Patient education and health literacy

Physiotherapist-targeted strategies and tools for recognising patients with limited health literacy and adapting physiotherapeutic communication: A scoping review

OBJECTIVE

To provide an overview of available strategies and tools that support physiotherapists to recognise patients with LHL and to adapt the physiotherapeutic communication during the diagnostic phase.

METHODS

PubMed, Embase, CINAHL and PsycINFO were searched for publications appearing between 2000 and June 2024. Additional grey literature was searched up till October 2022. Studies were included if they described strategies and tools aimed at supporting communication with patients with Limited Health Literacy in physiotherapy. Exclusion criteria focusing on general health literacy prevalence, behavioural interventions, or basic communication training.

RESULTS

Out of the 9960 unique studies identified by our literature searches, 314 full-text studies were assessed and 98 met the inclusion criteria. The data on strategies and tools were extracted into the following six categories: verbal communication (n = 3), written communication (n = 34), digital device (n = 9), questionnaire (n=19), interpreter (n = 22), and other media (n = 2). Within these categories, tools and strategies were further classified based on the communication aims. Some tools and strategies were uncategorisable.

CONCLUSION

While various strategies and tools exist for recognising patients with limited Health Literacy, they are often generic and not tailored to the physiotherapeutic context. This scoping review identifies a gab in physiotherapeutic approaches, particularly on those that go beyond information provision.

PRACTICE IMPLICATIONS

To improve communication in physiotherapy practice, there is a need for the development of tailored strategies and tools that reflect the specific dynamic of the physiotherapeutic process. We recommend engaging in design-based research that involves both patient and physiotherapist to co-create tools and strategies. In the meantime, physiotherapists are advised to use general communication strategies and tools and refer to our resources to select tools that best align with their specific goals.

Changes in Health Education Literacy After Structured Web-Based Education Versus Self-Directed Online Information Seeking in Patients Undergoing Carpal Tunnel Release Surgery: Nonrandomized, Controlled Study

Background

With advancements in anesthesiologic and surgical techniques, many surgeries are now performed as day-surgery procedures, requiring greater responsibilities for self-management from patients during the perioperative process. Online health information often lacks reliability and comprehensibility, posing risks for patients with low health literacy. Carpal tunnel release (CTR) surgery, a common day-surgery procedure, necessitates effective patient education for optimal recovery and self-management.

Objective

This study introduces the CTS Academy, a web-based education program designed for patients undergoing CTR day surgery. The study aimed to evaluate the CTS Academy's impact on patients' health education literacy (HEL) compared with self-directed online information seeking.

Methods

A scoping review on education programs focusing on the perioperative process of CTR was conducted before this study. In a nonrandomized controlled study, 60 patients scheduled for CTR were assigned to 2 groups based on the patients' preferences; the test group used the CTS Academy, while the control group performed self-directed online searches. HEL was assessed using the Health Education Literacy of Patients with chronic musculoskeletal diseases (HELP) questionnaire, focusing on patients's comprehension of medical information (COMPR), patients's ability to apply health-related information in an everyday life (APPLY), and patient's ability to communicate with health care professional (COMM). Secondary outcomes included content comprehensibility, patient preferences, platform usability, and clinical carpal tunnel syndrome (CTS)-related parameters.

Results

In the scoping review, 17 studies could be identified and included for full-text analysis. Eighteen patients each were included in the test group (13 women and 5 men) and in the control group (11 women and 7 men). The average time spent in the study was 167 and 176 days for the test and control groups, respectively. The test group showed significant improvements in APPLY (mean 28, SD 7.99 vs mean 24, SD 5.14; P<.05) and COMM (mean 30, SD 10.52 vs mean 25, SD 6.01; P=.02) after using the CTS Academy in a longitudinal analysis. No significant changes were observed in the control group. In a comparison between groups, the test group had significantly higher APPLY scores at follow-up (mean 24, SD 5.14 vs mean 33, SD 14.78; P=.044) and fewer comprehension issues at baseline (mean 38, SD 16.60 vs mean 50, SD 19.00; P=.03). The CTS-related knowledge assessment yielded 92% (66/72) versus 90% (65/72) correct answers in the test and control groups, respectively. The test group rated the CTS Academy highly in usability (6.22 of 7.00 points) and utility (6.13 of 7.00 points). Preferences leaned toward using CTS Academy alongside doctor consultations (16/18, 89%) and over self-directed searches (15/18, 84%). No significant differences were found in CTS-related symptoms between groups.

Conclusions

The CTS Academy effectively enhanced patients' HEL, especially in applying and communicating medical information. The platform's usability and utility were rated favorably, and patients preferred it over independent online information seeking. This suggests that structured, web-based education enhances patient self-management during the day surgery process.

Impact of family-oriented gamification on self-management of people with multiple sclerosis: a mixed-methods study protocol

INTRODUCTION

Multiple sclerosis (MS) is a chronic disease of the central nervous system that impacts millions worldwide, including individuals in Iran. It primarily affects young people, leading to biopsychosocial challenges with unpredictable symptoms. Self-management is crucial but challenging due to the lack of definitive treatment. New approaches, such as mHealth interventions, particularly gamification, aim to engage patients more effectively. Well-designed gamification may positively impact health behaviours and enhance collaborative care. However, its implementation in the field of MS in Iran is currently limited. So far, some mobile applications have been designed that do not incorporate gamification principles and only focus on one issue. These applications also fail to consider the family caregivers' understanding of the patient's condition. Therefore, this study aims to investigate the impact of family-oriented gamification on the self-management of Iranian patients with MS.

METHODS AND ANALYSIS

We propose a mixed-methods study with an exploratory sequential design consisting of a qualitative phase, gamification development and a dual-centre, prospective, single-blinded, parallel-group randomised controlled superiority trial. In the qualitative phase, data will be collected through purposive sampling via semistructured interviews with patients until data saturation is reached. Concurrently, the data will be analysed using conventional content analysis to provide insights into the patients' self-management challenges. Next, web-based and card gamification will be developed for patients and their families based on the findings of the qualitative phase. Ultimately, the effectiveness of these interventions will be evaluated through a randomised controlled trial. The preliminary literature suggests an initial sample size of 25-30 participants per group for this phase. After enrolling approximately 10 participants, the exact sample size will be recalibrated using G-Power software based on data analysis. Participants will then be randomly assigned to either the intervention or control group in a 1:1 ratio. Allocation concealment will be ensured using mixed block sizes of 2 and 4. The primary outcome, self-management, and the secondary outcome, self-efficacy, will be assessed both before and immediately after the intervention. Furthermore, the usability of the two gamification strategies will be evaluated following the intervention.

ETHICS AND DISSEMINATION

This study is part of a doctoral thesis approved by the Tehran University of Medical Sciences Research Ethics Board (IR.TUMS.FNM.REC.1401.185, 23 February 2023). Dissemination of findings will occur at the local, national and international levels.

TRIAL REGISTRATION NUMBER

IRCT20240116060708N1.

Patient at community clinics: Recommendations for advancing health literacy

OBJECTIVE

This study aimed to assess community clinics in enhancing health literacy among underserved patients. We focus on patient-provider communication at these clinics to understand how this communication may foster or hinder health literacy and how the organizational health literacy of clinics may be improved.

