), which is the level of a 12th grader. The ARI score was 7.8 (SD: 1.3), indicating a 7th-grade level. Conclusions: Overall, web-based CAR- T cell therapy patient educational materials scored poorly and does not meet the national recommendations. Authors of patient resources should incorporate readability criteria and prompt a revision or creation of new educational materials including videos and audio to support general patient understanding. By making CAR-T therapy information easily understandable, internet users can be better informed about their treatment decisions.

Misunderstood terms and concepts identified through user testing of educational materials for fragile X premutation: "Not weak or fragile?"

Complicated genetic mechanisms and unpredictable health risks associated with the FMR1 premutation can result in challenges for patient education when the diagnosis is made in a newborn. From October 15, 2018, to December 10, 2021, North Carolina parents could obtain FMR1 premutation results about their newborns through a voluntary expanded newborn screening research study. The study provided confirmatory testing, parental testing, and genetic counseling. We developed web-based educational materials to augment information about fragile X premutation conveyed by a genetic counselor. Many genetics education materials are developed for the lay population. However, relatively little research is published on how well individuals understand these materials. We conducted three rounds of iterative user testing interviews to help refine web-based educational materials that support understanding and self-paced learning. The participants included 25 parents with a 2-year college degree or less and without a child identified with fragile X syndrome, premutation, or gray-zone allele. Content analysis of interview transcripts resulted in iterative changes and ultimately saturation of findings. Across all rounds of interviews, there were two terms that were commonly misunderstood (fragile and carrier) and two terms that elicited initial misconceptions that were overcome by participants. Many also had difficulty understanding the relationship between fragile X premutation and fragile X syndrome as well as appreciating the implications of having a "fragile X gene." Website layout, formatting, and graphics also influenced comprehension. Despite iterative changes to the content, certain issues with understandability persisted. The findings support the need for user testing to identify misconceptions that may interfere with understanding and using genetic information. Here, we describe a process used to develop and refine evidence-based, understandable parental resources on fragile X premutation. Additionally, we provide recommendations to address ongoing educational challenges and discuss the potential impact of bias on the part of expert content developers.

How understandable are the patient education materials about flat foot on the Internet for parents?

Flat foot is a common reason for parents to visit orthopedic clinics. As the Internet has become an easy-search platform, parents often seek online educational materials before seeking out a professional. The aim of this study was to investigate the quality, readability, and understandability of such online materials for parents. An Internet search was performed for "flat foot" and "pes planus" using the Google search engine. The readability was evaluated using 6 different grading systems: Flesch Reading Ease Score, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, Fry Readability score, Gunning Fog Index tests, and Automated Readability Index. The Patient Education Materials Assessment Tool test was used to assess the understandability. For quality assessment, the Journal of American Medical Association benchmark criteria and Health on the Net code were applied. One hundred nine websites were included and evaluated for readability, understandability, and quality. The mean readability grade for all websites was 10.5 ± 2.0. The mean Gunning Fog Index tests and Flesch-Kincaid Grade Level scores for all websites were 12.4 ± 2.2 and 9.7 ± 2.1 sequentially. The mean Coleman-Liau index score was 10.0 ± 1.5, and the average Fry Readability score was 9.9 ± 2.0. The automated readability index for all websites was 10.3 ± 2.5. The average Flesch Reading Ease score for all educational materials was 59.3 ± 10.1. The average Patient Education Materials Assessment Tool score for all educational materials was 81% (range, 70-87%). The mean Journal of American Medical Association benchmark criterion for all websites was 1.0, with a range from 1.0 and 2.0. Eighteen (16.5%) websites had Health on the Net certificates. Readability, understandability, and quality of patient education materials about flat feet on the Internet vary and are often worse than professional recommendations.

