To examine children's knowledge, understanding and experience of stress from 4 to 11 years of age across four age groups (4-5, 6-7, 8-9, and 10-11 years old).
A semi-structured interview format was used to elicit information from 50 children about their understanding and experience of stress.
Most children were able to define stress, with older children providing more complex responses. Many children had indirect and/or personal experience of stress. Younger children were more likely than older children to report that there was nothing people could do to stop stress; children reported using both adaptive and maladaptive coping strategies to deal with stress.
Some young children have a basic understanding of stress and many have experience of stress; both understanding and experience develop with age.
The research has potential implications for provider-patient communication, particularly within preventative health education and clinically within the field of childhood post-traumatic stress disorder (PTSD).
The aim of the study was to explore the views of people aged over 70 years on involvement in their primary health care in 11 different European countries.
Older patients were asked about their views on patient involvement in a face-to-face interview. All interviews were audio-recorded, transcribed and analysed in accordance with the principles of 'qualitative content analysis'. An international code list was used.
Four hundred and six primary care patients aged between 70 and 96 years were interviewed. Their views could be categorized into four major groups: doctor-patient interaction, GP related topics, patient related issues and contextual factors.
People over 70 do want to be involved in their care but their definition of involvement is more focussed on the 'caring relationship', 'person-centred approach' and 'receiving information' than on 'active participation in decision making'.
The desire for involvement in decision making is highly heterogeneous so an individual approach for each patient in the ageing population is needed. Future research and medical education should focus on methods and training to elicit older patients' preferences. The similar views in 11 countries suggest that methods for enhancing patient involvement in older people could be internationally developed and exchanged.
The RE-AIM framework is used as a method of systematically considering the strengths and weaknesses of chronic illness management interventions in order to guide program planning.
The RE-AIM dimensions of Reach, Efficacy, Adoption, Implementation, and Maintenance are used to rate one-on-one counseling interventions, group sessions, interactive computer-mediated interventions, telephone calls, mail interventions, and health system policies.
The RE-AIM ratings suggest that, although often efficacious for those participating, traditional face-to-face intervention modalities will have limited impact if they cannot be delivered consistently to large segments of the target population. Interventions using new information technologies may have greater reach, adoption, implementation, and maintenance, and thereby greater public health impact. Policy changes received high ratings across a variety of RE-AIM dimensions.
Program planners should make decisions regarding implementing and funding health services based on multiple dimensions, rather than only considering efficacy in randomized clinical trials. Doing so may improve the resulting public health impact. Directions for future chronic illness management research related to RE-AIM, and implications for decision making, are described.
Clients seek genetic counseling in order to become informed, to make better decisions, and, if possible, to be reassured. Genetic knowledge, however, is fragmentary and incomplete and therefore it may involve more uncertainty than is desirable. In a cohort of 30 counseling sessions we studied the genetic information that was actually conveyed in terms of its predictability, controllability and novelty. With regard to predictability it emerged to be rather the rule than the exception that clients of genetic counseling were confronted with (1) an inconclusive diagnosis, (2) the chance or an estimate of the chance of the occurrence or recurrence of a genetic disorder, and (3) ambiguity about the severity of the disease. In case of bad news, possibilities for control (therapeutic or preventive measures) were minimal. In a few cases, clients were confronted with completely unexpected findings, i.e., information of high novelty. It is concluded that the high degree of uncertainty in the information provided during genetic counseling--reflecting the true state of the art--is in direct contrast to the needs of clients.