METHODS

We surveyed 303 patients at three community clinics to evaluate providers' communication behaviors related to health literacy. The city health department entered surveys into SurveyMonkey™ and analyzed them using Stata/SE™. The analysis included frequencies of all variables for all participants and by clinic. Qualitative methods were also used.

RESULTS

Community clinics are trusted care sources; however, around 13 % of patients reported rarely or never being encouraged to ask questions, 20 % reported providers spoke too fast, and 17 % reported that medical staff were not always informative. Patients needing an interpreter reported more communication problems than those not requiring one, making these results more salient.

CONCLUSIONS

Community clinics serving low-income patients can enhance personal and organizational health literacy by improving patient-provider communication such as active listening, encouraging patients to ask questions, and addressing language barriers.

PRACTICE IMPLICATIONS

Advancing health literacy impacts community and public health initiatives, improves health disparities, builds patient-provider trust, and improves health systems.

Is Functioning of Older Adults with Chronic Musculoskeletal Pain Related to Health Literacy?

We investigated the relationship between health literacy (HL) and functioning among older adults with and without chronic musculoskeletal pain (CMP). In a cross-sectional study, we assessed 121 older adults with CMP and 53 without pain using WHODAS 2.0 for functioning and the Newest Vital Sign for HL assessment. Cluster analysis identified groups based on functioning levels. A decision tree model was developed, to account for nonlinear interactions. We found a relationship of inadequate HL with lower functioning in older adults with CMP, particularly when aged over 70 and those younger but with lower education levels. Findings highlight the importance of screening HL among older adults with CMP and considering it for tailoring interventions.

Health Literacy and Related Factors in Perioperative Patients: A Cross-Sectional Descriptive Study

Background

Perioperative patient health literacy influences postoperative recovery and self-management. We conducted a cross-sectional study to determine perioperative patient health literacy levels and associated factors.

Methods

From August 2021 to January 2022, 187 patients undergoing surgery at an acute care hospital completed a self-administered questionnaire, based on the Functional, Communicative and Critical Health Literacy (FCCHL) scale, to assess health literacy and related factors. Multiple regression analysis was conducted to identify factors associated with health literacy.

Results

Out of 316 surveyed patients, 187 were included in the analysis. Over 70% of perioperative patients in this study were classified as having limited health literacy according to the FCCHL scale. These patients exhibited low communicative and critical health literacy. Factors significantly associated with patients' total health literacy scores included age, knowledge about diseases, education level, use of media about health and disease, and generalized self-efficacy.

Conclusion

Healthcare providers should recognize that perioperative patients generally possess low health literacy. Understanding factors influencing individual health literacy levels is essential to provide tailored support in the perioperative patient.

Health literacy, oral diseases, and contributing pathways: results from the Lifelines Cohort Study

OBJECTIVE

Health literacy (HL), the ability to deal with information related to one's health, may affect oral health via several routes. Therefore, this study aimed to examine the association of HL with oral diseases, and whether this association is mediated by oral health behaviour and dental care utilisation.

METHODS

We included 26,983 participants from the prospective multigenerational Dutch Lifelines Cohort Study to estimate the association between limited health literacy, and self-reported oral health outcomes (edentulism and gingivitis), and mediation by oral health behaviour and dental care utilisation. Structural equation modelling was used to assess HL's direct, indirect, and total effects on oral health outcomes.

RESULTS

Limited health-literate participants had increased odds of having poor oral health outcomes, i.e. edentulism (odds ratio: 1.41; 95 %-confidence interval: 1.24 to 1.58) and gingivitis (1.22; 1.14 to 1.30). After adjustment for age, income, and education, brushing behaviour and dental care utilization showed a significant mediation effect. Brushing behaviour mediated 7.4 % of the association between HL and edentulism and 6.7 % for gingivitis. Dental visits accounted for 38.0 % of the association between HL and edentulism and 16.4 % for gingivitis.

CONCLUSIONS

Limited HL makes edentulism and gingivitis more likely, with poor oral health behaviour and inadequate dental care utilisation being important mediators. The findings suggest that interventions should focus on helping dental professionals recognize patients with limited HL and providing training in patient-centered communication to improve oral health outcomes.

CLINICAL SIGNIFICANCE

This study demonstrates that limited health literacy significantly increases the risk of edentulism and gingivitis, mediated by inadequate oral health behaviours and dental care utilization. These findings highlight the need for targeted interventions to improve HL, thereby enhancing oral health outcomes and reducing disparities in clinical dental practice.

Integrating evidence from lived experience of Aboriginal people and clinical practice guidelines to develop arthritis educational resources: a mixed-methods study

BACKGROUND

Globally, osteoarthritis, rheumatoid arthritis, and gout (arthritis conditions) result in considerable pain and suffering and disproportionately affect First Nations Peoples, who are more likely than non-First Nations Peoples to have an arthritis condition and to experience a higher burden of disease. Access to culturally appropriate health information supports the health and wellbeing of First Nations Peoples. The aim of this study was to identify evidence-based, culturally appropriate recommendations to inform the development of arthritis educational resources for Aboriginal and Torres Strait Islander Peoples (First Nations Peoples in Australia).

METHODS

This mixed-methods study using community-based participatory action research had three phases: interviews (research yarns) with Aboriginal people to explore their informational needs and preferences for arthritis educational resources; systematic reviews and synthesis of education recommendations from high-quality arthritis clinical practice guidelines; and integration and interpretation of datasets from the first two phases. Details of the three systematic reviews have been published previously. We only included clinical practice guidelines that met our inclusion criterion of high quality, assessed using the Appraisal of Guidelines for Research and Evaluation II instrument.

FINDINGS

Between Dec 24, 2020, and Nov 2, 2022, 30 Aboriginal people participated in research yarns. 21 (70%) participants were female and nine (30%) were male, with median age 60 years (range 22-75). All participants identified as Aboriginal and no participants identified as Torres Strait Islander. Research yarn data was combined with education recommendations from 18 clinical practice guidelines. Synthesis of the two datasets generated the following recommendations for inclusion in educational resources: the impact of arthritis on health and wellbeing, when and how to access care, management options (eg, benefits and risks), and disease knowledge (eg, prognosis and addressing misconceptions). In addition, educational resources should be jargon-free and include positive lived experience stories, flags, and colourful local art. Educational resources should be created by Aboriginal people and delivered by health professionals, family, or Aboriginal Community members in the form of brochures, videos, or yarning circles.

INTERPRETATION

The recommendations from this study will inform the development of arthritis educational resources for Aboriginal Peoples. The findings can also support health professionals to deliver evidenced-based arthritis care to Aboriginal Peoples. Internationally, a community-based participatory action research approach can be applied to develop educational resources for First Nations Peoples and communities.

FUNDING

Australian Commonwealth Government through Arthritis Australia.

