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PubMed1993

Outreach childbirth education classes for low-income families: a strategy for program development.

Childbirth and parenting education programs are coming to the forefront of public health initiatives aimed at the reduction of infant mortality and low birth-weight in high-risk groups in the United States. Childbirth education programs have proven effective in helping parents make positive life style changes and can play an important role in the reduction of risks associated with poor pregnancy outcomes. Childbirth education gives parents the knowledge, desire, and confidence they need to change their health behaviors. The Florida Outreach Childbirth Education Project offers an example of a statewide program designed to serve a high risk population: low-income, low-literacy families.

Female↗

PubMed2005

Treating chronic hepatitis C in the primary care setting.

The National Institutes of Health and other institutions have emphasized the need to expand access to treatment of chronic hepatitis C virus infection to a larger and more diverse patient population. To begin to address this need, the divisions of General Internal Medicine and Liver Diseases of the Mount Sinai Medical Center created a program to identify patients who might benefit from hepatitis C treatment, to treat uncomplicated patients in the primary care setting, and to refer appropriate patients to liver disease specialists. Preliminary data from this program suggest that primary care-based treatment of chronic hepatitis C may offer unique advantages. The primary care setting allows special needs to be addressed and allows comprehensive services to be provided. Patients are guided through the complex pretreatment evaluation process, and non-liver-related comorbidities are managed. Our program may provide a useful model for increasing hepatitis C literacy among primary care providers and for extending treatment to a broader population of patients with hepatitis C.

Health Services Accessibility↗

PubMed1993

Experiences with a science hotline.

Scientific literacy of the population may be enhanced by outreach programs conducted by universities. One such program, the University of Kentucky Science Hotline, has been successful in attracting and answering many inquiries from students, teachers, and others. The authors describe the organization and management of this hotline. The operation is inexpensive and efficient, with 35 faculty and staff members in 21 departments responding to 515 calls during the first year of operation. Fifty-four outreach visits were arranged through the hotline. Other benefits have included a more positive public image of scientists and the creation of links between academic scientists and precollege teachers.

Hotlines↗

PubMedDate not supplied

Low literacy levels in adults: implications for patient education.

BACKGROUND: Patients are being discharged with the need for more complex care in the home. Written information frequently is used in health education. Patients and caregivers must be able to read and understand this information. METHOD: A comprehensive literature review of articles on literacy and health education materials was performed. RESULTS: The literature review revealed that low literacy is more prevalent in the United States than is generally recognized. Health education materials often require a reading level higher than the reading level of most patients. There are a number of tools available for assessing reading levels. CONCLUSION: Findings indicate there are implications for nursing practice, education, and research. There is a need for nurses to be aware of the prevalence of low literacy. They need to know how to accurately assess reading ability and develop material that is at the appropriate level for patients and caregivers. There is a need for research to investigate possible relationships between health status and low literacy and to examine the effects of remedial reading programs on health practices.

Adult↗

PubMed1991

The 1990s and beyond: determining the need for community health and primary care nurses for rural populations.

Increased numbers of primary care and advanced practice nurses with unique generalist skills will be required to meet the accelerating physiologic and sociocultural health care needs of rural populations. Several factors have been identified that will influence the demands and position of community-based nurses in rural practice settings during the next decade. A back-to-basics type of health care offered out of a growing elderly population; technological breakthroughs that make it possible for more chronically ill patients to live at home; serious substance abuse and other adolescent problems; AIDS; and high infant morbidity and mortality statistics are only some of the concerns that will demand nursing intervention. These changes speak to the need for improved nursing coordination, stronger collegial relationships, and better communication between physicians and nurses. Health care is moving in new directions to offer more efficient and technologically sophisticated care. These changes enhance the need for clinically expert educators who teach and jointly practice in programs with a rural focus. Telecommunications, and heightened computer literacy, will play a major role both in nursing education and clinical practice. The goals of kindergarten through 12th grade health promotion and disease prevention strategies in school health will be the norm and will require better prepared, and positions for, school nurses. More midwives and public health nurses will be needed to care for the growing population of sexually active adolescents who are in need of family planning and prenatal care. Underinsured and indigent populations will continue to fall within the purview of midlevel practitioners, as will providing anesthesia services in small rural hospitals. The transition of some rural hospitals into expanded primary care units (e.g., EACHs and RPCHs), and new models of case management will greatly influence nursing demands. This paper will further identify critical areas of advanced practice nursing within community settings, including new relationships with other health care providers, and will introduce strategies upon which rural health policy recommendations for the 1990s can be addressed.