Among the many changes which have occurred in the field of HIV research in the two years between the 11th and 12th World AIDS conferences was the emergence of medication adherence as a priority research area. While neither the word "adherence" nor the word "compliance" appear in the key word index of the Vancouver AIDS Conference from 1996 well over 100Abstracts focusing on adherence to highly-active antiretroviral therapy (HAART) were presented (in oral and poster presentations) at the 1998 Geneva World AIDS Conference. Why has adherence become such an important topic? HAART can be extremely effective in bringing plasma HIV-1 RNA copy number (viral load) to undetectable levels positively impacting clinical health status and forestalling disease progression in HIV-infected persons. HAART regimens are among the most complex ever prescribed typically requiring intake of 10-20 pills per day at multiple time points in coordination with meals. Very high levels of medication adherence (taking all pills at the prescribed times in correct relation to diet) are essential in order to achieve and maintain undetectable viral load. In the absence of high levels of adherence the development of drug-resistant strains of HIV and subsequent return of viral load to pre-treatment levels are quite likely. HAART demands these lifelong high levels of adherence from a group of persons with a heightened probability of experiencing cognitive deficits and consequent impairment in the capacities required for adequate adherence. Additionally HAARTs toxicity can result in side effects (nausea diarrhea headaches and body fat redistribution) and may prohibit the use of other needed medications. (excerpt)
To identify preferences of advanced lung cancer patients for receiving information and participating in decision-making concerning treatment options, health-care-setting transfers and end-of-life decision-making.
Over the course of 1 year, pulmonologists and oncologists in 13 hospitals in Flanders, Belgium, invited patients with an initial diagnosis of non-small-cell lung cancer IIIb/IV to participate in the study. Shortly after inclusion, the patients were interviewed with a structured questionnaire.
One-hundred and twenty-eight patients with a median estimated survival time of 10 months participated. Almost all wanted information on diagnosis, treatment and cure rate and slightly fewer on life expectancy (88.2%). Information about palliative care was desired by 63.5% of patients and information about end-of-life decisions by 56.8%. The percentage of patients who preferred personal control over medical decision-making increased to 14.8% for treatment, 25.0% for transfer and 49.2% for end-of-life decisions, all of which were higher than for medical decisions in general (9.3%).
Information and participation preferences of advanced lung cancer patients differ depending on the type of information or decision.
As part of a patient-centred approach, physicians should not only check the general but also the specific information and participation preferences of their patients.
About one-quarter of Canadian post-secondary students smoke cigarettes. We examined how physicians from Ontario university health clinics intervene with these young adult smokers.
A convenience sample of 16 universities was identified and surveys were hand-delivered to all 228 physicians from these schools. A total of 125 doctors (54.82%) responded; 70 were from universities that were involved in a government-sponsored, coordinated, multi-campus, tobacco control initiative.
Twenty percent of doctors reported asking all or almost all patients about tobacco use; 25.22% asked fewer than half. Describing how they respond to patients identified as smokers, 96.00% of physicians advised cessation, 72.00% offered assistance, and 64.00% arranged for follow-up. Doctors discussed patients' tobacco use with 78.59% of smokers. Nicotine replacement therapies were rarely offered to patients wanting to quit. Doctors from universities involved in the tobacco control initiative were more likely to keep patient education materials in the examining room.
Because most doctors ask only some patients about tobacco use, they may be missing opportunities to provide appropriate advice and assistance to all smokers.
Physician education and support to the clinic are needed to improve the frequency and quality of physician-delivered smoking cessation services to post-secondary students.
To profile and compare the content and presentation of written communications related to informed decision-making about mammography.
Materials from 16 screening programs organized at the national or regional level were analyzed according to five major information domains suggested by the international literature.
A majority of countries provided information on the program (interval, cost and quality). There was considerable variability in comprehensiveness of elements in the domains, e.g., test characteristics (false positive/negative) and pros and cons of screening. The majority noted the likelihood of recall for further tests, few commented on the risks of additional tests or finding unimportant tumors. The audit also found variation in presentation (words and pictures).
Presentation of comprehensive, but balanced information on screening benefits and risks is complex and daunting. Issues such as framing effects, coupled with debate about screening efficacy are challenging to the design of effective information tools. The objective of increasing screening prevalence at the population level must be balanced with objectively presenting complete and clear information. Additional research is needed on how information (and mode of presentation) impact screening decisions.
Public health officials need to articulate their objectives and review written communication according to important decision-making domains.
To investigate if attitudes towards disclosure of prognostic information vary by speciality, previous experience and demographic factors in a general physician population.
A postal survey among a representative sample of Norwegian physicians across all specialities (N=1605), using a translated questionnaire previously used to study attitudes towards disclosing prognostic information among US internists.