Keeping It Simple-Pain Science Education for Patients with Chronic Pain Referred to Community-Based Rehabilitation: Translation, Adaptation, and Clinical Feasibility Testing of PNE4Adults

Background/Objectives: Pain science education accommodating low health literacy is needed for people with chronic pain. The purpose of this study was to translate PNE4Kids, contextually adapt it into PNE4Adults, and test the feasibility of the newly developed pain science education program (PNE4Adults) for adult patients with chronic musculoskeletal pain in the municipality. Methods: A three-step approach was used to (1) translate PNE4Kids into Danish, (2) adapt to age and context (PNE4Adults), and (3) test the feasibility. (1) Translation was performed by a native Dane fluent in Dutch. (2) Two think-aloud group sessions were held, with therapists and end users. (3) Feasibility was tested amongst twenty adult patients with chronic musculoskeletal pain consecutively referred for rehabilitation in the municipality. The a priori success criteria were determined to be 70% acceptability and 70% understandability. Prior to inclusion of the first patient, the study was pre-registered on clinicaltrial.gov [NCT05140031]. Results: Translation was successfully performed. Both the therapist and end users found the program easy to grasp, the simplicity and interactive nature of the program ingenious, and the program to be well suited to an adult population. All patients (100%), across health literacy levels, found PNE4Adults comprehensible and acceptable. Conclusions: The aims were successfully met. Progression to a full trial is warranted and is underway.

Effect of health literacy-based teach-back training on quality of life and treatment adherence in type 2 diabetes: an experimental study

Education for patients with type 2 diabetes is an essential part of the treatment and control process. This study aimed to determine the effect of education based on health literacy strategies on adherence to treatment and quality of life in type 2 diabetic patients. This classic experimental study was performed on 94 patients with type 2 diabetes selected by convenient sampling method and then randomly allocated to intervention and control groups. The research instruments were a demographic information questionnaire, a Diabetes Quality of Life Brief Clinical Inventory, and an adherence to treatment questionnaire in patients with chronic disease. The educational intervention was five sessions of the virtual class of 80-90 min. All respondents completed the tools again two months after the intervention. Independent t-tests and paired t-tests were used for data analysis. The difference in the mean score of quality of life in the intervention group between the time before (53.21 ± 7.6) the intervention and two months after (55.28 ± 6.87) was statistically significant (p˂0.05). Comparison of the mean score of quality of life between the control and intervention groups, before the intervention (p > 0.05) and two months after (p > 0.05), neither showed a statistically significant difference. A comparison of the mean scores of adherence to treatment before (69.31 ± 5.32) and after the intervention (70.59 ± 5.21) showed that there was a statistically significant difference in the intervention group (p˂0.001). Comparison of the mean scores of adherence two months after the intervention revealed that, there is a significant statistical difference between the scores of the two groups (p˂ 0.001). Based on the findings of this study, it seems that providing training sessions based on health literacy strategies can improve the quality of life and adherence to treatment in patients with type 2 diabetes.

[Health literacy: Definition, assessment tools, state of the art in Europe, health consequences and ways to improve it]

The term "littératie" is derived from the English word "literacy", which refers to knowledge and skills in the fields of reading, writing, speech (or other means of communication) and calculation that allow people to be efficient and integrated into society. Health literacy is a recent concept that relies on the ability to find, understand, evaluate and communicate information in ways that promote, maintain and improve the health of the individual in various settings over the course of life. The objectives of this review are first of all to realize an overview on the health literacy of populations in Europe. Then, we propose to study the link between health literacy and health status (risk behaviors, chronic diseases, morbi-mortality, adherence to care and medical monitoring) and to study its medico-economic impact. We also analyzed the association between personalized therapeutic education and health literacy. Finally, we propose a review of the means put in place in the care system to improve the health literacy of the patients we manage.

Improving the quality of self-collected swab specimens for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae in a clinical setting

BACKGROUND

The practice of patient self-collected swab specimens for Neisseria gonorrhoeae and Chlamydia trachomatis is supported in the literature.

LOCAL PROBLEM

Health care providers observed that patients sometimes performed their self-swabs incorrectly resulting in cancelled or invalid specimens.

METHODS

The clinic's outdated visual aids were replaced with new visual aids. The goal was to improve health care provider proficiency in providing the health teaching and to reduce the clinic's number of cancelled or invalid swab specimens. Staff evaluated the visual aids using an online pretest and post-test survey. The percentage of invalid swabs was calculated before and after project implementation.

INTERVENTION

The posters were designed and printed. In-person teaching on the project and using the new visual aids was provided.

RESULTS

There was no change in the reported proficiency of staff in providing health teaching for self-collected swab specimens. There was a reduction in staff observed self-swabbing errors. Three percent of rectal swabs were reported as invalid in the 2 weeks before project implementation, and 1.4% of rectal swabs were invalid in the 2 weeks after.

CONCLUSIONS

Providing patient health teaching using verbal instructions combined with visual diagrams can improve patients' ability to retain health information.

Interventions to improve patient health education competence among nursing personnel: a scoping review protocol

INTRODUCTION

Patient health education has gradually become an indispensable and important part of nursing work. However, nursing personnel's performance in this domain remains below satisfactory levels. The absence of patient health education competence (PHEC) constitutes a significant impediment to the effective implementation of such education by nursing personnel. Effective training in PHEC can enable nursing personnel to recognise the importance of patient health education, improve their attitudes towards patient health education and gain comprehensive knowledge and skills, thus improving patients' health outcomes and quality of life, while also enhancing the overall quality of nursing. However, the related research is fragmented and there is a lack of systematic review of related literature. The scoping review aims to provide a comprehensive overview of the existing interventions related to cultivating the PHEC of nursing personnel.

METHODS AND ANALYSIS

We will use the Joanna Briggs Institute methodology to guide the scoping review proposed by this protocol. Between 1 April 2024 and 15 April 2024, a systematic search of electronic bibliographic databases, including Cochrane Library, PubMed, EMBASE, CINAHL, MEDLINE and ERIC, will be conducted. In addition, the grey literature source Google search engine will also be searched. Two reviewers will independently screen and conduct data extraction. Any discrepancies that arise will be resolved through consultation with a third reviewer. The data will be analysed and presented in tables, flow diagrams and text.

ETHICS AND DISSEMINATION

Ethical approval is not applicable for this study. We will share the findings from the study at national and/or international conferences and in a peer-reviewed journal in the fields of nursing education and/or patient education.

REGISTRATION NUMBER

This scoping review had been registered on Open Science Framework (http://osf.io/dapq7).

Same patient but different worlds: A state-of-the-art review translating best practice psychosocial care from musculoskeletal care to the orthopaedic context

BACKGROUND

Individuals with chronic musculoskeletal conditions experience persistent pain and disability that has deleterious impacts on physical function, psychological health, social engagement, relationships, and work participation. This impact is greater in people with psychosocial risk factors, and best practice musculoskeletal care recommends a biopsychosocial approach to management. Orthopaedic surgery is often an effective management approach for chronic musculoskeletal conditions, but research has only recently explored the links between differing patient outcomes after orthopaedic surgery and psychosocial risk factors. Implementing biopsychosocial approaches to musculoskeletal care has taken great strides in the primary care setting however, implementation of the biopsychosocial approach in orthopaedic surgery brings complexity as the context changes from primary care to hospital based secondary care. The aim of this review therefore is to explore implementation of psychosocial care in the elective orthopaedic surgery context, informed by evidence in musculoskeletal care.

ASSESSMENT AND MANAGEMENT OF PSYCHOSOCIAL FACTORS

Several composite screening tools for psychosocial factors or 'yellow flags' are recommended for use in primary care for musculoskeletal conditions alongside a comprehensive patient interview. However, in the orthopaedic surgery context, composite measures have focused on discharge destination, and there is not a universal approach to comprehensive patient interview incorporating a biopsychosocial approach. A range of biopsychosocial approaches to musculoskeletal conditions have been developed for the primary care setting, yet few have been explored in the context of orthopaedic surgery.

