Readability of Diabetes Education Materials: Implications for Reaching Patients with Written Materials

Objetivo: Determinar el nivel educativo necesario para comprender los materiales educa­­tivos suministrados a pacientes diabéticos por organizaciones gubernamentales y NGOs. Materiales y métodos: Este es un estudio descriptivo que explora la legibilidad de 81 materiales de educación disponibles a pacientes con diabetes y distribuidos por proveedores de salud. Se utilizó 2 medidas para determinar los niveles de legibilidad de los materiales informativos para diabéticos, el SMOG Readability Formula y el Fray Graph. La mues­­tra excluyó materiales educativos que no estuvieran en inglés y aquellos con objetivos comerciales. Para el análisis se utilizó medidas descriptivas y prueba t para muestras y se interpretó el valor de p. Resultados: Los resultados muestran que aunque los materiales provistos por organizaciones no gubernamentales son más fáciles de leer, éstos están generalmente escritos a niveles de lectura más alta de la audiencia para la cual son desarrollados. Conclusiones: Se concluye que los materiales educativos de educación en salud para dia­­béticos no permiten una comprensión total de su contenido, ya que están escritos utilizando vocabulario más complejo que el que posee la población que los recibe.Palabras clave: Diabetes Mellitus, educación en salud, alfabetismo en salud.AbstractObjective: To ascertain the health literacy levels of diabetes patient education materials distributed by government-funded or nonprofit organization.Methods: This descriptive study explored readability levels of 81 written diabetes health education materials available from healthcare providers. The Simplified Measure of Gobbledygoop (SMOG) readability formula and the Fray Graph were utilized to determine readability levels of diabetes patient information materials. The sample size excluded materials not in English and those with commercial purposes. Data analysis included measures of central tendency. In adition used t test and p-value.Results: Results from this study show that while education materials provided by nonprofit organizations are easier to read, they are still generally above the reading level of a large portion of the population they are intended to reach.Conclusion: Results from this study suggest that the majority of diabetes patient education materials are not adequate to reach their intended population due to high readability levels.Keywords: diabete mellitus, health education,health literacy

Fotonovelas and Anglo Designs in Health Communications for Spanish-Speaking Residents along the U.S.-Mexico Border

This study compares the intercultural instructional designs, based on eight intercultural value sets, of two types of health communications for Spanish-speaking U.S.-Mexico border populations. The first design is the fotonovela, or photo drama pamphlet, an approach that is well developed in Latin America and modeled after the famous Latin American television soap opera genre of telenovelas. This design dramatizes health information in culturally appropriate ways. The second design is Anglo dominant, representing predominant rhetorical and cultural preferences of the United States. Grounded in a Texas Health Equity project, the research team created a fotonovela for septic maintenance for border colonias. The team then compared the preference and effectiveness of the fotonovela to an existing EPA manual that reflected the Anglo dominant design, asking Spanish-speaking residents on the U.S. side of the U.S.-Mexico border their preferences for instructional designs. The results showed a very strong correlation between the fotonovela/Anglo designs and birthplace, language proficiency, and education. These results suggest that professional communicators need to move beyond demographics in designing their health communications for Spanish-speaking audiences. Instead, the study proposes a typology of five Hispanic/Latino identities for the U.S.-Mexico border, which helps professional communicators better assess rhetoric preferences and traditions

Development and pretesting of culturally appropriate nutrition education materials and messages for low income Latina immigrants of Guilford County.

The purpose of this study was to develop and pre-test culturally appropriate, theoretically-based nutrition education materials targeting low-income Latina immigrant caretakers in Guilford County, North Carolina. Six focus groups and three household interviews were held with low-income Latina caretakers (N=20 women total) to identify key areas of interest, preferences, and concerns regarding their family’s diet. Sessions were conducted by a bicultural, bilingual community interviewer using a semi-structured question guide. Interviews were conducted in Spanish, tape recorded, transcribed and translated. Content analysis identified common themes. A response was considered a “theme” if mentioned greater than five times by different participants. Many women reported they cannot identify healthy foods when shopping and wanted tips about how to do so. The most common challenge reported was persuading children to eat vegetables. Most requested healthy recipes that are child-friendly and include serving size information. Spanish translated, colorful recipe cards or brochures were the most requested materials. Many wanted healthier recipes for traditional Hispanic dishes. These findings indicate that this low income group is very interested in providing healthy foods to their families and want the skills to do so. Thus, results were used to develop nutrition education messages and materials based on the Social Cognitive Theory. Materials were pretested with the target audience (N= 6) and revised accordingly. This project was funded by the NC Agricultural Research Service

Eating Like a Rainbow: The Development of a Visual Aid for Nutritional Treatment of CKD Patients. A South African Project.