A response rate of 70% was obtained after one reminder. 85% of the responders agreed to the helpfulness of an optimistic attitude. A factor analysis revealed three meaningful factors: 'Prognostic communication is stressful', 'Fearing loss of reputation' and 'Reinforcement of positive prospects'. In multivariable models significantly more female than male physicians found aspects of prognostication straining (beta=0.143, p<0.001). Those more experienced in communication of prognostic information towards end of life were less likely to support using reinforcement of positive prospects (beta=0.067, p=0.001).
After years of focusing on patient autonomy and open communication between patient and physician many Norwegian physicians display attitudes that might hide the true content of prognostic information from the patients.
Many physicians think they are inadequately trained in prognostication and communication of prognostic information, suggesting that increased education and training are needed if patients' wishes for information on prognosis are to be met in an individualised manner.
The technology for using the telephone to deliver interventions to improve health behavior and health care has expanded dramatically and exciting innovations continue to emerge. These developments enable the telephone to be used to deliver individualized services to a broad cross section of target groups, while minimizing logistic and system barriers, and cost. However, as telephone-delivered interventions have proliferated, a number of questions remain concerning the elements that are essential to their effectiveness. We provide a broad overview of telephone interventions, published in the past 10 years to identify gaps in knowledge about these services, and make recommendations for future program development and evaluation.
Four hundred posters on passive smoking were placed on billboards in the streets of Geneva, Switzerland, for 2 weeks in 2001. We conducted a postal survey before and immediately after the campaign, in Geneva and Neuchatel. The Geneva sample (n = 834) was exposed to the campaign while the Neuchatel sample (n = 1121) acted as a control group. Following the poster campaign, 36% of respondents in Geneva reported having seen posters about smoking prevention, compared to 18% beforehand (P < 0.001). Corresponding figures in Neuchatel were 18% (after) and 13% (before). The difference in before-after change between the target and control groups was significant (P < 0.001). The poster had no effect on cigarette consumption or intention to quit. The poster was widely seen and remembered by the target audience, but the campaign was probably too short and isolated to have an impact on smoking behaviour.
A quantitative review of the literature (meta-analysis) was conducted with 191 studies of the effects of psychoeducational care on the recovery, postsurgical pain and psychological distress of adult surgical patients. Studies issued between 1963 and 1989 were included in the review. Statistically reliable, small to moderate sized beneficial effects were found on recovery, postoperative pain and psychological distress. In further analyses it was shown that these beneficial effects were not an artifact of the biases associated with the decision whether to publish a paper, low internal validity, measurement subjectivity, or a Hawthorne effect. The overall efficacy of psychoeducational care provided to adult surgical patients has been reconfirmed with this larger sample of studies. It is particularly noteworthy that these findings are of more than strictly historical interest. Despite changes in health care delivery, beneficial effects continue even in studies issued between 1985 and 1989. Implications for clinical practice are drawn.
To examine whether GPs' communication styles have changed since the introduction and implementation of clinical guidelines for psychosocial problems in Dutch general practice in the 1990s.
From a database of 5184 consultations videotaped between 1977 and 2008, 512 consultations assessed by GPs as 'completely psychosocial' were coded with RIAS (Roter Interaction Analysis System). The 121 consultations prior to and 391 consultations after implementation of guidelines were analyzed whether communication styles have changed over time.
We found that GPs were more likely to consider consultations to be mainly (17%) or completely (12%) psychosocial after the implementation of guidelines. They gave more biomedical and psychosocial information and advice in the second period compared to the first period. We also found that empathy decreased over time (frequency of empathic statements by GPs changed from 2.9-3.2 to 1.4-1.6 between periods).
Communication in psychosocial consultations has changed; GPs have become more focused on task-oriented communication (asking questions, giving information and advice) and less on showing empathy.
GPs face the challenge of integrating an evidence-based approach of applying guidelines that promote active symptom exploration with understanding patients' personal contexts and giving room to their emotions.
