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Evaluating A Patient-Led Health Literacy Program for People Living With Metastatic Breast Cancer.

IntroductionLow cancer health literacy undermines patients' ability to interpret complex information and participate in shared decision making, and is associated with worse outcomes. Evidence for effective health literacy interventions in metastatic breast cancer (MBC) remains limited. We evaluated a patient-led, virtual health literacy program designed to strengthen MBC-specific knowledge and self-efficacy.MethodsWe conducted a mixed-methods, pre-post evaluation across two program iterations (Fall 2023; Spring 2024) delivered by a national, patient-led-MBC organization, Project Life. The five-week synchronous course called Spinning Science covered breast cancer subtyping, genetic/genomic testing, clinical trials, circulating tumor DNA, and information literacy, with small-group activities and polling. Program participants were adults living with MBC. De-identified pre/post surveys assessed (1) self-efficacy for engaging in health decisions, and (2) knowledge using items adapted from the Cancer Health Literacy Test aligned to course content. Paired two-sample t-tests examined pre-post changes (&#x3b1;=0.05). Open-ended responses were analyzed thematically.ResultsFifty-four people with MBC were enrolled (cohort 1, n=17; cohort 2, n=37); 46 provided matched pre- and post-surveys (14 and 32, respectively). Agreement with "I don't know enough to make my own medical decisions" declined from 43% pre to 13% post (p<0.05), indicating improved self-efficacy. Baseline knowledge scores were high, and knowledge item gains were not statistically significant, consistent with ceiling effects. Post-program items showed >80% agreement for increased confidence in self-advocacy, improved health literacy, and sense of community. Qualitative feedback highlighted strengths like digestible content, approachable patient facilitators and flexible scheduling, as well as priorities for refinement such as continued access to materials, and more MBC-specific and numeracy content.ConclusionsA patient-developed, virtual health literacy program for people living with MBC showed meaningful improvements in self-efficacy, with actionable, participant-driven refinements between cohorts. This model offers a practical, scalable pathway for advancing self-efficacy within and beyond MBC.

Humans

Computer literacy in today's medical center environment.

The need for computer literacy is becoming increasingly important across the broad scope of the American work scene. At the Wilford Hall USAF Medical Center (WHMC) numerous computer systems have been introduced into the operational environment. Training for these systems has been restricted primarily to transaction processing and routine report generation for those actually involved as users of these systems. WHMC has developed and implemented a broad computer literacy program designed generally to raise the computer literacy of the overall staff, and specifically to inform executive and middle management of the general capabilities of the computer systems. The program consists of a brown-bag lunchtime videotape theater on a series of computer-related subjects as well as formal classes developed in a modular format. Each formal class is tailored to the specific needs of the target executive or middle-management group.

Administrative Personnel

Preparing young people in Canada for emancipation from child welfare care.

Reviewing preparation-for-independence programs operating in Canada at present yields a number of observations. 1. A well-developed range of preparation-for-independence programs exists across Canada despite regional differences in both mandate and resources. 2. The resources, however, do not meet the need. There are not enough for each young person to be assured of getting what he or she needs for a successful transition. 3. Failure to develop an adequate resource will be costly in the long run. Those whom child welfare, in its parenting role, fails to prepare for independence and support adequately during the transition will most likely come to the attention of social services again either as social assistance recipients before adult welfare, or as parents and families requiring the services of the child welfare system within which they themselves grew up. 4. At the field level, effective solutions have been demonstrated. What remains to be achieved is the development of both political will and financial commitment on the part of the government to support the maintenance of existing programs, and the proliferation of an adequate range of additional programs. It must be ensured that all children for whom the state assumes responsibility benefit from an adequately supported transition into productive adulthood. As pointed out in a literacy program proposal prepared by the Pape Adolescent Resource Centre in Toronto: Unless the problems were addressed effectively, the probability was that the teens would be discharged from children's aid society care without the ability to support themselves in the community either economically or practically. In the absence of familial or institutional supports, a street life awaited them. Many had begun to apprentice for that reality. [Martin 1986: 2] Where the state has intervened to rescue a youth from inadequate parenting, the obligation exists for the state to properly complete the undertaking.

Activities of Daily Living

Prognosis: the adult with a learning disability.