Community Health Nursing↗

PubMedDate not supplied

Health literacy: an introduction to the literature.

Adult literacy is inextricably linked with adults' understanding of educational and informational materials concerning their health. Approximately 90 million American adults are functionally illiterate or have only marginal reading skills. This article describe the impact of poor literacy skills on patient health and the scope of the challenges to health literacy. The author also describes simple steps which dentists can undertake to identify patients with poor literacy skills and methods which may help improve educational programs for those patients.

Adult↗

PubMedDate not supplied

OSHA regulations on universal precautions: a sample training curriculum.

1. Training must be provided to each newly hired employee before that employee can work in a risk environment. Current staff must be trained annually, and additional training must be provided when infection control or universal precaution techniques are revised. 2. Training should include written material, oral presentations, films, videos, computer programs, and audio tapes at the employee's educational, literacy, and language level. Interactive discussion between the trainer and employees is required. 3. Employee evaluation should consist of written pretraining and posttraining tests and a practical demonstration of steps to protect against infectious diseases in the workplace.

Curriculum↗

PubMed2001

The health information brochure: a useful tool for chiropractic practice?

BACKGROUND: It has been suggested that clinicians should be looking at new ways to enhance their patients' self-care. Patient education is one strategy that primary providers may use. OBJECTIVE: This study investigates the format in which patients would like to pursue their health education within the chiropractic clinic. METHODS: An exploratory study of chiropractic patients was undertaken to investigate patients' preferred health education formats, their commitment to pursuing health objectives, and their literacy level. Purposive sampling of 9 Australian chiropractic clinics was undertaken. Convenience sampling of patients attending these clinics resulted in 102 patients participating. Participants completed a questionnaire. A research assistant was available to clarify any questions. Data were collected and collated. A Likert scale was used to capture responses to questions ascertaining patient opinions. RESULTS: Patients considered health the most important of the life objectives listed; however, they preferred spending time with family to undertaking health- and fitness-promoting activity. More chiropractic patients opted for health information brochures than health promotion classes, personally supervised self-care programs, or practitioner-supervised self-care contracts. Patient literacy levels varied within and between clinics. CONCLUSIONS: Brochures may provide a definitive health information tool for chiropractors who limit their clinical role to primary contact and a helpful adjunct to patient education for chiropractors committed to a primary care role. However, care should be taken to select brochures consistent with the patients' literacy level. Tips for selecting and preparing suitable brochures are provided. The discrepancy between how greatly patients value health and how they prefer spending their time may have implications for successful behavior change. Brochures may not alone constitute adequate practitioner involvement.

Adult↗

PubMedDate not supplied

Computer literacy study: report of qualitative findings.

Computer literacy and information literacy are critical to the future of nursing. The very nature of health care is being transformed in response to environmental drivers such as the demands for cost-effective delivery of high quality services and enhanced patient safety. Facilitating the quality transformation depends on strategic changes such as implementing evidence-based practice (), promoting outcome research (), initiating interdisciplinary care coordination [Zwarenstein, M., Bryant, W. (2004). Interventions to promote collaboration between nurses and doctors. The Cochrane Library(I)], and implementing electronic health records (). Information management serves as a central premise of each of these strategies and is an essential tool to facilitate change. This report of the analysis of qualitative data from a national online survey of baccalaureate nursing education programs describes the current level of integration of the computer literacy and information literacy skills and competencies of nursing faculty, clinicians, and students in the United States. The outcomes of the study are important to guide curriculum development in meeting the changing health care environmental demands for quality, cost-effectiveness, and safety.

Anthropology, Cultural↗

PubMed2001

The role of inadequate health literacy skills in colorectal cancer screening.