Understanding what cancer patients need to know and from whom they receive information during the course of care is essential to ensuring quality care. We reviewed 112 articles published from 1980 to 2003 and developed a typology summarizing cancer patients' information needs and the sources from which they receive information. The majority of articles focused on information needs and sources during the diagnosis and treatment phase. Thus, the most frequent information need was treatment-related (38.1%). The most frequent information source was health professionals (27.3%). We examined patients' information needs and sources along the continuum of care and found that during diagnosis and treatment, information needs about the stage of disease, treatment options, and side-effects of treatment were prominent; during post-treatment, patients continued to need information about treatment, and information about recovery was also important. Future research should examine cancer patients' information needs and sources throughout their cancer journey.
In 1987, the Dutch STD Foundation started several safe sex campaigns targeting the general population. These campaigns have been accompanied by surveys which were conducted every 6 months. Questions were asked about knowledge, attitudes and behavior. The number of people who regard condom use as being a safe sex practice increased over the years, as did the number of people who know that condoms protect against STDs and AIDs. Surprisingly, no accompanying changes in attitudes occurred. Nevertheless, the number of people saying they have done something to prevent HIV infection increased significantly among the young and non-monogamous. Also, specifically in these groups, both actual and intentional condom use increased remarkably. Although it is encouraging that those towards whom the campaigns were particularly directed, show the largest changes, there are also signs that these behavioral changes are levelling off.
Arthritis is a chronic disease that is estimated to affect 14.5% of the American population and is the leading cause of functional dependency in the activities of daily living (ADLs) and the instrumental activities of daily living (IADLs) in all persons over the age of 65 years. Clinical studies have shown that medical care, including the use of medications, can offer a 20-50% improvement in reported arthritis symptoms. Data from patient education studies suggest that a further improvement of 15-30% is attainable through patient education interventions. This literature review has been completed to update the reviews of patient education studies by Lorig and Riggs in 1983 and Lorig, Konkol, and Gonzalez in 1987. More specifically, the objectives of this review are: (1) to provide a summary of arthritis patient education studies published or presented since 1987; (2) to summarize the findings concerning the effectiveness of arthritis patient education studies which attempt to change knowledge, behavior, psychosocial status, and health status; (3) to discuss shifting trends in observed outcomes of arthritis patient education studies; and (4) to discuss implications for the future.
This article concerns the evolution of the concept of health, as reported in selected nursing journals, over the last 10 years. It builds on an analysis reported by Reynolds [Reynolds CL. The measurement of health in nursing research. Adv Nurs Sci 1988;10(4):23-31.] who initially investigated the concept of health and the means by which it was measured during the period 1977-1987. Using the same journals as Reynolds, the methodology of systematic review is used to analyse the way in which health is defined, the frequency with which it is investigated and the means by which it is measured, and these data are compared with Reynolds findings. The results indicate that; three times as many studies have been conducted in the last 10 years, a more holistic concept of health has emerged, and the instruments used are becoming more sophisticated. These findings are discussed and the implications for patient education and health care professionals considered.
To compare and contrast the duration and content of physician-patient interaction for patients presenting to an emergency department with problems of low acuity in 1990 and 2005 treated by different grades of physician.
Observational study with data collection in May-July 1990 and May-July 2005. Patients identified at nurse triage as presenting with 'primary care' problems were allocated by time of arrival to senior house officers (1990, n=7; 2005, n=10), specialist registrars/staff grades (1990, n=4; 2005, n=7) or sessionally employed general practitioners (1990, n=8; 2005, n=12) randomly rostered to work in a consulting room that had a wall-mounted video camera. A stratified sample of 430 video-taped consultations (180 (42%) from 1990 and 250 (58%) from 2005) was analysed using the Roter Interaction Analysis System. Main outcome measures -- length of consultation; numbers of utterances of physician and patient talk related to building a relationship, data gathering, activating/partnering (i.e. actively encouraging the patient's involvement in decision-making), and patient education/counselling.