Providing nutritional education for chronic kidney disease (CKD) patients in South Africa is complicated by several conditions: the population is composed of diverse ethnic groups, each with its own culture and food preferences; eleven languages are spoken and illiteracy is common in the lower socio-economic groups. Food preparation and storage are affected by the lack of electricity and refrigeration, and this contributes to a monotonous diet. In traditional African culture, two meals per day are often shared “from the pot”, making portion control difficult. There is both under- and over-nutrition; late referral of CKD is common. Good quality protein intake is often insufficient and there are several misconceptions about protein sources. There is a low intake of vegetables and fruit, while daily sodium intake is high, averaging 10 g/day, mostly from discretionary sources. On this background, we would like to describe the development of a simplified, visual approach to the “renal diet”, principally addressed to illiterate/non-English speaking CKD patients in Southern Africa, using illustrations to replace writing. This tool “Five steps to improve renal diet compliance”, also called “Eating like a Rainbow”, was developed to try to increase patients’ understanding, and has so far only been informally validated by feedback from users. The interest of this study is based on underlining the feasibility of dietary education even in difficult populations, focusing attention on this fundamental issue of CKD care in particular in countries with limited access to chronic dialysis

Live Well Springfield – A Community Transformation Movement: Evaluation of the Live Well Springfield Website

The Live Well Springfield (LWS) movement is a collaborative effort of partner organizations in Springfield, Massachusetts. The project promotes healthy living by increasing knowledge and awareness of food and physical activity. A key LWS strategy was the creation of a website to function as an information hub. In addition to local event and health information, the website features 16 narratives depicting residents practicing healthy lifestyle choices, designed to encourage community engagement. To date, there has been no evaluation of the website’s reach and effect. A mixed methods approach, surveys and focus group discussions, was designed to collect data from people who live, work, or attend school in Springfield. Focus group participants were recruited in person at Springfield Community College, via recruitment posters (distributed at STCC), and through email requests from a previously compiled list of residents willing to be contacted. A website evaluation survey was developed using eHealth research constructs and the Expectation-Confirmation Model (ECM). This survey measured users’ perceived quality and satisfaction with the website. The survey was accessible via the livewellspringfield.org homepage, the LWS Facebook page, and emailed directly to potential respondents. The validated eHealth Literacy Scale (eHEALS) was incorporated into the survey and focus group sessions to assess self-reported skills for using eHealth resources. Each hour-long focus group (n=5 and n=6, respectively) was video/audio recorded and fully transcribed. Focus group transcripts were analyzed to thematically organize responses to narratives and fact-based health messages and assess the appeal, relevance, effectiveness, perceived purpose, and appropriateness. Survey data was analyzed to produce frequencies, descriptive statistics, and correlations. A mean eHEALS score of 4.22 of 5.00 (SD=0.83) was calculated from 36 responses, suggesting this sample felt very knowledgeable and confident using eHealth resources. Health Literacy Advisor (HLA) software was used to analyze an aggregate of all narratives, resulting in a Fry-based reading grade level of 8.4. On a five-point Likert scale, mean satisfaction with the website was 4.71 (SD=0.53), and mean likelihood to return was 4.76 (SD=0.51). Content analysis of focus group transcripts resulted in 184 responses coded for one or more themes. The largest proportion of responses (40.2%) related to effectiveness. One third of these effectiveness-related responses were negative toward the fact-based examples. Although the narratives were greatly preferred in both groups, all respondents made comments or agreed with suggestions to have both affective narratives and strictly fact-based health messages accessible, regardless of initial preferences. Results and interpretations will be reported to LWS partners to inform potential revisions of the website revisions and contribute to ongoing activities of the LWS initiative

Exploring West Virginia diabetes educators\u27 perceptions of and experiences with integrating Internet technology in their practice