Colorectal cancer is ideally suited for early detection strategies that are likely to improve survival rates. Screening with either a fecal occult blood test (FOBT) or flexible sigmoidoscopy has been shown to identify precancerous polyps or cancers in early stages. However, persons with limited education and of lower socioeconomic status infrequently participate in screening programs in general and have very low rates of colorectal screening. Low literacy, which is common among persons with limited education and low income, may be an overlooked factor in understanding patients' decision making about colorectal cancer screening. This article provides information from focus groups about colorectal cancer screening, which we examine in the context of relevant literature on cancer screening and literacy. Using the health belief model, we examine the association between inadequate health literacy skills and low rates of colorectal cancer screening. The theoretical model also provides insights into strategies for improving knowledge, attitudes, and beliefs and screening rates for this challenging patient population.

Colorectal Neoplasms↗

PubMedDate not supplied

Supporting cardiac recovery through eHealth technology.

The Internet continues to evolve as a popular and increasingly vital channel for health information and communication among patients, families, and health providers. This article provides an overview of published studies that have described or tested Internet-based resources and interventions designed to support recovery and enhance health outcomes for the cardiac population. Three categories of applications are discussed: (1) peer support communities; (2) information support through automated, tailored patient education; and (3) professionally facilitated education and support programs. The article also address key issues such as barriers to innovation adoption, patient literacy, and the digital divide that must be overcome for successful integration of such interventions into clinical practice. How Internet-based interventions will fit with existing conventional programs and clinical practice structures is not yet clear. However, evidence that supports use of this new communication channel is likely to emerge as more programs are developed and rigorously evaluated.

Cardiac Rehabilitation↗

PubMedDate not supplied

Predicting achievement of a low-fat diet: a nutrition intervention for adults with low literacy skills.

BACKGROUND: This paper identifies factors that predict achievement of a low-fat diet among 242 California adults with low literacy skills, following their participation in the Stanford Nutrition Action Program (SNAP), a randomized classroom-based nutrition intervention trial (1993-1994). METHODS: The intervention classes received a newly developed curriculum that focuses on reducing dietary fat intake (SNAP); the control classes received an existing general nutrition (GN) curriculum. Data were collected at baseline and 3 months postintervention. This hypothesis-generating analysis uses a signal detection method to identify mutually exclusive groups that met the goal of a low fat diet, defined as < 30% of calories from total fat, at 3 months postintervention. RESULTS: Three mutually exclusive groups were identified. Twenty-three percent of Group 1, participants with high baseline dietary fat (> 60 g) who received either the GN or the SNAP curriculum, met the postintervention goal of < 30% of calories from total fat. Thirty-four percent of Group 2, participants with moderate baseline dietary fat (< or = 60 g) who received the GN curriculum, were successful. Sixty percent of Group 3, participants with moderate baseline dietary fat who received the SNAP curriculum, were successful. Members of Group 3 also significantly increased their intake of vegetables, grains, and fiber. CONCLUSIONS: Within this population of adults with low literacy skills, a large proportion of those with moderate baseline dietary fat who participated in the SNAP classes met the postintervention criteria for a low-fat diet. A much smaller proportion of those with high baseline dietary fat were successful, suggesting that this group may benefit from different, more intensive, or longer-term interventions.

Adult↗

PubMedDate not supplied

Developing an outcomes management program in a public health department.

A local public health department planned and implemented a comprehensive outcomes management program over a 5-year period. Critical components included commitment of leadership and staff, collaborative decision-making related to clinical record software selection, extensive staff training and support in documentation and automation, and ongoing evaluation. This successful program now provides reliable and valid quantitative outcomes data for the department.

Computer Literacy↗

PubMed2004

Methodology of an ongoing, randomized, controlled trial to improve drug use for elderly patients with chronic heart failure.