On average consultation length was 251s (95% CI for difference: 185-316) longer in 2005 than in 1990. The difference was especially marked for senior house officers (mean duration 385s in 1990 and 778s in 2005; 95% CI of difference: 286-518). All groups of physician showed increased communication related to activating and partnering and building a therapeutic relationship with the patient. While senior house officers demonstrated a greatly increased focus on data gathering, only general practitioners substantially increased the amount of talk centred on patient education and counselling; compared to senior house officers, the odds ratio for the number of such utterances included in consultations was 2.8 (95% CI: 1.4, 5.3).
Although patient-centredness together with consultation length increased for all three physician groups over the duration of this study, senior house officers and specialist registrars/staff grades continued to place less emphasis on advice-giving and counselling than did general practitioners. The extent to which these observed changes in practice were determined by policy, management and training initiatives, and their impact on patient outcome, needs further study.
Video-recording consultations is feasible in an acute hospital setting, and could be used to support training and workforce development. General practitioners can make a distinctive contribution to the workforce of emergency departments. Their consulting style differs from that of hospital physicians and may benefit patient care through a greater focus on patient education and counselling.
This literature review focuses on information and communication needs of parents of children admitted to the NICU and on their use of information sources in the illness trajectories at NICU.
Literature search in 4 electronic databases (Ovid Medline, PsycINFO, CINAHL and Sociological Abstracts), covering 1990-March 2008.
The seventy-eight included articles revealed that NICU parents have high information needs. The illness trajectory mediates parental information needs and induces a changing pattern in information use and information needs. Most attention is paid to the prenatal and acute phases, while information behaviour in sudden events and later phases receives limited attention.
In-depth studies on information needs and corresponding use of information sources are lacking. More longitudinal studies are needed, taking the illness trajectory into account and investigating the determinants and outcomes of the information and communication needs of NICU parents.
Healthcare professionals should adapt their information provision along the illness trajectory. The development of guidelines of information provision during the illness trajectory at NICU would support all professionals.
A personal review is presented about the conclusions and highlights during the Congress on Patient Education 2000 (14 June 1994, Geneva, Switzerland). Attention is paid to differences between diseases concerning patient education. Further, a summary is presented of the discussion of quality of life, over-optimism, medical information supply, purpose of patient education, the need for discipline and the psychological problems due to wrong patient education.
The aim was to assess implementation of a national 4-year project to promote professional strategy in Finnish community pharmacies during the 2.5 years of program's action in 2000-2002. A survey of random sample of 734 community pharmacists in Finland was conducted in 2002 (response rate 51%, n = 376). The questionnaire included an implementation scale and two open-ended questions on patient counselling. Many of the actions were not optimally implemented 2.5 years after starting the project. Some individual actions may have been taken, but the systematic long-term development process has not yet been started in many pharmacies. Future challenges in implementation will be a better commitment of the pharmacy owners to the goals of the national professional strategy and a better access to Internet-based drug information sources while counselling patients.
The extensive nationwide involvement in the development of year 2000 health objectives, and the breadth of the 298 objectives produced, illustrate the scope of contemporary public health and preventive medicine in the United States. Patient education is an essential element of numerous year 2000 priority targets; full accomplishment of the patient education objectives will be influenced by several policy issues. This paper discusses special needs in three areas: data for decision-making, prevention effectiveness and research gaps. One major data issue is difficulty in documenting the existence and scope of patient education, and better measurement systems are desirable. A renewed interest in prevention effectiveness suggests that patient education would benefit from emphasis on five elements of prevention effectiveness: guidelines development; guidelines dissemination; demonstrations and technical assistance; monitoring; and research. Emerging research needs are identified, with particular focus on quality-of-life measurement and on integrated patient education and health communication strategies.
To assess whether the practice and rehearsal of communication skills is likely to lead to better outcomes following training, and whether the use of simulated patients in training is likely to be superior to role-play in terms of communication skill acquisition.
The databases Medline, Amed, Cinahl, BNI, Embase, Psychinfo and HMIC were searched for articles which compared the use of simulated patients and/or role-play in training healthcare practitioners in acquiring communication skills.