IMPLEMENTATION OF PSYCHOSOCIAL CARE

Implementing best practice psychosocial care into the orthopaedic context has enormous potential for all stakeholders, but several barriers exist at the level of the individual patient and practitioner, workforce, health service and society. We have discussed key considerations for implementation including workforce composition, patient-centred care and shared decision making, health literacy, continuity of care, and consideration of preferences for women and culturally diverse communities.

CONCLUSION

This review considers current literature exploring implementation of psychosocial care into the orthopaedic surgery context, informed by current research in musculoskeletal care. This presents a critical opportunity for orthopaedic surgery to provide optimised, equitable, high-value, patient-centred care.

Impact of short-term patient education intervention on the teaching skills of physical therapy students: a randomized controlled trial

BACKGROUND

Patient education is an important aspect of physiotherapy. Effective education is based on quality communication and understanding of patients' needs. For a successful practice, it is necessary to recognize the factors that affect the ability to teach the patient and prepare new physiotherapists for this task. The research aims to determine the effect of training on the self-efficacy and skills of physiotherapy students in patient education.

METHODS

Final-year physiotherapy students were randomized into an intervention group (52 students) and a control group (51 students). The intervention group participated in 2.5 hours of lectures, discussions, simulated exercises with colleagues, and video examples of patient education. Students in the control group received standardized instruction without the additional intervention provided to the experimental group. All students performed a self-assessment of their teaching abilities. Patient education was assessed by a blinded evaluator using the Objective Structured Clinical Examination from an audio-recorded simulated clinical practice task.

RESULTS

The results show no differences in demographic variables, while a significant improvement was achieved for the intervention group after the training. The intervention group before the experiment did not perform differently than the control group on self-efficacy items (p>.05), but they did perform significantly better than the control group after the experiment (p<.001). The intervention group showed better results than the control group in almost all observed fields.

CONCLUSION

Short-term educational intervention significantly enhances physiotherapy students' self-efficacy and patient education skills, emphasizing the value of structured educational interventions.

Counselling for patients with a temporomandibular disorder: A scoping review and concept analysis

BACKGROUND

An integral component of comprehensive temporomandibular disorder (TMD) treatment involves what is commonly referred to in literature as patient counselling or patient education. Despite its importance, a clear definition of the concept is lacking.

OBJECTIVES

To describe the concept of counselling (i.e. what is it, what should it consist of, and when should it be given) through a concept analysis of the literature.

ELIGIBILITY CRITERIA

All papers that include a description of counselling or education for TMD are included.

SOURCES OF EVIDENCE

Literature searches were performed in the electronic databases PubMed, Cinahl, and PsycInfo.

CHARTING METHODS

A qualitative analysis was done using the principle-based concept analysis approach, where descriptions of counselling from the included papers were analysed by the researchers.

RESULTS

A total of 71 articles were included. Based on the qualitative analysis of the included articles and descriptions of counselling, the following content themes were identified: (1) general information on TMD; (2) overuse of the masticatory system; (3) posture education; (4) lifestyle and psychosocial factors; (5) exercise- and thermotherapy; and (6) additional information and therapies.

CONCLUSIONS

A definition and framework of counselling for TMD has been provided, which can be used in the clinic, research, and educational programs.

Not All Pain Is Caused by Tissue Damage in Sports. Should Management Change?

SYNOPSIS: A sports injury need not imply objective or subjective signs of tissue damage. Pain and impaired performance can count as an injury, which is often measured by the inability to play or participate in training and/or competition. Pain in the presence, and in the absence, of objective tissue damage is common in sports, but there are important differences in how sports-related pain and injury are managed, such as whether return to sport should be time and/or pain contingent. This editorial proposes a pragmatic definition of sports-related pain to support clinicians with a semantic and practical description of what sports-related pain is, and the implications for helping athletes manage pain in the absence of tissue injury. J Orthop Sports Phys Ther 2024;54(11):681-686. Epub 21 October 2024. doi:10.2519/jospt.2024.12462.

Advice-giving skills in pre-registration physiotherapy training

BACKGROUND

With increased emphasis on self-management in healthcare, clinicians need outstanding skills in offering advice and empowering patients to attain an optimal outcome.

OBJECTIVES

This study explores how undergraduate physiotherapists acquire knowledge, skills, and confidence to offer advice to patients in clinical practice.

METHODS

Convenience sampling was used to recruit 50 BSc and MSc pre-registration physiotherapy students across all years of study in one university in southern England, UK. Semi-structured interviews were conducted for first year BSc students (n = 13). Six focus groups of mixed BSc and MSc students were conducted, three groups (n = 15 students) were mid-training, and three groups (n = 22 students) were in their final year.

RESULTS

Thematic analysis identified 6 themes: advice content; a patient-centered approach; delivery; acquisitions; perceptions; and uptake of advice. Students placed high value on advice-giving, drawing upon multiple learning opportunities, however they felt under-prepared to deliver this skill in practice. Furthermore, perceptions of their student status, and pressures to perform on graded placements were reported to influence the advice they offered to patients.

CONCLUSIONS

Developing high-level skills in promoting self-management is essential in physiotherapy, this study highlights the challenges for students to develop these skills. Academic and practice educators must explicitly enable and support students to develop the knowledge and skills to confidently offer high-quality advice to patients.

Impact of a transformative health literacy model for Thai older adults with hypertension

BACKGROUND

Hypertension is the important risk factor for cause disability and death, particularly if there is a loss of self-care knowledge. Health literacy encompasses the comprehension and awareness of health-related information, which is beneficial for managing the health of older adults with hypertension. Therefore, the objective of this study was to examine the impact of a transformative health literacy model to develop the health literacy levels among Thai senior citizen with hypertension.

METHOD

This research employed an experiment. Thirty-six participants engaged in the transformative health literacy model. The instrument is the health literacy in hypertension scale, which had acceptable reliability and validity.

RESULTS

The study revealed that the level of health literacy in the post-test and follow-up phases of the experimental group who received the health literacy promotion model was significantly higher than the pre-test level of health literacy at a significance level of 0.05.

CONCLUSION

The study outcomes create a new pathway to enhancements of health literacy in Thai older adults with hypertension.

Evaluating cancer patient-reported experience measures against health literacy best practices

PURPOSE

Positive patient experiences can lead to better adherence to cancer treatment and greater patient health outcomes. The primary aim of this descriptive study was to determine whether commonly used cancer PREMs have been developed according to health literacy best practices. The secondary and third aims were to examine the development of PREMs and to assess their comprehensiveness against principles of patient-centered care.

METHODS

To assess adherence to best practice literacy principles regarding readability and understandability of commonly used cancer PREMs, three validated readability calculators and a validated instrument were utilized. To better understand how PREMs were developed, data about survey items, patient involvement, and expert consultation were collected. Finally, the Picker framework was used to evaluate the comprehensiveness of PREMs against principles of patient-centered care.

RESULTS

Thirty-five PREMs studies met inclusion criteria for the study. The mean reading grade level of cancer PREMs was 9.7 (SD = 0.75, range = 8.2-11.2) with best practice recommendation being a grade 6 reading grade level. Twenty-eight PREMs were rated on understandability, with a mean score of 74% (SD = 10.6, range = 46-93%, with optimal score of greater than 80%). The mean number of items across PREMs was 49 (SD = 31, range = 13-136). Recommendations for the number of items to include in a questionnaire is 25-30 items. Most PREMs (n = 33, 94.3%) asked ≥ 1 double-barreled question. All PREMs addressed ≥ 2 patient-centered care principles.