Deficiencies in reading and writing appear to be major and lasting handicaps for learning-disabled college students. However, gains have been made in program modifications for learning-disabled students in many higher education institutions. Many adults with learning disabilities find that their handicap makes it difficult to obtain and keep jobs. Although they perceive a need for a wide range of educational and vocational services, there are few services available at most community agencies. Service providers and educators in vocational rehabilitation and adult education and literacy programs need to know more about learning disabilities in adults and how to identify such persons and provide them with more appropriate educational instruction and job counseling and training.

Adult

Availability and use of services for maternal and child health care in rural Nigeria.

A personal in-home interview was conducted in four rural towns in Nigeria. The aims of the interview were to describe the content of Maternal and Child Health (MCH) care in these rural towns and to assess how patterns of prenatal, delivery and postnatal service use are related to a variety of demographic and socioeconomic variables in the population. Findings from data analysis indicate that services available are deficient in terms of the number of centers and content of care. Variables found to be statistically significant (P less than 0.01) for use of services are maternal education, occupation, distance and previous use of a physician. Husband's occupation was significant only for prenatal registration, but not for subsequent use of services. Recommendations include a reorganization of rural MCH services and an introduction of female literacy programs, especially at the rural level.

Adolescent

Focus group responses of potential participants in a nutrition education program for individuals with limited literacy skills.

OBJECTIVE: To obtain information to direct the design and development of a nutrition intervention program targeted at a low-literacy audience. SUBJECTS: Thirty-nine female and two male clients of the Expanded Food and Nutrition Education Program (EFNEP) participated in five focus-group discussions. The focus groups included 23 African American, 9 white, 4 Southeast Asian, 1 American Indian, 2 Hispanic American, and 2 Middle Eastern EFNEP participants. DESIGN: All focus groups were moderated and co-moderated by University of Minnesota staff members. The focus groups were tape-recorded and transcribed. A written report was generated based on the independent evaluation of two staff members. RESULTS: We learned that EFNEP participants thought they would be motivated to change their eating habits for health concerns, including weight loss, and to help their families develop healthful eating habits. They mentioned several barriers to making changes, including extra time and money needed to purchase and prepare healthful foods, food preferences of family members, lack of interest and skills in cooking, and insufficient knowledge about which foods are healthful. Participants shared ideas for program content and delivery. CONCLUSIONS: Clients with limited literacy skills have valuable opinions and insights that program developers targeting this hard-to-reach group should hear. The EFNEP participants wanted simple, practical, and relevant information about what foods to eat and how to prepare them. They considered lectures an ineffective way to receive nutrition information, and they expressed a preference for hands-on activities that were enjoyable and allowed participants to share ideas and experiences.

Black or African American

Health status of illiterate adults: relation between literacy and health status among persons with low literacy skills.

BACKGROUND: In nonindustrialized nations, illiteracy is independently associated with poor health. The objective of this research was to determine whether such a relation exists in the United States. METHODS: One hundred ninety-three persons were randomly selected from a group of adult students enrolled in a publicly funded literacy training program. Subjects' health status was measured with the Sickness Impact Profile (SIP), a behaviorally based measure of sickness-related dysfunction. Subjects' literacy skills were also measured. Multivariate statistical techniques were then used to evaluate the relation between health status and literacy level and to adjust for confounding sociodemographic factors. RESULTS: The physical health (measured by the SIP) of subjects with extremely low reading levels was poor compared with that of subjects with higher reading levels. The relation between reading level and physical health was statistically significant (P less than 0.002), even after adjusting for confounding sociodemographic variables. Psychosocial health (measured by the SIP) was poor across all levels of reading skills and was comparable with the psychosocial health of populations with severe psychosocial disability. The relation between reading level and psychosocial health was statistically significant (P less than 0.02) after adjusting for confounding variables. CONCLUSIONS: In the United States, illiteracy and poor health status are independently associated.

Adolescent

Cognitive Behavioral Therapy vs Media Literacy for Prevention of Gaming Disorder and Unspecified Internet Use Disorder: A Randomized Clinical Trial.