Most studies appear to indicate that outcomes are better in communication skills training programs where skills practice has taken place. However, a number of methodological weaknesses make concrete conclusions difficult to draw. There was just one study that directly compared the use of role-play with simulated patients. This found no significant difference in outcomes between the two methods.
There is a need for more well-designed studies that assess skill acquisition following the use of simulated patients and/or role-play in a number of different settings.
Simulated patients and role-play are frequently used in teaching communication skills worldwide. Given the expense of using simulated patients, educators should be made aware of cheaper alternatives that may be equally effective in facilitating the acquisition of communication skills.
To investigate the appreciation of written education about pain neurophysiology in patients with fibromyalgia (FM) and its effects on illness perceptions and perceived health status.
A booklet explaining pain neurophysiology was sent to participants with FM. Appreciation was assessed with 10 questions addressing relevance (0-30) and reassurance (0-30). Illness perceptions, catastrophizing and health status were measured with the Revised Illness Perception Questionnaire (IPQ-R), the Pain Catastrophizing Scale (PCS) and the Fibromyalgia Impact Questionnaire (FIQ) at baseline (T0), after a 2-week control period (T1) and 6 weeks after the intervention (T2).
Forty-one patients participated. Mean (SD) scores for relevance and reassurance were 21.6 (5.6) and 18.7 (5.7), respectively. Only illness coherence, emotional representations, pain and fatigue changed significantly between T0 and T2. Correlations between appreciation and changes in outcomes ranged between r=0.00 and r=0.34.
Although a majority of subjects appreciated the written information, it did not have clinically relevant effects on illness perceptions, catastrophizing or impact of FM on daily life.
Written education about pain neurophysiology is inadequate toward changing illness perceptions, catastrophizing or perceived health status of participants with FM; education should be incorporated into a broader multidisciplinary self-management program.
To understand patients' perceptions of decision making and identify relationships among decision-making models.
This qualitative study was made up of four focus group interviews (elderly persons, users of health support groups, students, and rural inhabitants). Participants were asked to report their perceptions of decision making in three written clinical scenarios (hypertension, breast cancer, prostate cancer). The analysis was based on the principles of grounded theory.
Most patients perceived decision making as shared decision making, a deliberative question-response interaction with the physician that allowed patients to be experts in obtaining clearer information, participating in the care process, and negotiating compromises with physician preferences. Requesting second opinions allowed patients to maintain control, even within the paternalistic model preferred by elderly persons. Facilitating factors (trust, qualitative non-verbal communication, time to think) and obstacles (serious/emergency situations, perceived inadequate scientific competence, problems making requests, fear of knowing) were also part of shared decision making.
In the global concept of patient-centered care, shared decision making can be flexible and can integrate paternalistic and informative models. Physicians' expertise should be associated with biomedical and relational skills through listening to, informing, and advising patients, and by supporting patients' choices.
Much has been written about the psychosocial and sexual dysfunction associated with the diagnosis and treatment of breast cancer. Hopes that breast conserving techniques would lead to a reduction in some of the psychosocial morbidity experienced, have not materialised. Most of the methodologically sound studies reported to date demonstrate few differences in quality of life domains between women whatever their primary surgical treatment. Some researchers suggested that if women were offered an opportunity to select the surgical option they preferred, then two things would occur: (1) women would choose breast-conserving techniques, and (2) choice in itself would prevent psychosocial morbidity. Despite strong support for both of these assumptions, neither have been borne out. Significant numbers of women, when offered choice, opt for mastectomy and choice in itself does not convey protection from psychological morbidity. The majority of women seem to welcome being given clear information about the options available, together with the reasons as to why a clinician would advise one policy rather than another. However, fewer women than expected wish to take a major role in decision-making about their breast cancer treatment.
To share our experiences with an educational program to increase pharmacy students' patient counseling competency.
A description is given of the various steps taken to develop an educational program about patient counseling:
The Health Belief Model has been chosen as the theoretical model to make students understand patients' drug use behavior. A stepwise development of students' communication skills is combined with assessments in which relatively high norms are applied. Actors act as patients in standardized role plays. In total the basic education consists of 20h of training.