Effectiveness of Standard vs Enhanced Self-measurement of Blood Pressure Paired With a Connected Smartphone Application

Self-measured blood pressure (SMBP) with commercially available connected smartphone applications may help patients effectively use SMBP measurements. To determine if enhanced SMBP paired with a connected smartphone application was superior to standard SMBP for blood pressure (BP) reduction or patient satisfaction. This randomized clinical trial was conducted among 23 health systems participating in PCORnet, the National Patient-Centered Clinical Research Network, and included patients who reported having uncontrolled BP at their last clinic visit, a desire to lower their BP, and a smartphone. Enrollment and randomization occurred from August 3, 2019, to December 31, 2020, which was followed by 6 months of follow-up for each patient. Analysis commenced shortly thereafter. Eligible participants were randomly assigned to enhanced SMBP using a device that paired with a connected smartphone application (enhanced) or a standard device (standard). Participants received their device in the mail, along with web-based educational materials and phone-based support as needed. No clinician engagement was undertaken, and the study provided no special mechanisms for delivering measurements to clinicians for use in BP management. Reduction in systolic BP, defined as the difference between clinic BP at baseline and the most recent clinic BP extracted from electronic health records at 6 months. Enrolled participants (1051 enhanced [50.0%] vs 1050 standard [50.0%]; 1191 women [56.7%]) were mostly middle-aged or older (mean [SD] age, 58 [13] years), nearly a third were Black or Hispanic (645 [31%]), and most were relatively comfortable using technology (mean [SD], 4.1 [1.1] of 5). The mean (SD) change in systolic BP from baseline to 6 months was -10.8 (18) mm Hg vs -10.6 (18) mm Hg (enhanced vs standard: adjusted difference, -0.19 mm Hg; 95% CI, -1.83 to 1.44; P = .81). Secondary outcomes were mostly null, except for documented attainment of BP control to lower than 140/<90 mm Hg, which occurred in 32% enhanced vs 29% standard groups (odds ratio, 1.15; 95% CI, 1.01-1.34). Most participants were very likely to recommend their SMBP device to a friend (70% vs 69%). This randomized clinical trial found that enhanced SMBP paired with a smartphone application is not superior to standard SMBP for BP reduction or patient satisfaction. ClinicalTrials.gov Identifier: NCT03796689.

An evaluation of readability and understandability of online education materials for breast cancer survivors.

We aimed to determine the availability of existing web-based educational materials on breast cancer survivorship and assess their readability and understandability. We identified materials eligible for review in two ways: (1) reviews of websites of major cancer-related organizations (e.g., American Cancer Society); (2) Google searches for breast cancer survivorship, breast cancer, breast cancer follow-up care, and cancer survivorship. We measured Flesch-Kincaid and New Dale Readability of existing breast cancer and breast cancer survivorship materials. Readability grade levels 5 to 8 were considered ideal to acceptable. We used the Patient Education Materials Assessment Tool (PEMAT) to measure the understandability of 53 videos and 152 written materials, such as booklets and manuals. A resource was considered understandable and/or actionable if it scored ≥ 70% on either the understandability section or the actionability section of the PEMAT. We identified a total of 205 existing materials including brochures, booklets, facts sheets, websites, and videos in English. The average Flesch-Kincaid grade score of written educational materials was 9.7 (range 3.5-16.4), which translates to a 9th grade reading level. According to the New Dale-Chall readability assessment, most of the materials were in the 9 to 10 grade level range. The average PEMAT score was 88.6% (range 56-100%). Patient educational materials are available online as printable, written materials, and videos and they focus on a wide selection of survivorship-related topics. Most of the breast cancer educational materials that are available online were above an 8th grade reading level. The PEMAT results, however, suggest that materials are easy to understand regarding word choice and style, use of numbers, organization, layout and design, and use of visual aids. Understandable patient education materials are essential for guiding breast cancer survivors towards improving their health outcomes and optimizing their quality of life.

Web-Based Patient Educational Material on Osteosarcoma: Quantitative Assessment of Readability and Understandability.