IMPORTANCE: Mitigating the harmful effects of digitalization on youth mental health is essential. OBJECTIVES: To evaluate the effectiveness of cognitive behavioral therapy (CBT) compared with a media literacy-based intervention for gaming disorder and unspecified internet use disorder and to determine whether universal or indicated prevention yields stronger benefits. DESIGN, SETTING, AND PARTICIPANTS: PROTECTconfirm was a randomized clinical trial conducted from July 1, 2020, to August 31, 2024, across 44 secondary schools in Baden-W&#xfc;rttemberg, Germany, with 1-, 4-, and 12-month follow-up. All students were included in universal prevention analyses, whereas indicated prevention analyses included a subgroup of adolescents at high risk meeting 2 or more Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for gaming disorder or unspecified internet use disorder at baseline. INTERVENTIONS: Students were individually randomized within 90 classes to PROTECTtraining, a CBT-based program; or PROTECTinfo, a structurally parallel media literacy program. Both consisted of four 90-minute sessions delivered weekly during school hours by trained local prevention professionals under live supervision and adherence protocols. MAIN OUTCOMES AND MEASURES: The primary outcome was gaming disorder symptom severity and unspecified internet use disorder symptom severity, assessed at 12 months with a modified version of the Video Game Dependency Scale. Secondary outcomes included internalizing, externalizing, and transdiagnostic symptoms. Primary and secondary outcomes were analyzed according to the intention-to-treat principle. RESULTS: A total of 1793 students were randomized to PROTECTtraining (n&#x2009;=&#x2009;896; mean [SD] age, 13.1 [1.5] years; 498 male students [56.1%]) or PROTECTinfo (n&#x2009;=&#x2009;897; mean [SD] age, 13.1 [1.5] years; 484 male students [54.8%]). Participants in the subsample of 205 adolescents at high risk showed significantly lower 12-month severity of gaming disorder and unspecified internet use disorder symptoms with PROTECTtraining than with PROTECTinfo (mean [SD] Modified Video Game Dependency Scale score: 14.7 [9.7] vs 17.7 [10.3]; within-group Cohen d&#x2009;=&#x2009;-0.91 [95% CI, -1.10 to -0.72] vs Cohen d&#x2009;=&#x2009;-0.61 [95% CI, -0.80 to -0.42]; between-group Cohen d&#x2009;=&#x2009;-0.30 [95% CI, -0.55 to -0.05]), but not in the total sample (mean [SD] Modified Video Game Dependency Scale score: PROTECTtraining, 8.8 [8.3] vs PROTECTinfo, 9.4 [8.4]; within-group Cohen d&#x2009;=&#x2009;-0.11 [95% CI, -0.18 to -0.05] vs Cohen d&#x2009;=&#x2009;-0.04 [95% CI, -0.11 to 0.02]; between-group Cohen d&#x2009;=&#x2009;-0.07 [95% CI, -0.16 to 0.01]). Secondary outcomes did not differ significantly between groups. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of 1793 adolescents, the CBT-based intervention reduced gaming disorder symptoms and unspecified internet use disorder symptoms more effectively than the media literacy-based intervention among adolescents at high risk. These findings support the use of CBT-based approaches primarily within indicated, rather than universal, prevention. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) trial registration: DRKS00033989.

Humans

Computer literacy for physicians.

Medical schools and residency programs can help physicians acquire a basic knowledge of computers by offering education in computer literacy. The program currently being offered in the Family Practice Residency Program at Moses H. Cone Memorial Hospital has been integrated into the practice management curriculum and has proven very successful in its initial year. It has served to broaden the residents' knowledge of automation systems and has prepared them for the future automation of their offices. It is hoped this knowledge base will help physicians make sound decisions concerning the purchase of a computer system.

Computers

Nutrition education for cardiovascular disease prevention among low income populations--description and pilot evaluation of a physician-based model.

Low income Americans are at greatest risk for coronary heart disease but have least access to health promotion programs for life style modification. Primary care physicians may represent one of the few sources of preventive care available to the poor. However, the majority of physicians feel unprepared to help patients achieve dietary change, and few existing nutrition intervention programs address the special needs of low literacy populations. The Food for Heart Program was developed to facilitate dietary counseling experienced by primary care physicians who care for low literacy patients and to overcome barriers to behavior change faced by patients. The program consists of three components: (1) a validated dietary risk assessment that rapidly identifies atherogenic eating habits and requires no nutritional expertise to administer or interpret, (2) a structured diet treatment program that is culturally specific for a southern patient population and links practical behavior change recommendations with results of the diet assessment, and (3) a system for monitoring and reinforcement that prompts physicians to review progress, reinforce prior messages, and reward positive change. Behavior change theory is used to guide the intervention and readability of the material has been assessed at the 5-6th grade level. An evaluation study of the Food for Heart Program suggests that it has a positive impact on physician counseling and that patients are responding favorably to these efforts.