With a rather small educational investment, 50% of our students achieve the required level of patient counseling. The remaining students succeed to pass the assessments, after having received additional education.
Pharmacy students differ in their needs for educational support in developing their patient counseling competency. These differences are to be taken into account in educational programs addressed to student's patient counseling competency.
To investigate the attitude among pregnant women regarding non-invasive prenatal testing (NIPT) for detecting trisomy 21 (T21) and to quantify their willingness to pay for NIPT.
A questionnaire was administered to pregnant women who received counselling for first-trimester screening (FTS) in two hospitals and nine midwife practices in the Netherlands.
A total of 147 women completed the questionnaire, yielding a response rate of 43%. If NIPT for detecting T21 were available, 81% stated they would choose to have this test, and 57% of women who elected not to undergo FTS in their current pregnancy would perform NIPT if available. Willingness to pay for NIPT was correlated with age and income, but not education level. The price that participants were willing to pay for NIPT was similar to the current price for FTS.
The pregnant women in our study had a positive attitude regarding NIPT for T21, and more than half of the women who rejected prenatal screening would receive NIPT if available.
Due to the elimination of iatrogenic miscarriage, caregivers should be aware that informed decision-making can change with respect to prenatal screening with the introduction of NIPT.
The purpose of this quasi-experimental research was to assess the effectiveness of a perimenopausal health education intervention for mid-life women in northern Taiwan. The health education intervention included a health education brochure, one-on-one teaching. One hundred seventy-nine women were in the intervention group and 174 women were in the control group. Education effectiveness was assessed by participants' scores on four questionnaires at the beginning of the study and 3 months after initial recruitment. Both groups of women were compared on changes in their scores on health knowledge, level of perceived uncertainty, health behaviors and perceived perimenopausal disturbances. The intervention group had significantly reduced scores on perimenopausal disturbances (P < 0.005) and reported increase practice of healthy behaviors (P < 0.001) compared to the control group. However, a significant decrease of perceived uncertainty was only found in the subgroup of women recruited from the Chinese medicine clinic of the control group (t = 2.22; d.f. = 58; P < 0.05). Chinese medicine physicians assess patients based on a philosophical approach that treats all symptoms holistically. This may have helped reduce patient uncertainty.
To describe the health beliefs and practice in a rural Iraqi community.
Personal observations and practice; narratives of colleagues.
Rural Iraqi society has remained unchanged in beliefs and practices in many ways since the Babylonian and Sumerian eras over four millennia ago. Like other rural societies, it has a culture that includes values, beliefs, customs, communication style, and behaviors. Those beliefs often invoke supernatural agents such as evil, jinni, witchcraft and the results of sin, bad luck and envy. Primitive and current religious beliefs join with the effects of poverty and illiteracy. These rural people view health and disease quite differently from the views of their physicians and these cultural beliefs and practices confound current patient-clinician communication. Although physicians view the medical encounter as the main tool of diagnosis and therapy, especially when biomedical technology is lacking, ignorance of the characteristics of the rural society and people may make physicians' work all the more difficult.
As with all cross-cultural interactions, better understanding of the patient or family's beliefs allow the clinician to find compromises and reach agreements that ignorance of their beliefs would deny.
Simply asking the patient and the family how they view the illness, what they consider to be the cause, what treatments they have already tried and what treatments they hope you will use, may go a long way toward building a therapeutic relationship.
To investigate (i) marital benefit, e.g., that infertility has strengthen the marriage and brought the partners closer together among people beginning fertility treatment and (ii) communication and coping strategies as predictors of marital benefit 12 months later.
A prospective cohort design including 2250 people beginning fertility treatment and a 12-month follow-up. Data were based on self-administered questionnaires measuring marital benefit, communication, and coping strategies. The analyses of predictors were based on the sub-cohort (n=816) who had not achieved a delivery after fertility treatment.
25.9% of women and 21.1% of men reported high marital benefit. Among men medium use of active-confronting coping (e.g., letting feelings out, asking others for advice) and use of meaning-based coping were significant predictors for high marital benefit. Having the infertility as a secret, difficult marital communication, and using active-avoidance coping (e.g., avoid being with pregnant women or children, turning to work to take mind off things) were among men significant predictors for low marital benefit. No significant predictors were identified among women.