CONCLUSION

Cancer PREMs included in this study did not meet evidence-informed thresholds for readability and understandability. As such, it is possible that there may be gaps in how we understand the care experiences of low health literacy populations. Future development of PREMs should engage patients with low health literacy to ensure their perspectives are accurately captured and that PREMs are designed to meet the needs of all patients.

Physicians Are Unable to Consistently Predict Patient Health Literacy in a Breast Clinic

INTRODUCTION

Health literacy (HL) is a patient's capacity to understand health information. Low HL is associated with worse cancer outcomes and adherence to treatment regimens. This study aimed to test physicians' ability to predict their patients' HL after an initial consultation to determine if routine HL screening is valuable.

METHODS

From February 2023 through June 2023, patients seen at an academic breast clinic completed a validated, self-reported HL assessment. Surgical and medical oncologists estimated their patients' HL by answering the same HL questionnaire based on their perception of the patient visit. Patient and physician scores were compared using an intraclass correlation coefficient. Linear regression was used to evaluate associations between physicians' ability to predict HL and other variables.

RESULTS

The cohort included 210 patient HL scores with corresponding physician scores for each. Most patients (75.7%) had adequate HL. There was moderate agreement between the patient and physician HL scores (intraclass correlation coefficient = 0.677, P < 0.01), meaning physicians could somewhat predict their patient's HL. Physicians were worse at predicting HL when patients had low HL. There was no difference in physicians' ability to predict HL based on patient age (P = 0.09) or race (P = 0.29). Additionally, we found no difference in the ability to predict HL based on the physician's specialty (P = 0.25).

CONCLUSIONS

After an initial consultation, physicians cannot accurately predict patient HL, particularly in patients with lower HL. Given the impact of low HL on a patient's ability to make treatment decisions and adhere to treatment plans, using a validated tool to measure HL is necessary.

Exploring the potential of virtual reality for the self-management of chronic pain: A scoping review of its use to address health literacy

BACKGROUND

Individuals with low health literacy struggle to manage long-term conditions. Addressing pain-related health competencies is important in the management of chronic pain. Virtual reality may be a useful tool for empowering sustainable health-related stratgies due to its unique ability to engage users in artificial environments.

OBJECTIVES

The aim of this scoping review was to explore existing research on the use of virtual reality as a tool to promote health literacy in people with chronic pain.

DESIGN

Scoping Review guided by framework proposed by Arksey & O'Malley.

METHOD

Articles related to "pain", "virtual reality" and "health literacy" were searched in four electronic databases: CINAHL, PubMed, Embase and PsycINFO using a formal search strategy. Studies were categorised based on intervention content using the Health Literacy Pathway Model which encompasses health knowledge, self-management skills, health communication and information seeking.

RESULTS

Thirteen studies met the inclusion criteria. Several elements of pain related health literacy were not addressed in the research. Interventions addressed health knowledge, self-management skills, decision making and featured content aiming to address emotional barriers to pain-related health literacy. Other components including active information seeking and use, actively communicating with health professionals and seeking and negotiating treatment options, were not explicitly addressed.

CONCLUSION

There is heterogeneity in existing research exploring the use of VR to support people with chronic pain. Existing VR tools to address pain-related health literacy do not cover several key components of health literacy. More research is required before a robust assessment of efficacy can be undertaken.

Working as a physiotherapist in a rapid response team: 'An emotional rollercoaster'

BACKGROUND AND INTRODUCTION

Rapid Response Teams (RRTs) are multidisciplinary, 'hospital at home' services which have developed over the last 10 years, aiming to improve recovery from illness more efficiently, prevent unnecessary hospital admission, and prevent early admission to residential care. However, little is known about the experience of professionals working in these roles.

PURPOSE

The aim of this study was to explore how working in an RRT is experienced and perceived by physiotherapists.

METHODS

This study used phenomenographically inspired methodology. Six participants who were working in RRTs were recruited to this study and all were working in the South of England. Data were collected via semi-structured interviews, and phenomenographic analysis was undertaken.

RESULTS

Participants working in RRTs described a range of varied, concrete lived-through experiences in addition to a more rhetorical discussion of how they conceptualized their work. Six main categories of description were generated from the analysis; each was assigned a metaphor. These included 'the detective,' 'the guru,' 'the lone ranger,' 'the team player,' 'the bricoleur,' and 'an emotional rollercoaster'; all categories were present with varied meanings. 'An emotional rollercoaster' was present within and throughout participants' descriptions of all other categories.

CONCLUSION

This study provides valuable insights into physiotherapists' experience and conceptualization of working within this discipline, which may have implications for physiotherapy practice, workforce development, new and current RR physiotherapy services, RRT health professionals, and physiotherapy education.

Knowledge, attitude, and practice toward interstitial lung disease among patients: a cross-sectional study

Objective

To explore the knowledge, attitude, and practice (KAP) toward interstitial lung disease (ILD) among patients and analyze the factors affecting KAP.

Methods

This cross-sectional study enrolled patients with ILD treated at the Respiratory Department of Shanghai Pulmonary Hospital between January 2023 and June 2023. A self-administered questionnaire was developed to evaluate their KAP toward ILD through convenient sampling. Multivariate regression analysis and structural equation model (SEM) were used to analyze the factors influencing KAP and their interactions.

Results

A total of 397 patients were enrolled, with 61.71% male. The mean KAP scores were 4.60 ± 3.10 (possible range: 0-12), 16.97 ± 2.16 (possible range: 5-25), and 32.60 ± 7.16 (possible range: 9-45), respectively. Multivariate logistic regression analysis showed that junior high school [OR = 2.003, 95%CI: 1.056-3.798, p = 0.033], high school and above [OR = 2.629, 95%CI: 1.315-5.258, p = 0.006], and duration of disease ≥5 years [OR = 1.857, 95%CI: 1.132-3.046, p = 0.014] were independently associated with adequate knowledge. The knowledge [OR = 1.108, 95%CI: 1.032-1.189, p = 0.005] and duration of disease ≥5 years [OR = 0.525, 95%CI: 0.317-0.869, p = 0.012] were independently associated with a positive attitude. The knowledge [OR = 1.116, 95%CI: 1.036-1.202, p = 0.004], attitude [OR = 1.180, 95%CI: 1.061-1.312, p = 0.002], and the age of >70 years [OR = 0.447, 95%CI: 0.245-0.817, p = 0.009] were independently associated with the proactive practice. SEM showed that patients' knowledge of ILD directly affected their attitude (β = 0.842, p < 0.001) and practice (β = 0.363, p < 0.001), and their attitude also affected their practice (β = 0.347, p = 0.014).

Conclusion

Patients with ILD in China had poor knowledge, intermediate attitude, and proactive practice toward ILD, which suggests that the health education of patients should be further strengthened.