The purpose of the study was to explore how diabetes educators integrate Internet technology in their medical practice. The study focused on diabetes educators\u27 perceptions and experiences using the Internet to provide diabetes education and how this educational strategy has influenced their diabetes educator-patient relationships.;Employing both quantitative and qualitative research methodologies, the research population of this study involved 41 diabetes educators working in West Virginia. The quantitative research method consisted of a survey with a series of correlational analyses to describe perceptions and use of computer and Internet that diabetes educators employed in their practice. The qualitative case study followed the quantitative design. Using maximum variation sampling strategy, five diabetes educators were purposively sampled. In-depth interviews were conducted at the educators\u27 worksites. Case and cross-case analyses were conducted to answer how educators\u27 perceptions and other factors relate to their integration of Internet technology in their practice.;The results from this research point to the following: educators shared a favorable view of Internet technology, integrated the Internet technology in their practice in a variety of methods, felt that computer use increased their productivity, and viewed their patients bringing information retrieved from the Internet as opportunities for additional education. Diabetes educators are becoming better consumers of online diabetes information. With the use of the Internet to interact with their patients more frequently, educators can extend the reach of counseling.;The study was limited to diabetes educators practicing in West Virginia. Diabetes educators practicing in urban other states may have different perspectives and experiences on how Internet technology could work for diabetes self-management

The Effect of an Educational Intervention on Oral Anticoagulation Therapy Knowledge in Primary Care

It is estimated that three million people in the United States are on oral anticoagulation therapy (warfarin). Populations studied have been found in therapeutic range 64% of the time (Pernod, Labarere, & Bosson, 2008). The low percentage of therapeutic range is attributable to (a) adherence, (b) monitoring infrequency, (c) Vitamin K antagonists, and (d) the effects of aging and comorbidities. The purpose of this evidence-based practice (EBP) project was to examine whether an educational intervention would improve the knowledge of patients receiving warfarin therapy. Roy’s model for patient adaptation and the Stetler Model for EBP were used as frameworks for the project. A pretest/posttest design was used over a 2-week period that included 38 patients aged 42 through 90 (M = 74.7, SD = 10.1). An educational intervention done by the project manager using a booklet, video, and food models on warfarin therapy was completed after the pretest. Patients’ INR (International Normalized Ratio) values were tracked at pretest, posttest, and every two weeks for twelve weeks. A paired sample t test found a statistically significant difference between the pre- and posttest scores. The mean pretest score was 11.11; SD = 2.35 compared to the posttest mean score of 12.48; SD = 1.45; (t (37) = - 4.215, p \u3c .001). No significant difference from pretest INR to posttest INR was found (t (26) = -2.002, p \u3e .056). A Cochran’s Q test showed INR results from 4 to 12 weeks were not statistically significant (x²(4) = 4, p \u3e .406). Results demonstrated that an educational intervention improved patient knowledge, but the intervention did not improve the patients’ INR values over two weeks, or over the four to 12 week time frame. There were no trends over time, other than to support the literature of a low percentage of the population in therapeutic range. Replication of this EBP project has been patterned by the project manager’s institution

What are the informational needs of patients with ANCA Associated Vasculitis? a Mixed Methods Study

Background: The ANCA –associated vasculitides (AAVs) are a group of rare, potentially life-threatening conditions which if untreated can be fatal. Little is known about the information needs of people with AAV. Objectives: To explore what it is like to be diagnosed with AAV and to find out the informational needs of this group. Study design: A mixed methods approach using focus groups and one-to-one interviews, then a questionnaire surveying the membership of Vasculitis UK (VUK) and the Vasculitis Clinical Research Consortium (VCRC). Results: Emergent themes from the first phase were: reaction to diagnosis, need for information on disease management and access to knowledgeable practitioners. There were 314 VUK, 273 VCRC respondents. Respondents rated information on diagnosis, prognosis, investigations, treatment, and side effects as extremely important. Information on patient support groups and psychosocial care was less important. There was no difference in the ratings of information needs based on group, sex, age, disease duration, disease, or method of questionnaire delivery. Conclusion: Receiving the diagnosis of a rare, potentially life-threatening disease causes anxiety and fear and can impede information retention and recall. People with AAV seek specific information concerning their disease, treatment regimes and side effects, and the results of investigations. Individuals preferred to receive this information from a doctor. Recommendations: Patients with AAV should be treated in a similar manner to patients with other chronic illnesses in which patient education is a fundamental part of care