Fertility patients frequently experience marital benefit.
The study provides information about where to intervene with male fertility patients in order to increase their marital benefit after medically unsuccessful treatment.
The effects on burnout of a career counseling program were measured among general dental practitioners. Out of a group of 171 dentists, identified with unfavorable scores on the Maslach Burnout Inventory - Dutch version (MBI-NL), nineteen chose to participate in the program. It consisted of individual counseling and group sessions, using cognitive and behavioral intervention techniques, over a 6-month period. One month after the last session, both program participants (N=17) and invited, but not participating, dentists (N=66) again filled in the MBI-NL. Comparison of participants' pre- and post-test scores showed significant statistical improvement on the MBI-NL scales emotional exhaustion (EE), and personal accomplishment (PA). Among the control group, a distinction was made between dentists who had self-initiated preventive measures (N=35) and those who had not (N=31). Self-prevention also appeared to have an effect on EE and PA. Among dentists who reported not to have undertaken preventive action, no change in burnout levels was found. With reservations, it can be concluded that the prevention program does have a positive effect on burnout scores among dentists, while different forms of self-initiated prevention activities also appeared to be effective.
The study objective was to evaluate the effect of a patient information video during the informed consent process of a perinatal trial. Ninety women, between 19 and 33 weeks gestation, were randomised to receive written information about this perinatal trial and watch an information video or to receive written information only. Participants completed a questionnaire immediately after entry and 2-4 weeks later assessing knowledge of; feelings about the worth of; and willingness for future participation in the perinatal trial. When initially asked, more women who watched the video thought they would consent to the study (chi 2 = 6.3; df = 1; P = 0.01). No differences in knowledge about the perinatal trial were found initially, but 2-4 weeks later more knowledge had been retained by women who had watched the video (chi 2 = 6.7; df = 1; P = 0.01). These results suggest that a patient information video combined with an information sheet may result in greater participation in a research trial and may increase women's knowledge of a specific health problem and related research trial.
To investigate the effectiveness of snoezelen, integrated in 24-hour care, on the communication of Certified Nursing Assistants (CNAs) and demented nursing home residents during morning care.
A quasi-experimental pre- and post-test design was conducted, comparing sic psychogeriatric wards, that implemented snoezelen, to six control wards, that continued in giving usual care. Measurements were performed at baseline and 18 months after a training 'snoezelen for caregivers'. Independent assessors analysed 250 video-recordings directly from the computer, using an adapted version of the Roter Interaction Analysis System (RIAS) and non-verbal measurements.
Trained CNAs showed a significant increase of resident-directed gaze, affective touch and smiling. The total number of verbal utterances also increased (more social conversation, agreement, talking about sensory stimuli, information and autonomy). Regarding residents, a significant treatment effect was found for smiling, CNA-directed gaze, negative verbal behaviours (less disapproval and anger) and verbal expressed autonomy.
The implementation of snoezelen improved the actual communication during morning care.
Teaching CNAs to provide snoezelen has added value for the quality of care. Morning care by trained CNAs appeared to take more time. This suggests that (some) time investment might be required to achieve positive effects on CNA- resident communication.
A short-term, problem-focused Individual Psychological Support (IPS) intervention was evaluated. The IPS was one of the interventions in a study where 527 patients newly diagnosed with breast, colorectal, gastric or prostate cancer were randomised between IPS (n = 265) and a control condition (n = 262). The IPS made use of cognitive-behavioural techniques and aimed at reducing depression and anxiety, to increase the feeling of mastery of the situation and to facilitate active participation in medical treatments. Half of the patients receiving the IPS had more than 2 sessions. After termination of the IPS, the patients were mailed a questionnaire concerning satisfaction with and perceived benefit from the IPS. A majority of the responding patients stated that their problems were addressed to a great extent, that the number of contacts was adequate and that the IPS came at the right time. Patients reporting problems received more sessions and perceived more benefits than patients reporting no problems.