Psychometric Testing of the Filipino Version of the Clients' Perceptions of Providers' Cultural Competency Instrument Among LGBTQ+ Population in the Philippines

Background and Purpose: Cultural competence is significant in addressing the health needs of vulnerable populations. This study conducted psychometric testing of a cultural competency instrument in the Philippines. Methods: Brislin's translation and a cross-sectional online design were used. Exploratory factor analysis (EFA) with varimax rotation examined construct validity of the 23-item scale among 157 adult LGBTQ+ residents. The scale revealed overall reliability (α = .85) including two subscales (α = .87, α = .81, and α = .61). The EFA yielded three theoretical factorial solutions. Conclusion: The Filipino version of the instrument demonstrated reliability and validity. Measuring clients' perceptions of provider and organizational cultural competency can improve the utilization of healthcare in Filipino LGBTQ+ communities. Future research will examine the dimensional structures of the instrument among expanded LGBTQ+ communities.

Acceptability and feasibility of virtual reality to promote health literacy in primary care from the health professional's view: A qualitative study

OBJECTIVE

The development of health literacy is important in the management of chronic pain and virtual reality may be an effective medium for its development. This study aims to understand the usability and acceptability of a virtual reality-based pain education system for the facilitation of health literacy.

METHODS

Semi-structured interviews were conducted with health professionals who had used a VR-based pain education system within their clinical practice, to explore perceptions of feasibility. Data collection and analyses were informed by the Unified Theory of Acceptance and Use of Technology and the Integrated Model of Health Literacy.

RESULTS

From 10 participants, the VR-based system was considered feasible in providing immersive experiential learning which addressed patient understanding and health-related communication.

CONCLUSION

VR appears to be perceived as an acceptable and feasible technology to support the development of health literacy in people with chronic pain. Its largest perceived benefit was its capacity to provide an immersive and entertaining alternative to conventional methods of pain education.

PRACTICE IMPLICATIONS

Virtual reality is considered as a feasible method of facilitating patient understanding and health-related communication related to chronic pain. Feasibility of such a tool relies clinically on time available, social expectations of VR, and the role of immersive and experiential learning within the management of chronic pain.

How do young women approaching screening age interpret the NHS cervical screening leaflet? A mixed methods study of identifying interpretation difficulties, barriers, facilitators, and leaflet interpretation, engagement and future screening behaviour

BACKGROUND

Cervical cancer is a common cancer among young women aged 25-29 in England, and the NHS cervical screening leaflet is the first point of contact for those being invited for their first screening. This study aimed to explore how young women (18-24) understand and engage with the leaflet, as well as the barriers and facilitators associated with its interpretation, engagement, and screening intentions.

METHODS

The study used a mixed-methods approach, including a survey (n = 120) to identify interpretation difficulties and how they were affected by different characteristics, and a follow-up interview (n = 10) to assess the utility of the leaflet, identify issues with its practicality, and determine the factors that influence screening intentions.

RESULTS

The survey results showed that interpretation difficulties were common, particularly regarding HPV assessment, screening results, additional tests/treatment, and screening risks. Lower interpretation accuracy was associated with lower numeracy scores and non-white ethnicity. Despite these difficulties, participants had high confidence and motivation to engage with the leaflet. The interviews revealed knowledge gaps, issues with the leaflet's practicality, and a preference for digital information. Factors that were identified as barriers and facilitators of leaflet interpretation, engagement, and screening intentions included knowledge, social influence, beliefs about consequences, environmental context and resources, social role and identity, emotions and intentions.

CONCLUSION

The current leaflet does not provide enough information for young women to make an informed decision about screening attendance. Implementing a digital invitation featuring simplified gist representation, targeted behaviour change techniques (BCTs), videos, and interactive tools can enhance education and promote screening behaviour. Future research should consider using digital tools and strategies to address existing barriers related to interpretation and engagement.

Racial and Socioeconomic Disparities in Laminoplasty Versus Laminectomy With Fusion in Patients With Cervical Spondylosis

STUDY DESIGN

A retrospective cohort study using prospectively collected data.

OBJECTIVE

The aim of this study was to investigate preoperative differences in racial and socioeconomic factors in patients undergoing laminoplasty (LP) versus laminectomy and fusion (LF) for degenerative cervical myelopathy (DCM).

SUMMARY OF BACKGROUND DATA

DCM is prevalent in the United States, requiring surgical intervention to prevent neurological degeneration. While LF is utilized more frequently, LP is an emerging alternative. Previous studies have demonstrated similar neurological outcomes for both procedures. However, treatment selection is primarily at the discretion of the surgeon and may be influenced by social determinants of health that impact surgical outcomes.

MATERIALS AND METHODS

The Quality Outcome Database (QOD), a national spine registry, was queried for adult patients who underwent either LP or LF for the management of DCM. Covariates associated with socioeconomic status, pain and disability, and demographic and medical history were collected. Multivariate logistic regression was performed to assess patient factors associated with undergoing LP versus LF.

RESULTS

Of 1673 DCM patients, 157 (9.4%) underwent LP and 1516 (90.6%) underwent LF. A significantly greater proportion of LP patients had private insurance (P<0.001), a greater than high school level education (P<0.001), were employed (P<0.001), and underwent primary surgery (P<0.001). LP patients reported significantly lower baseline neck/arm pain and Neck Disability Index (P<0.001). In the multivariate regression model, lower baseline neck pain [odds ratio (OR)=0.915, P=0.001], identifying as non-Caucasian (OR=2.082, P<0.032), being employed (OR=1.592, P=0.023), and having a greater than high school level education (OR=1.845, P<0.001) were associated with undergoing LP rather than LF.

CONCLUSIONS

In DCM patients undergoing surgery, factors associated with patients undergoing LP versus LF included lower baseline neck pain, non-Caucasian race, higher education, and employment. While symptomatology may influence the decision to choose LP over LF, there may also be socioeconomic factors at play. The trend of more educated and employed patients undergoing LP warrants further investigation.

Evaluating ChatGPT's Accuracy in Responding to Patient Education Questions on Acute Kidney Injury and Continuous Renal Replacement Therapy

INTRODUCTION

Acute kidney injury (AKI) and continuous renal replacement therapy (CRRT) are critical areas in nephrology. The effectiveness of ChatGPT in simpler, patient education-oriented questions has not been thoroughly assessed. This study evaluates the proficiency of ChatGPT 4.0 in responding to such questions, subjected to various linguistic alterations.

METHODS

Eighty-nine questions were sourced from the Mayo Clinic Handbook for educating patients on AKI and CRRT. These questions were categorized as original, paraphrased with different interrogative adverbs, paraphrased resulting in incomplete sentences, and paraphrased containing misspelled words. Two nephrologists verified the questions for medical accuracy. A χ2 test was conducted to ascertain notable discrepancies in ChatGPT 4.0's performance across these formats.

RESULTS

ChatGPT provided notable accuracy in handling a variety of question formats for patient education in AKI and CRRT. Across all question types, ChatGPT demonstrated an accuracy of 97% for both original and adverb-altered questions and 98% for questions with incomplete sentences or misspellings. Specifically for AKI-related questions, the accuracy was consistently maintained at 97% for all versions. In the subset of CRRT-related questions, the tool achieved a 96% accuracy for original and adverb-altered questions, and this increased to 98% for questions with incomplete sentences or misspellings. The statistical analysis revealed no significant difference in performance across these varied question types (p value: 1.00 for AKI and 1.00 for CRRT), and there was no notable disparity between the artificial intelligence (AI)'s responses to AKI and CRRT questions (p value: 0.71).