BackgroundPatients often turn to web-based resources following the diagnosis of osteosarcoma. To be fully understood by average American adults, the American Medical Association (AMA) and National Institutes of Health (NIH) recommend web-based health information to be written at a 6th grade level or lower. Previous analyses of osteosarcoma resources have not measured whether text is written such that readers can process key information (understandability) or identify available actions to take (actionability). The Patient Education Materials Assessment Tool (PEMAT) is a validated measurement of understandability and actionability.ObjectiveThe purpose of this study was to evaluate web-based osteosarcoma resources using measures of readability, understandability, and actionability.MethodsUsing the search term “osteosarcoma,” two independent Google searches were performed on March 7, 2020 (by AGS), and March 11, 2020 (by TRG). The top 50 results were collected. Websites were included if they were directed at providing patient education on osteosarcoma. Readability was quantified using validated algorithms: Flesh-Kincaid Grade Ease (FKGE), Flesch-Kincaid Grade-Level (FKGL). A higher FKGE score indicates that the material is easier to read. All other readability scores represent the US school grade level. Two independent PEMAT assessments were performed with independent scores assigned for both understandability and actionability. A PEMAT score of 70% or below is considered poorly understandable or poorly actionable. Statistical significance was defined as P≤.05.ResultsTwo searches yielded 53 unique websites, of which 37 (70%) met the inclusion criteria. The mean FKGE and FKGL scores were 40.8 (SD 13.6) and 12.0 (SD 2.4), respectively. No website scored within the acceptable NIH or AHA recommended reading level. Only 4 (11%) and 1 (3%) website met the acceptable understandability and actionability threshold. Both understandability and actionability were positively correlated with FKGE (ρ=0.55, P<.001; ρ=0.60, P<.001), but were otherwise not significantly associated with other readability scores. There were no associations between readability (P=.15), understandability (P=.20), or actionability (P=.31) scores and Google rank.ConclusionsOverall, web-based osteosarcoma patient educational materials scored poorly with respect to readability, understandability, and actionability. None of the web-based resources scored at the recommended reading level. Only 4 achieved the appropriate score to be considered understandable by the general public. Authors of patient resources should incorporate PEMAT and readability criteria to improve web-based resources to support patient understanding.

Assessment of the Readability of Web-Based Patient Education Material From Major Canadian Pediatric Associations: Cross-sectional Study.

BackgroundWeb-based patient education materials (PEMs) are frequently written above the recommended reading level in North America. Poor PEM readability limits the accessibility of medical information for individuals with average literacy levels or lower. Pediatric hospital and association websites have not only been shown to be a preferred source of information among caregivers but have also become a necessity during the COVID-19 pandemic. The readability of Canadian pediatric association websites has not yet been assessed.ObjectiveThe aim of this study is to determine if the content of PEMs from Canadian pediatric associations is written at a reading level that the majority of Canadians can understand.MethodsA total of 258 PEMs were extracted from 10 Canadian pediatric associations and evaluated for their reading level using 10 validated readability scales. The PEMs underwent a difficult word analysis and comparisons between PEMs from different associations were conducted.ResultsWeb-based PEMs were identified from 3 pediatric association websites, where the reading level (calculated as a grade level) was found to be an average of 8.8 (SD 1.8) for the Caring for Kids website, 9.5 (SD 2.2) for the Pediatric Endocrine Group website, and 13.1 (SD 2.1) for the Atlantic Pediatric Society website. The difficult word analysis identified that 19.9% (SD 6.6%) of words were unfamiliar, with 13.3% (SD 5.3%) and 31.9% (SD 6.1%) of words being considered complex (≥3 syllables) and long (≥6 letters), respectively.ConclusionsThe web-based PEMs were found to be written above the recommended seventh-grade reading level for Canadians. Consideration should be made to create PEMs at an appropriate reading level for both patients and their caregivers to encourage health literacy and ultimately promote preventative health behaviors and improve child health outcomes.

A Health Communication Assessment of Web-based Obstructive Sleep Apnea Patient Education Materials.