Cardiovascular Diseases

Providers link health with human service.

This issue's cover story looks at a handful of hospital leaders who appear to be radically redefining their hospital's role, but who are really just returning to the basics of hospital management and the basic hospital mission of community service. These CEOs of innercity hospitals are taking a leadership role in community development programs, ranging from literacy to housing. They bring together community groups to solve problems, work to find funding for projects, and attract new business to the hospital's service area. They also provide community residents with a sense of hope and a sense of stability. But their actions have ramifications that extend beyond their communities. These leaders may also be providing other health care executives with an approach to strategic planning that will add new meaning to the term "community hospital" in the 1990s.

Chicago

Evaluation of the Master's in Genomic Medicine framework: A national, multiprofessional program to educate health care professionals in NHS England.

PURPOSE: Genomic medicine is revolutionizing health care but requires health care professionals to update their understanding of genomics and its application to clinical practice for successful implementation. To meet this need, Health Education England developed the Master's in Genomic Medicine, a national multiprofessional program to increase genomic literacy in the National Health Service workforce. This study summarizes an evaluation of the program, which will inform its future development. METHODS: Underpinned by Moore's evaluation framework, a mixed methods approach was used to characterize (1) learner demographics, (2) perceptions of the program, (3) knowledge and/or qualifications achieved, and (4) the outcome(s) for practice in the workplace. RESULTS: Learners were a diverse cohort of health care professionals, including doctors, health care scientists, nurses and midwives. Participant satisfaction was high for all elements of the program, including the curriculum, learning environment(s), and multiprofessional cohort(s), despite the challenges of engaging working professionals in part-time learning. Both learners and their managers reported enhanced genomic practice after completion of their studies. CONCLUSION: The Master's in Genomic Medicine program is an effective approach to professional education in genomic medicine. This broad multiprofessional learning complements training aimed at specific groups of health care professionals.

Humans

Fostering literacy learning in supportive contexts.

Young children with learning disabilities typically encounter difficulty with academic tasks requiring intentional effort and effective use of metacognitive skills--qualities that competent readers and writers possess. In response to these difficulties, special educators often modify literacy instruction, isolating the "basic skills" of literacy (such as decoding and penmanship) from meaningful reading and writing activities. Such instruction contributes to impoverished notions of literacy and exacerbates problems of metacognition. The two research programs reported here challenge the conventional literacy instruction provided to many young students with LD. The programs are rooted in developmental and cognitive theory and research, as well as emergent literacy theory. The social nature of learning is emphasized, with a focus on the role of the teacher, the form of discourse, and the role of text in literacy instruction. Results show that children with learning disabilities benefit from strategy instruction occurring within classroom cultures that support collaborative discourse, the flexible application of comprehension strategies, and appropriate, meaningful opportunities for reading and writing.

Child

Computer speech-based training of literacy skills in neurologically impaired children: a controlled evaluation.

Twenty-two reading-disabled children were randomly assigned to one of four training conditions to evaluate the effectiveness of a computer speech-based system for training literacy skills. The sample included 17 children with significant neurological impairment of various etiologies (including spina bifida and hydrocephalus, seizure disorder, brain tumors, cerebral palsy, and head injury) and five developmental dyslexics. The training employed a "talking" computer system that provides synthesized speech feedback during the course of learning. The training conditions included three word recognition and spelling-training programs and a math-training control program. Three different literacy-training procedures were compared, with the size of the trained print-to-sound unit varying as letter-sound (LSD: train-->t/r/ai/n); onset-rhyme (OR: train-->tr/ain) and whole word units (WW: train-->train). All literacy-training groups made significant gains in word recognition and spelling, with the LSD- and OR-trained subjects making the greatest word recognition gains on the words that could be trained with segmented speech feedback (i.e., words with regular spelling-to-sound patterns). All literacy-training groups demonstrated significant transfer on uninstructed rhymes of instructed regular words, with the greatest degree of transfer achieved by the LSD-trained subjects. These findings suggest that the neurologically impaired children were able to profit from instructional procedures that segment the printed word into units corresponding to onsets, rhymes, and phonemes and that this segmentation training may facilitate transfer-of-training for them.

Analysis of Variance