The impact of food allergy on household level

Adverse reactions to food can be caused by food hypersensitivity. Prominent examples include food allergy or food intolerance. Patients suffering from food hypersensitivity have inappropriate autoimmune system reactions to potentially harmless food components. Symptoms can vary from uncomfortable skin rashes to cardiovascular problems such as anaphylactic shock. To date, no general cure is available. As a consequence, the management of food allergy consists of allergen avoidance, which may cause negative consequences in terms of patient anxiety and their experience of quality of life. Furthermore, implementation of dietary restrictions can have a negative effect on the quality of life and economic functioning of not only the food allergic patient but also their family members. An important issue in the assessment of the impact of food hypersensitivity and food allergy is the assessment of the economic costs that accrue to afflicted consumers. This information will contribute to the prioritising of healthcare resources, as well as developing effective policies to insure consumer protection. It is also important to evaluate whether wellbeing and welfare are affected. If this is indeed the case, a question arises as how to best manage dietary avoidance strategies. The aim of the research reported in this thesis is to provide information salient to the assessment of the impact of food hypersensitivity and allergy on households with respect to costs (time and money), welfare, well-being, and information search strategies. A systematic review of the existing literature revealed that researchers had not yet developed and validated an instrument to measure the individual and household costs of food hypersensitivity and/ or allergy. This thesis describes the development of the “household costs of food allergy” questionnaire and the exploratory analyses applied to validate the instrument. Thereafter, the “household costs of food allergy” questionnaire was used on a large sample of clinician-diagnosed food hypersensitive patients to confirm these cost effects. This study was part of an epidemiological study to investigate the prevalence of food allergy and food intolerance in four European countries, data were collected in The Netherlands, Poland, Spain and the United Kingdom. The respondents in this study were either diagnosed with food allergy or food intolerance. For the purposes of this discussion, the term food hypersensitivity will be used to indicate both diseases. Contrary to expectation, households with food hypersensitive respondents had significantly lower direct and indirect costs across all countries compared to households without food hypersensitive members. In addition, no differences in welfare between food hypersensitive respondents and respondents asymptomatic to foods were found. However, adult food hypersensitive respondents and their spouses reported significantly less happiness than respondents, or their spouses, who were asymptomatic. Thus, the results presented in this thesis do not support the commonly held belief of clinical researcher and patient organisations that all food allergies incur high costs to the individual. Given that an individual’s experience of quality of life is negatively impacted by food hypersensitivity, it is feasible that this might be improved by the implementation of more effective management strategies. As the primary viable management strategy involves avoidance of problematic foods, facilitating consumer choice in the retail environment may optimise risk management. The labelling preferences of food allergic consumers were investigated in two European countries, The Netherlands and Greece. At the time the research was conducted, food legislation had been developed to facilitate management of food allergens in order to protect food allergic consumers, rather than food intolerant consumers. For this reason, the research was confined to the study of the information needs of food allergic patients, and how this related to the current legislative situation. The research utilised ethnographic interviews with food allergic consumers during the course of shopping in a supermarket. The results suggest that current labelling practice is perceived to be inadequate for food allergic consumers if safe food choices are to be made. This is due to inappropriate use of fonts, colours with low contrasts and inconsistencies in the different languages, application of precautionary labelling, and lack of European and international harmonisation in labelling legislation. Based on these results, new information scenarios, such as uniform labelling, information booklet and ICT solutions, were developed and tested through an online survey. The results were used to develop prototype information delivery tools. An experiment was conducted to understand if the information delivery was in fact optimal, and to confirm if the additional attributes of the prototype tools were sufficient to facilitate allergen avoidance. The results suggested that the label should show the percentages of the allergens in the food product, as well as provide specific details about allergy management in the food chain, and use standardised symbols and standardised location of allergy information on the package. Additional visual and auditory warnings were also treated as being important for the ICT driven information delivery approaches, the results indicated that ICT methods are not appropriate replacements for effective food labelling on packaging, but may be used to supplement information provided by labels. To conclude, this thesis provides insight in the financial impact of food hypersensitivity, as well as the welfare and well-being. The “household costs of food allergy” questionnaire can be used by regulators and policy makers to prioritise healthcare resources, as well as to test the effectiveness of policy interventions. Limitations in current risk management strategies based on consumer information were also identified. The results of the consumer preferences studies can be used by policy makers and food industry to optimise the information delivery to food allergic consumers and therewith improve their quality of life. The combination of economic research and consumer research is relevant to investigate the dynamic impact of food allergy on individuals and their families. <br/