BackgroundThe current care pathway for screening, diagnosis, and treatment for obstructive sleep apnea (OSA) is often fragmented and heavily reliant on patient action, leading to delays and gaps in care, which disproportionately affect race and ethnic minorities. There is a need for well-designed, accessible patient education materials (PEMs) to improve OSA awareness and empower those at risk for the condition with the necessary knowledge and skills to adhere to treatment.ObjectiveOur study aimed to evaluate the understandability, accessibility, actionability, and readability of web-based PEMs designed for patients with OSA and their families and caregivers.MethodsWe engaged patients with OSA, clinicians, and patient advocates (n = 11) to identify a list of web-based OSA PEMs from the media, medical centers, medical device companies, and health professional and patient advocacy organizations. Two trained coders scored the PEMs using validated health communication assessments, including the Centers for Disease Control and Prevention Clear Communication Index (CCI; on a scale from 0 to 100%); the Patient Education Materials Assessment Tool (PEMAT), which features subscales for understandability and actionability, each measured from 0 to 100%; and readability measures, including the Simple Measure of Gobbledygook and Flesch-Kincaid, which correspond to grade levels.ResultsWe identified 20 web-based PEMs, which included websites (n = 12, 60%), online flyers (n = 4, 20%), videos (n = 3, 15%), and one discussion board (n = 1, 5%). Scores on the CCI ranged from 21.4 to 85.7%. No PEMs met the CCI cutoff (90%). Scores on the PEMAT scales for understandability ranged from 37.5 to 100%. Scores on the PEMAT scales for actionability ranged from 0 to 100%. Fifteen percent of the PEMs met the PEMAT cutoff for understandability and actionability. Readability of the PEMs ranged from a 5th to a 15th-grade reading level, as scored by the Simple Measure of Gobbledygook and Flesch-Kincaid. Only one PEM (5%) met the recommended sixth-grade reading level.ConclusionOur study found that the majority of commonly used web-based PEMs for OSA did not meet recommended standards for clear communication and health literacy demands. OSA practitioners and future research should consider health communication best practices to design PEMs that reduce the gap between materials and average patient health literacy.

Quality evaluation of patient educational resources for catheter ablation treatment of atrial fibrillation.

The prevalence of atrial fibrillation (AF) is increasing rapidly with the growing utilization of catheter ablation (CA) as a treatment strategy. Education for individuals undertaking this procedure is diverse, with varying degrees of information provided and little standardization. Many individuals utilize the internet as an educational resource. However, there is limited regulation of online patient information. To evaluate the quality of web-based patient education resources for patients undergoing CA for AF. A cross-sectional observational study was performed to obtain all freely accessible online educational resources about CA for AF from inception until 1 October 2019. Search engines used: Google, Yahoo!, and Bing. The Patient Education Materials Assessment Tool (PEMAT) was used to evaluate the quality of web-based patient education materials and printable tools. The PEMAT score objectively measures both the understandability and actionability of educational material. A total of 17 websites and 15 printable sources were included in the analysis. Non-government organizations developed 19% of materials and 75% were created by private or university hospitals. Nineteen sources (59.4%) were rated as highly understandable: 9 websites (52.9%) and 10 printable tools (66.7%). Seven sources (21.9%) were rated as highly actionable: 6 (35.3%) websites and 1 (6.7%) printable tool. The overall understandability of educational CA material was high, whilst improvement of actionability is warranted. The addition of summaries, visual aids, and tools, such as checklists may improve quality. These findings have significant implications for the development of patient educational material for CA in AF.

Quality evaluation of patient educational resources for catheter ablation of atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background The prevalence of atrial fibrillation (AF) is increasing rapidly with growing utilisation of catheter ablation (CA) as a treatment strategy. Education of individuals undertaking this procedure is diverse, with varying degrees of information provided and little standardisation. Many individuals utilise the internet as an educational resource. However, there is limited regulation of online patient information. Aims The purpose of this study was to evaluate the quality of web based patient education resources for patients undergoing CA in the management of AF. Methods A cross-sectional observational study was performed to obtain all freely accessible online educational resources designed to inform AF patients about CA. from inception until 1st October 2019. Three search engines were used: Google, Yahoo! and Bing, using the search terms "atrial fibrillation" and "catheter ablation" combined with "patient information and patient education" in English and Spanish. The Patient Education Materials Assessment Tool (PEMAT) is a validated tool used to evaluate web-based patient education materials as well as printable tools. The PEMAT score objectively measures the understandability and actionability of printable tools for audio-visual material. Results A total of 17 websites and 15 printable tools were included in the analysis. Non-government organizations developed 19% of materials and 75% were created by private or university hospitals. Nineteen materials (59.3%) were rated as highly understandable and 25 materials (21%) were rated as highly actionable, whilst ten materials had an actionability of 0% (6 websites and 4 printable tools). Less than a half of the materials evaluated were highly rated by the PEMAT score, with a total of 7 websites (41%) and 7 printable tools (46,6%) scoring &amp;gt;70%. Conclusion The overall understandability of educational CA material was high, whilst improvement of actionability is warranted. The addition of summaries, visual aids and tools such as checklists may improve quality. These findings have significant implications for developing new patient educational material for CA in AF.