CONCLUSION

ChatGPT 4.0 demonstrates consistent and high accuracy in interpreting and responding to queries related to AKI and CRRT, irrespective of linguistic modifications. These findings suggest that ChatGPT 4.0 has the potential to be a reliable support tool in the delivery of patient education, by accurately providing information across a range of question formats. Further research is needed to explore the direct impact of AI-generated responses on patient understanding and education outcomes.

The association between health literacy and pedestrian safety behavior among adults: a cross-sectional study

INTRODUCTION

Pedestrians are considered the most vulnerable and complex road users as human behavior constitutes one of the fundamental reasons for traffic-related incidents involving pedestrians. However, the role of health literacy as a predictor of Pedestrian safety behavior remains underexplored. Therefore, the current study was designed to examine the level of health literacy and its association with the safety behavior of adult pedestrians in the city of Tabriz.

METHODS

This cross-sectional analytical study was conducted among individuals aged 18 to 65 years in the metropolitan area of Tabriz from January to April 2023. Data were collected using the HELIA standard questionnaire (Health Literacy Instrument for adults), comprising 33 items across 5 domains (access, reading, understanding, appraisal, decision-making and behavior), as well as the Pedestrian Behavior Questionnaire (PBQ) consisting of 29 items. Data were analyzed using descriptive and analytical statistics (independent t-tests, ANOVA, and Pearson correlation coefficient) via SPSS-22 software.

RESULTS

Based on the results, 94% (376 individuals) had excellent health literacy levels, and their safety behavior scores were at a good level. Health literacy and safety behavior were higher among the age group of 31 to 45 years, women, married individuals, those who read books, and individuals with higher education. However, safety behavior showed no significant association with education level (P > 0.05). There was a significant and positive relationship between health literacy and all its domains and pedestrian safety behavior (r = 0.369, P < 0.001).

CONCLUSION

This study underscores the significant impact of health literacy on pedestrians' safety behavior. The findings reveal that higher levels of health literacy are associated with better safety behavior among individuals aged 18 to 63. Demographic factors such as age, gender, marital status, and education level also play a role in shaping both health literacy and safety behavior. By recognizing these relationships, interventions can be tailored to improve health literacy levels and promote safer pedestrian practices, ultimately contributing to a healthier and safer community in Tabriz city.

An Analysis of the Readability of Online Sarcoidosis Resources

Introduction Sarcoidosis is an inflammatory disease characterized by the formation of noncaseating granulomas in multiple organ systems. The presentation can vary widely; although some patients with sarcoidosis can be asymptomatic, sarcoidosis can also present in others with symptomatic multiorgan system involvement. Considering the potential severity of the disease, patients need to be well-informed about sarcoidosis to better manage their health. This study aims to assess the readability levels of online resources about sarcoidosis. Methods We conducted a retrospective cross-sectional study. The term "sarcoidosis" was searched online using both Google and Bing to find websites written in English. Each website was categorized by type: academic, commercial, government, nonprofit, and physician. The readability scores for each website were calculated using six different readability tests: the Flesch-Kincaid reading ease (FKRE), Flesch-Kincaid grade level (FKGL), Gunning fog score (GFS), Simple Measure of Gobbledygook (SMOG), automated readability index (ARI), and Coleman-Liau index (CLI). FKRE gives a score that corresponds to the difficulty of the text, while the remaining tests give a score that corresponds to a grade level in terms of reading ability. A one-sample t-test was used to compare all test scores with the national recommended standard of a sixth-grade reading level. Our null hypothesis was that the readability scores of the websites searched would not differ statistically significantly from the sixth-grade reading level and that there would be no significant differences across website categories. To evaluate the difference between the categories of websites, ANOVA testing was used. Results Thirty-four websites were analyzed. Each of the six readability tests for the websites had an average score, which corresponded to being significantly harder to read than the nationally recommended sixth-grade reading level (p<0.001). None of the mean readability scores showed a statistically significant difference across the five different website categories. Conclusions This is the first study, to our knowledge, to examine the readability of online English resources on sarcoidosis and calculate standardized readability scores for them. It implies that the online English material for sarcoidosis is above the health literacy recommended reading levels for patients. There is a need to simplify the material to be easier to read for patients.

Effects of Manual Therapy Plus Pain Neuroscience Education with Integrated Motivational Interviewing in Individuals with Chronic Non-Specific Low Back Pain: A Randomized Clinical Trial Study

Background and Objectives: Chronic non-specific low back pain (CNLBP) persists beyond 12 weeks. Manual therapy recommended for CNLBP demonstrates short-term efficacy. Pain Neuroscience Education (PNE) teaches patients to modify pain perception through explanations, metaphors, and examples, targeting brain re-education. Motivational Interviewing (MI) enhances motivation for behavioral change, steering patients away from ambivalence and uncertainty. These approaches collectively address the multifaceted nature of CNLBP for effective management. The aim of this study was to investigate a manual therapy intervention combined with PNE with MI on pain, pressure pain threshold (PPT), disability, kinesiophobia, catastrophizing, and low back functional ability in individuals experiencing CNLBP. Materials and Methods: Sixty adults with CNLBP were randomly divided into three equal groups (each n = 20). The first group received manual therapy and PNE with integrated MI (combined therapy group), the second group underwent only manual therapy (manual therapy group), and the third group followed a general exercise program at home (control group). Pain in the last 24 h was assessed using the Numeric Pain Rating Scale (NPRS), functional ability with the Roland-Morris Disability Questionnaire (RMDQ), PPT in the lumbar region through pressure algometry, kinesiophobia with the Tampa Scale for Kinesiophobia (TSK), catastrophizing with the Pain Catastrophizing Scale (PCS), and performance using the Back Performance Scale (BPS) at baseline, in the fourth week, and six months post-intervention. Results: Statistically significant differences between the intervention groups and the control group were found in both the fourth-week measurement and the six-month follow-up, as evident in the NPRS and RMDQ scores, as well as in the total values of tested PPTs (p < 0.05). Differences were also observed between the two intervention groups, with a statistically greater improvement in the combined therapy group at both time points (fourth week and six-month follow-up) (p < 0.05). Regarding the TSK and PCS scores in the fourth week, statistically significant differences were observed between the two intervention groups compared to the control group, as well as between the two intervention groups (p < 0.05). However, in the six-month follow-up, statistically significant differences were found only between the combined therapy group and the other two groups, with the combined therapy group showing significant improvements (p < 0.05). In relation to BPS, both intervention groups exhibited statistically significant differences compared to the control group in the fourth week, without any significant differences between the two intervention groups. However, in the six-month follow-up, significant differences were noted between the combined therapy group and the other two groups (p < 0.05), with combined therapy demonstrating greater improvement. Conclusions: The addition of PNE with integrated MI enhanced the positive effects of a manual therapy intervention in all outcome measures. The combination of manual therapy plus PNE with integrated MI appeared to provide greater improvements compared to the isolated application of manual therapy, and these improvements also lasted longer. These short- and long-term positive effects are likely attributed to the combination of PNE with integrated MI, which contributed to increasing the effectiveness of the treatment. Further studies are required to investigate the optimum dosage of manual therapy and PNE with integrated MI in individuals with CNLBP.

Use of podcasts for health education: a scoping review

OBJECTIVES

to map the scientific evidence related to the characteristics, themes, and outcomes of using health education podcasts aimed at individuals over 18 years of age in intra or extrahospital environments.