BACKGROUND: Medications can improve the functioning and health-related quality of life of patients with chronic heart failure (CHF) and reduce morbidity, mortality, and costs of treatment. However, patients may not adhere to therapy. Patients with complex medication regimens and low health literacy are at risk for nonadherence. OBJECTIVE: The primary goal of this project is to develop and assess a multilevel pharmacy-based program to improve patient medication adherence and health outcomes for elderly CHF patients with low health literacy. METHODS: In this 4-year, controlled trial, patients aged 50 years with a diagnosis of CHF who are being treated at Wishard Health Services (Indianapolis, Indiana) are randomly assigned to pharmacist intervention or usual care. Intervention patients receive 9 months of pharmacist support and 3 months of postintervention follow-up. The intervention involves a pharmacist providing verbal and written education, icon-based labeling of medication containers, and therapeutic monitoring. The pharmacist identifies patients' barriers to appropriate drug use, coaches them on overcoming these barriers, and coordinates medication use issues with their primary care providers. Daily updates of relevant monitoring data are delivered via an electronic medical record system and stored in a personal computer system designed to support pharmacist monitoring and facilitate documentation of interventions. To measure medication adherence objectively, electronic monitoring lids are used on all CHF medications for patients in both study groups. Other assessments include self-reported medication adherence, results of echocardiography (eg, ejection fraction), brain natriuretic peptide concentrations, and health-related quality of life. Health services utilization, refill adherence, and cost data derive from electronic medical records. After completion of this study, the data can be used to assess the effectiveness and cost-effectiveness of our intervention. RESULTS: One hundred twenty-two patients have been assigned to receive the intervention and 192 to receive usual care. CONCLUSIONS: Our study aims to improve patients' knowledge and self-management of their medication and to improve medication monitoring in a multilevel pharmacy-based intervention. By doing so, we intend that the intervention will improve the health outcomes of elderly patients with CHF.

Aged↗

PubMed2006

Acknowledging adult bias: a focus-group approach to utilizing beauty salons as health-education portals for inner-city adolescent girls.

To assess the feasibility of using beauticians as health literacy agents and beauty salons as health-education portals for adolescent, inner-city, African American girls, the authors conducted focus groups with 25 women: salon clients, salon owners, and medical students. Facilitators to program development included (a) beautician-client relationships, (b) teens' access to health information, and (c) beauticians as information resources. Barriers included (a) adult opinions of teen behaviors, (b) teen mistrust of adults, and (c) low health literacy of beauticians. In developing a health-education program for this population, beauticians and salons may be excellent health information agents and portals if barriers including beautician poor health literacy, adolescent mistrust in adults, and adults' anti-adolescent bias are improved. Program implementation must not solely focus on teens but should also include adult salon users, with the goal of reaching the teens first through these adults and, with time and trust, reaching the teens directly.

Adolescent↗

PubMedDate not supplied

Preparing preceptors through online education.

Preceptor education is vital to the success of healthcare institutions. Preceptors' roles are complex and require up-to-the-minute programs reflecting crucial mentoring responsibilities for orientees in multifaceted working environments. Finding the time to properly educate preceptors while maintaining quality bedside care is a challenge for staff development educators during the nursing shortage. Offering a preceptor education program online can assist preceptors in the adoption of role changes in a timely manner. The outcome can provide excellent, competent, caring preceptors. In this article, the course content and intended outcomes of online preceptor preparation programs are discussed. The role of the staff development educator in assessing, planning, implementing, and evaluating online preceptor programs is also discussed.

Computer Literacy↗

PubMed1991

Clinic-based intervention to promote literacy. A pilot study.

Educational research has shown that children become literate more easily if their parents read to them. A clinic-based program was designed to encourage early book use among parents of children at risk. It included (1) waiting room readers, (2) guidance about literacy development, and (3) provision of children's books at each visit. Seventy-nine parents of children aged 6 to 60 months were interviewed. Parents who had previously received a book were more likely to report looking at books with their children or that looking at books was a favorite activity (adjusted odds ratio, 4.05). This association was strongest among parents receiving Aid to Families With Dependent Children (odds ratio, 7.8). This preliminary study suggests that pediatricians can play a role in enriching children's early literacy environments, especially for children at high risk of school failure.

Aid to Families with Dependent Children↗

PubMed1995

Two-generation programs: design, cost, and short-term effectiveness.

Two-generation programs are relatively new attempts to deal with the nation's social ills. In two-generation programs, services such as early childhood educational programs are offered to children to help them get the best possible start in life, while, at the same time, parents are offered training to help enhance their parenting skills, and education, literacy, or job training to help them become economically self-sufficient. These multistrategy programs are relatively new additions to the broad array of programs designed to serve children and families, but many have already been the subjects of fairly sophisticated evaluations. This article describes two-generation programs and how they differ from earlier single-focus approaches to serve children and families. In-depth descriptions of six premier two-generation programs are used to illustrate the variability in content and costs of these programs. The short-term results of these six programs are reviewed and indicate mixed and modest results in promoting the development of children and improving the parenting skills and economic self-sufficiency of parents. The results suggest several lessons, and the article concludes with recommendations for program improvement and future research.

Adolescent↗