Simulation-based education for staff managing aggression and high-risk behaviors in children with autism spectrum disorder in the hospital setting: A pilot and feasibility cluster randomized controlled trial

Background and objective: Aggression and high-risk behaviors, which can result in behavioral emergencies, are common in children with autism and can be magnified in the hospital environment. Children with autism, with or without intellectual disability, have complex communication needs which require a sophisticated level of knowledge, understanding and skill from health care professionals. Pediatric acute care nursing staff are often not trained and lack confidence in managing children with autism. The purpose of this study was to conduct a pilot and feasibility cluster randomized controlled trial (RCT) of simulation-based education for staff in managing behavioral emergencies with autism spectrum disorder (ASD) in the hospital setting.Methods: This study used a mixed method, to explore the acceptability and feasibility of delivering a large-scale cluster RCT and assess trial processes including recruitment, completion rates, contamination, and outcome measures. The simulation-based training format comprised two scenarios involving an adolescent with autism, intellectual disability and aggressive behaviors. Two pediatric wards of similar size and patient complexity were selected to participate in the study and randomized to receive either simulation-based education plus web-based education materials or web-based education materials only. Results: The RCT design is feasible with recruitment, acceptability and completion rates reaching target. Self-perceived baseline levels of confidence in managing aggression in children were mid-range and lower for children with autism and intellectual disability. Forty to fifty percent of intervention participants rated the training highly in terms of developing skills and knowledge respectively. The mean group score for observer ratings of de-escalation across four simulations was 20 out of a possible 35. Data for ward aggression were not collected.Conclusions: Simulation-based education is an acceptable training format for acute care pediatric nurses. This study is feasible to conduct as a cluster RCT with some modifications to this protocol including assessment of baseline differences in confidence. Observer ratings of de-escalation skills indicated that more than one episode of training may be required for acute care pediatric staff to successfully de-escalate aggressive incidents. As such, we will use repeated simulation scenario exercises for each intervention group in the next trial.

Tablet-based patient educational interventions in care and management of complex movement disorders

Background Patient education is an essential part of management of complex, disabling neurological disorders. Mobile web-based educational materials provide a novel and potentially valuable means to communicate clinical information that can aid in both medical management and rehabilitation. Aims We, therefore, evaluated an educational tablet-based intervention in three patient cohorts regarding the following topics: Parkinson’s disease (PD) medications, dystonia and botulinum toxin treatment. Methods A total of 50 subjects with PD, 32 with dystonia and 61 receiving botulinum toxin treatment for movement disorders or sialorrhoea were enrolled. Participants in each cohort completed a specific educational module at the time of their regularly scheduled clinic visit, comprising slides, in addition to pre- and post-module quizzes and a satisfaction survey. Additionally, participants in the dystonia and botulinum toxin modules were given a follow-up test at their 3- or 6-month clinical treatment visit. Results There were 143 participants with 50 completing the PD module, 32 completing the dystonia module and 61 completing the botulinum toxin module. All three groups demonstrated significant improvement in knowledge of module content between their pre- and post-module test scores (PD: p=.0001, dystonia: p<.0001 and botulinum toxin: p=.008), and those who took the dystonia module maintained significant improvement at either a 3- or 6-month follow up compared to pre-module (p <.0001). Conclusions Tablet-based teaching modules are an effective means of communicating key concepts to patients. This study supports their use for improving patient understanding that can support lifelong approaches to managing disabling, neurological conditions. Implication for Rehabilitation Tablet-based modules are relatively easy to use for enhancing education during clinic visits and can possibly help reduce and maintain disability with chronic conditions like Parkinson’s disease and dystonia. Improvements in post-test scores suggested that patient participants were able to retain information from the tablets about their complex and challenging conditions and treatments. Adding patients who are fluent in another language would have made this study more generalizable and future studies exploring educational interventions are warranted to help better tailor interventions to patients with chronic neurologic illnesses to help understand the complex aspects of their medical and rehabilitation therapy. The effect of cognitive changes in neurological conditions and understanding of educational information needs to be further tested. This positive result is especially meaningful during the COVID-19 pandemic when in-person access to both medical and rehabilitative care has been curtailed.

