Written Information Materials Research Articles

Evaluating the reliability of DISCERN: a tool for assessing the quality of written patient information on treatment choices

Patients require good quality, evidence based information so that they can participate actively in the decision making process. The DISCERN instrument has been developed to help patients rate the quality of written information materials about treatment choices. This study evaluated the reliability of DISCERN using 31 information leaflets discussing treatment options for prostate cancer. The index of agreement between two independent raters was substantial for the overall quality rating ( κ=0.65, 95% confidence interval 0.49, 0.82), indicating that the instrument could be used to discriminate reliably between low and high quality prostate cancer publications. Healthcare professionals should inform patients of the availability of the instrument and encourage its use by patients who regularly attend to written sources of information on treatment choices. Early indications show that DISCERN could enable both patients and healthcare professionals to discriminate between the plethora of variable quality information currently available.

Do undereducated patients read and understand written education materials?

Objectives: The aim of our study is to evaluate the effect of written information in improving the knowledge of the undereducated nonsteroidal anti-inflammatory drug (NSAID) users about the side effects of NSAIDs and to investigate the compliance of patients with the written information materials. Methods: Thirty patients received only verbal information, 38 patients received only written, and 40 patients received both verbal and written information. After seven or ten days a questionnaire was administered to the patients on the phone to assess the patients' knowledge. Results: Sixty one (78.2%) patients read the leaflets. Higher number of correct answers was obtained with both verbal and written information. Written information better informed than verbal information alone (p=0.02). Conclusion: We conclude that the undereducated patients will read and understand written education materials especially when the materials are written simple and short.

Evaluation of a patient file folder to improve the dissemination of written information materials for cancer patients.

Many cancer centers make available to patients written information material to supplement verbal information provided by clinicians. Randomized trials have demonstrated that providing such information can increase patient knowledge and satisfaction. However, little data are available regarding effective means of dissemination of such materials. The purpose of this study was to determine whether providing patients with a personal file folder after their first clinic appointment would improve the dissemination of written information materials and increase patient satisfaction. A before/after study was performed. Consecutive patients with newly diagnosed cancer attending the Hamilton Regional Cancer Centre were selected randomly and interviewed by telephone within 1-2 weeks of the first clinic appointment regarding the number of information pamphlets received, patient satisfaction, and general preference for written information materials. The preintervention evaluation (T1) occurred over a 4-month period followed by the introduction of the personal file folder into the clinical practice. Six weeks after its introduction, the postintervention (T2) evaluation took place over the ensuing 4 months. A total of 300 patients completed the evaluation (150 each in T1 and T2). Responding patients in the two time periods were comparable with respect to background demographic variables. The mean number of information pamphlets received by patients increased with the introduction of the personal file folder from 2.4+/-2.0 standard deviations (SD) in T1 to 3.6+/-2.5 SD in T2 (P=0.0001). The percentage of patients planned for treatment who received treatment-related information increased from 36% (42 of 116 patients) in T1 to 65% (68 of 105 patients) in T2 (P=0.002). Mean patient satisfaction increased from 3.3+/-1.1 SD to 3.8+/-1.0 SD over the 2 time periods (P=0.0001). The majority of patients (87%) believed it was important to receive written information materials. The patient file folder increased the dissemination of written information materials and currently is being incorporated into routine practice.

Risky business: challenges in vaccine risk communication.

* Abbreviations: AAP = : American Academy of Pediatrics • ACIP = : Advisory Committee on Immunization Practices • IPV = : inactivated polio vaccine • FDA = : Food and Drug Administration • DTwP = : diphtheria and tetanus toxoids and whole-cell pertussis vaccine • DTaP = : diphtheria and tetanus toxoids and acellular pertussis vaccine • DTP = : diphtheria, tetanus, and pertussis vaccine • CDC = : Centers for Disease Control and Prevention • NCVIA = : National Childhood Vaccine Injury Act • VICP = : Vaccine Injury Compensation Program • IOM = : Institute of Medicine • OPV = : oral polio vaccine • VIS = : Vaccine Information Statements Concern over vaccine safety has been a major determinant of immunization policy—from passage of the Biologics Control Act in 1902 to the recent American Academy of Pediatrics (AAP) and Advisory Committee on Immunization Practices (ACIP) recommendations for expanded use of inactivated polio (IPV) and acellular pertussis vaccines.1-4 With the availability of new vaccines and vaccination options comes the challenge of how best to communicate these options to patients and their parents. Lessons from the field of risk communication on predictors of risk acceptability and vaccination decision heuristics provide insight into why some parents resist vaccination. This article provides a historical perspective on vaccine adverse events and applies lessons from risk communication research to help physicians improve their ability to discuss vaccine risks. Immunizations have been described as the single most effective health intervention after clean water and sewage disposal,5 and have an extraordinary safety record. However, public policy has long reflected concern for the safety of vaccines and related biologics. In 1902, Congress passed the Biologics Control Act in response to the death of 13 children who had received injections of diphtheria antitoxin contaminated with tetanus toxin.6 This act required biologics to be manufactured in a manner that assured their safety, purity, and potency. Responsibility for these regulations was assigned originally to the Hygienic Laboratory of the Public Health Service, which evolved into the National Institutes of Health. The regulation of biologics including vaccines was transferred to the Food and Drug Administration (FDA) in 1972. The first published accounts of serious adverse events after whole cell pertussis vaccine occurred in 1933 with Madsen's7 report of two deaths within 48 hours of immunization, and in 1948 with the report in Pediatrics by Byers and Moll8 of encephalopathy after diphtheria and tetanus toxoids combined with whole-cell pertussis …