Integrated Development Frameworks Based on Linked Data for Web- Based Interactive Educational Materials

This paper treats one of the activities of ICER (Innovation Centre for Educational Resources) in Kyushu University Library of Kyushu University, Japan. It is the development of attractive educational materials using recent ICT (Information Communication Technologies) like 3D CG (Computer Graphics) and VR (Virtual Reality) for enhancing the educational efficiency in the university. The authors have already proposed a framework dedicated for the development of web-based interactive 3D educational materials. Firstly, this paper introduces this development framework and its educational material example of Japanese history education. For developing attractive educational materials, such materials need multimedia contents like images and videos related to the teaching target. If the multimedia contents can be retrieved from the Internet, the development cost can be reduced. To do so, the authors focused on Linked Data and have already proposed an authoring tool of educational materials based on Linked Data. Furthermore, the authors integrated the authoring tool into the development framework. Secondly, this paper introduces the integrated development framework based on Lined Data and its educational materials of two teaching targets, i.e., IoT security education and Japanese history education. Furthermore, the authors have proposed another educational material development framework that supports 360VR images/videos and integrated the authoring tool with it. Finally, this paper introduces this integrated development framework based on Linked Data and its example educational material for IoT security education.

The Readability of Online Educational Materials for Femoroacetabular Impingement Syndrome.

Level III.

Gaps in Online Breast Cancer Treatment Information for Older Women

For women older than 70years with early-stage breast cancer, the routine use of sentinel lymph node biopsy (SLNB) and adjuvant radiotherapy offers no overall survival benefit and may be perceived as undesirable by many women. National guidelines allow possible omission of these practices for older women. This study aimed to assess the availability of web-based educational materials targeting older women and their age-specific treatment recommendations. The study systematically assessed the websites of the top 25 "Best Hospitals for Cancer" ranked by the U.S. News & World Report, as well as the websites of four prominent national cancer organizations. Websites for the leading cancer hospitals and national cancer organizations contain extremely limited information directed toward older patients with breast cancer. Both SLNB and adjuvant radiotherapy are described as treatments "typically," "most often," or "usually" used in combination with breast-conserving surgery without circumstances noted for possible omission. Specifically, no hospital website and only one national organization in this study included information on the recommendation to avoid routine SLNB. Only two hospitals and two national organizations included information suggesting possible omission of adjuvant radiotherapy for patients older than 70years. The absence of online material for older patients with breast cancer represents a gap potentially contributing to overtreatment by framing SLNB and adjuvant radiotherapy as necessary. Informational resources available to women aged 70years or older may aid in informed physician-patient communication and decision-making, which may reduce SLNB and adjuvant radiotherapy for patients who might opt out of these procedures if fully informed about them.

Understandability and Actionability of Web-based Education Materials on Hypertension Management

Hypertension websites are widely and easily accessible. This study aims to assess the understandability and actionability of hypertension websites. Eight websites that met the inclusion criteria were included. Eight experts were appointed to evaluate the websites using PEMAT instrument. The overall mean scores for understandability and actionability were 76.08% and 52.83% respectively. One website did not meet the criteria for understandability (score of ≥70%), while almost all materials failed to meet the criteria for actionability (score of ≤70%). In conclusion, this study provides evidence that many of the available hypertension websites can be easily understood but are less actionable. Keywords: Hypertension; Health promotion; Internet; Website quality eISSN: 2398-4287© 2020. The Authors. Published for AMER ABRA cE-Bsby e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning &amp; Surveying, UniversitiTeknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v5i14.2230

Simulation-Based Education for Staff Managing Aggression and Externalizing Behaviors in Children With Autism Spectrum Disorder in the Hospital Setting: Pilot and Feasibility Study Protocol for a Cluster Randomized Controlled Trial.