Small group intervention vs formal seminar for improving appropriate drug use

In an attempt to evaluate the efficacy of different methods of interventions to improve the appropriate use of drugs for acute diarrhoea, a controlled study has been carried out in 6 districts in Yogyakarta and Central Java provinces, Indonesia. This study was designed to investigate the impacts of two different methods of educational intervention, i.e. a small group face-to-face intervention and a formal seminar for prescribers, on prescribing practice in acute diarrhoea. The districts were randomly assigned into 3 groups and 15 health centers were selected from each district. Prescribers in Group 1 underwent a small group face-to-face intervention conducted in the respective health center. Those in Group 2 attended a formal seminar conducted at the district level. Prescribers in Group 3 served as the control group. Both interventions were given on a single occasion without follow-up supervision or monitoring. Written information materials on the appropriate management of acute diarrhoea were developed and were provided to all prescribers in the intervention groups. Focus group discussions (FGDs) involving prescribers and consumers in the 6 districts were carried out to identify various underlying motivations of drug use in acute diarrhoea. The findings of the FGDs were used as part of the intervention materials. To evaluate the impacts of these interventions on prescribing practice, a prescribing survey for patients under five years old with acute diarrhoea was carried out in health centers covering 3-month periods before and after the intervention. The results showed that both interventions were equally effective in improving the levels of knowledge of prescribers about the appropriate management of acute diarrhoea. They were also partially effective in improving the appropriate use of drugs, reducing the use of non-rehydration medications. There was a highly significant reduction of antimicrobial usage either after small-group face-to-face intervention (77.4 ± 2.7% to 60.4 ± 2.9%; P < 0.001) or formal seminar (82.3 ± 3.0% to 72.3 ± 3.6%; P < 0.001), and the former caused significantly ( P < 0.001) greater reduction than the latter. There was also a significant ( P < 0.01) reduction in the usage of antidiarrhoeals after both interventions, i.e. from 20.3 ± 3.7% to 12.5 ± 3.3% ( P < 0.01) after face-to-face intervention and from 48.5 ± 4.1% to 27.0 ± 4.3% ( P < 0.01) after seminar. However, the formal seminar had a significantly ( P < 0.01) greater impact than the small group face-to-face intervention. There was also a trend toward increased oral rehydration solution (ORS) usage after both interventions, but this did not achieve the level of statistical significance ( P > 0.05). No changes were observed in the control group. Although the small group face-to-face intervention did not appear to offer greater impacts over large seminars in improving the appropriate use of drugs in acute diarrhoea, since the unit cost of training is far less costly than the seminar, it might be feasibly implemented in the existing supervisory structure of the health system.

Supply of dental health information by 182 Dutch organizations working in the field of dentistry.

Little is known about the exchange of Dental Health Information (DHI), as part of the dental health education process, between the Dutch public, organizations active in or related to dentistry and Dutch dental professionals. Based on the ideas of HAVELOCK a communication model was developed. The main question was: how and through which organizations is information supplied, on what subjects related to dental health? A group was formed, consisting of 182 organizations and institutions and 85% decided to collaborate with the study. Telephone interviews were used for the sampling of the data. Of the 154 organizations and institutions only 56% reported to be active in the field of DHI. Preventive information appears to be the main subject. Not the public, but dental professionals and other provider groups are seen as the main target groups. DHI activities appear to consist mainly of providing written information material with a preventive content. These activities are hardly evaluated. Further on: there seems to be no central coordination for DHI activities in the Netherlands. It is concluded that in the field of DHI activities the resource system (organizations and institutions who generate information) and the users system (the public and dental patients) are not in accordance with each other.

Communication Behaviour of the Agricultural Extension Officers Working in Rural Development Blocks of Tamil Nadu

An analysis of the communication behaviour of the Agrl, extension workers revealed the following. The Agricultural Extension Officers were very poor in their output behaviour due to pre-occupation in their administrative and organization work in the office. Therefore facilities should be provided to relieve them from more of administration work and concent rate on other areas like educating the farmers, supervising and guiding the Village Level Ex- tension Workers and farmers in the field. The administrators should provide more opportu nities for the Agricultural Extension Officers to arrange special lectures, participating in radio broadcast and encouraging to write more of written information materials to the farming community. The information unit may be strengthened further to screen film shows and slide shows during evenings in the villages.