BackgroundChildren with autism spectrum disorder (ASD) frequently demonstrate aggression and externalizing behaviors in the acute care hospital environment. Pediatric acute care nursing staff are often not trained in managing aggression and, in particular, lack confidence in preventing and managing externalizing behaviors in children with ASD. High-fidelity simulation exercises will be used in this study to provide deliberate practice for acute care pediatric nursing staff in the management of aggressive and externalizing behaviors.ObjectiveThe purpose of this study is to conduct a pilot and feasibility cluster randomized controlled trial (RCT) to evaluate the effectiveness of simulation-based education for staff in managing aggression and externalizing behaviors of children with ASD in the hospital setting.MethodsThis study has a mixed design, with between-group and within-participant comparisons to explore the acceptability and feasibility of delivering a large-scale cluster RCT. The trial process, including recruitment, completion rates, contamination, and completion of outcome measures, will be assessed and reported as percentages. This study will assess the acceptability of the simulation-based training format for two scenarios involving an adolescent with autism, with or without intellectual disability, who displays aggressive and externalizing behaviors and the resulting change in confidence in managing clinical aggression. Two pediatric wards of similar size and patient complexity will be selected to participate in the study; they will be randomized to receive either simulation-based education plus web-based educational materials or the web-based educational materials only. Change in confidence will be assessed using pre- and posttraining surveys for bedside nursing staff exposed to the training and the control group who will receive the web-based training materials. Knowledge retention 3 months posttraining, as well as continued confidence and exposure to clinical aggression, will be assessed via surveys. Changes in confidence and competence will be compared statistically with the chi-square test using before-and-after data to compare the proportion of those who have high confidence between the two arms at baseline and at follow-up. The simulation-based education will be recorded with trained assessors reviewing participants’ abilities to de-escalate aggressive behaviors using a validated tool. This data will be analyzed using mean values and SDs to understand the variation in performance of individuals who undertake the training. Data from each participating ward will be collected during each shift for the duration of the study to assess the number of aggressive incidents and successful de-escalation for patients with ASD. Total change in Code Grey activations will also be assessed, with both datasets analyzed using descriptive statistics.ResultsThis study gained ethical approval from The Royal Children's Hospital Melbourne Human Research Ethics Committee (HREC) on November 1, 2019 (HREC reference number: 56684). Data collection was completed in February 2020. Data analysis is due to commence with results anticipated by August 2020.ConclusionsWe hypothesize that this study is feasible to be conducted as a cluster RCT and that simulation-based training will be acceptable for acute care pediatric nurses. We anticipate that the intervention ward will have increased confidence in managing clinical aggression in children with ASD immediately and up to 3 months posttraining.Trial RegistrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000139976; http://www.ANZCTR.org.au/ACTRN12620000139976.aspxInternational Registered Report Identifier (IRRID)DERR1-10.2196/18105

Evaluating the Understandability and Actionability of Web-Based Education Materials for Patients Taking Non-vitamin K Oral Anticoagulants.

More patients are now taking high-risk medicines such as non-vitamin K oral anticoagulants (NOACs). Hence, patient education materials need to be in an understandable format so that they can be empowered to act on their knowledge. Factors such as health literacy and the design of the medicine information material may influence the patient's ability to understand and act on key information. The PRISMA checklist was used to inform the study design. A structured search was conducted to obtain all freely accessible online educational resources designed for patients about the non-vitamin K antagonists (NOACs) during August 2018. Three search engines were used: Google, Yahoo! and Bing, using the search terms "NOAC" and "anticoagulant" combined with "patient/consumer information and patient/consumer resources."We applied the Patient Education Materials Assessment Tool (PEMAT) to evaluate web-based patient education materials in terms of understandability and actionability for patients taking NOACs. Of the 35 materials included, the majority of the materials (n=32, 91%) were rated as highly understandable (PEMAT score ≥70%), and more than three-quarters of all the materials (n=29, 83%) were rated as poorly actionable (PEMAT score <70%). For understandability, the majority of materials neither provided a summary of the key points nor used visual aids for several items such as simple tables, illustrations, and photographs. For actionability, few materials provided a tangible tool, such as a checklist, to prompt the user into action (n=4). Few used visual aids such as nonverbal cues to the written instructions (n=4). To improve the understandability and actionability of most of the NOAC patient education materials, there is a need to include more summaries of information, visual aids, and tangible tools such as checklists. Further research is warranted where patients are involved in providing feedback on the design of medicine information materials for NOACs.