METHODS

a scoping review, based on the Joanna Briggs Institute method, conducted in 11 databases, including studies from 2004 to 2022.

RESULTS

11 studies were selected, categorized, highlighting the characteristics, evaluated outcomes, areas, and conditions of podcast application, indicating it as an effective tool for promoting behavioral change, health promotion, and social interaction, demonstrating its potential to improve well-being, quality of life, and user/client autonomy.

CONCLUSIONS

the use of podcasts proves to be an effective, innovative, and low-cost tool, with a significant social impact, being effective for behavioral change, satisfaction, and social interaction. However, the lack of comprehensive studies on podcast development methodologies represents challenges to be overcome.

Fertility education: recommendations for developing and implementing tools to improve fertility literacy†

Many recent societal trends have led to the need for fertility education, including the age at which individuals become parents, the development of new reproductive technologies, and family diversity. Fertility awareness has emerged as a concept very recently and is increasingly gaining recognition. However, fertility education is often neglected as there is no consensus on the appropriate content, target populations, or on who should provide it. This article attempts to provide an overview of the use of interventions to improve fertility education. We emphasize the importance of delivering evidence-based information on fertility and reproductive health through various methods while providing guidelines for their standardization and systematization. Recommendations are provided to aid the development and implementation of fertility education tools, including: the establishment of a comprehensive understanding of the target populations; the incorporation of theories of behavioural change; the inclusion of the users' perspectives and the use of participatory research; and the use of specific guidelines for increasing engagement. By following these recommendations, it is expected that fertility education resources can contribute to improving fertility literacy, empowering individuals and couples to make informed reproductive decisions, and ultimately reducing the incidence of infertility and need for fertility treatment.

Uncovering communication strategies used in language-discordant consultations with people who are migrants: Qualitative interviews with healthcare providers

BACKGROUND

Global migration has led to a sharp increase in the number of language-discordant consultations (LDCs) in healthcare. Evidence on how healthcare providers (HCPs) meet migrant patients' needs while mitigating language barriers is lacking.

DESIGN

Using purposive and snowball sampling, we recruited twenty-seven Dutch HCPs (Mage = 45.07, SD = 11.46) and conducted semi-structured interviews to collect qualitative, open-ended data for identifying the communication strategies used with migrant patients in LDCs. We analysed the transcripts using deductive and inductive approaches (e.g., constant comparative method from Grounded Theory). Final pattern codes (i.e., key themes) were discussed among the research team until mutual agreement had been achieved.

RESULTS

Five key themes emerged from the analyses: HCPs often 'got-by' with (1) instrumental and (2) affective communication strategies used in language-concordant consultations to start medical consultations. When some instrumental communication strategies were deemed ineffective (e.g., lingua franca, gesturing, etc.) to bridge language barriers, HCPs turned to (3) incorporating digital tools (e.g., Google Translate). When HCPs were unable to communicate with migrant patients at all, (4) informal, ad-hoc and professional interpreters were involved. Finally, HCPs often (5) involved additional support to engage migrant patients to engage in treatment-related behaviours.

DISCUSSION AND CONCLUSIONS

Our results highlight the importance of raising awareness among HCPs about using various combinations of different strategies. The development of a guideline indicating the optimal combination of communication strategies for different medical consultation goals may be useful in reshaping the current communication behaviour of HCPs in LDCs.

PATIENT OR PUBLIC CONTRIBUTION

HCPs were the study population involved in this qualitative study. Refugee health advisors, general practitioners and linguistic specialists (i.e., members of the Right2Health consortium) with experience with the Dutch healthcare system were involved throughout the development of this research. This includes a review of the research question, participant information sheet and interview topic guide as well as providing interpretations of the data and feedback to this manuscript.

Limited health literacy results in lower health-related quality of life in spine patients

BACKGROUND CONTEXT

Spinal conditions impact health-related quality of life (HRQoL). Patient education and counseling improve HRQoL, yet the effects may be limited for patients with inadequate health literacy (HL). Despite the established relationship between HRQoL and HL in other fields, research in the orthopedic spine population is lacking.

PURPOSE

To investigate if limited HL results in lower HRQoL and to evaluate factors are associated with HRQoL in patients seen at an outpatient orthopedic spine center.

STUDY DESIGN/SETTING

Prospective single-center cross-sectional study.

PATIENT SAMPLE

Patients 18 years of age or older seen at a tertiary urban academic hospital- based multi-surgeon outpatient spine center.

OUTCOME MEASURES

EQ-5D-5L health-related quality of life (HRQoL) questionnaire, and the Newest Vital Sign (NVS) HL assessment tool.

METHODS

Between October 2022 and February 2023, consecutive English-speaking patients over the age of 18 and new to the outpatient spine clinic were approached for participation in this cross-sectional survey study. Patients completed a sociodemographic survey, EQ-5D-5L HRQoL questionnaire, and Newest Vital Sign (NVS) HL assessment tool. The EQ-5D-5L yields two continuous outcomes: an index score ranging from below 0 to 1 and a visual analog scale (EQ-VAS) score ranging from 0 to 100. The NVS scores were divided into limited (0-3) and adequate (4-6) HL. Multivariate linear regression with purposeful selection of variables was performed to identify independent factors associated with HRQoL.

RESULTS

Out of 397 eligible patients, 348 (88%) agreed to participate and were included in statistical analysis. Limited HL was independently associated with lower EQ-5D-5L index scores (B=1.07 [95% CI 1.00-1.15], p=.049. Other factors associated with lower EQ-5D-5L index scores were being obese (BMI≥30), having housing concerns, and being an active smoker. Factors associated with lower EQ-VAS scores were being underweight (BMI<18.5), obese, having housing concerns, and higher updated Charlson comorbidity index (uCCI) scores. Being married was associated with higher EQ-VAS scores.

CONCLUSIONS

Limited HL is associated with lower EQ-5D-5L index scores in spine patients, indicating lower HRQoL. To effectively apply HL-related interventions in this population, a better understanding of the complex interactions between patient characteristics, social determinants of health, and HRQoL outcomes is required. Further research should focus on interventions to improve HRQoL in patients with limited HL and how to accurately identify these patients.

LEVEL OF EVIDENCE

Level II prognostic.

Facilitators and barriers to pressure injury prevention, management and education: Perspectives from healthcare professionals-A qualitative study

This study aims to (1) characterize healthcare professionals' (HCPs') experiences related to the prevention and management of pressure injuries (PIs) and (2) explore the educational needs of individuals with a past or current history of PIs and their caregivers from the perspective of HCPs. This is a qualitative descriptive study. HCPs (n = 18) were interviewed using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim and coded using NVivo. Three overarching themes encompassing various dimensions were identified: (1) Facilitators related to PI prevention and management, (2) Challenges related to PI prevention and management and (3) Recommendations for improving patient and caregiver PI education. HCPs identified a greater number of challenges than facilitators related to PI care. This study emphasizes the importance of a patient-centred and interprofessional approach to patient education for PI prevention and management. Meaningful interventions focused on the patient may improve health literacy and empower patients and caregivers in PI care. Investing in preventive measures and raising awareness are crucial to reducing PI incidence. The findings have implications for HCPs and researchers seeking to enhance patient care and promote effective PI prevention strategies.

Collaborating with patients and caregivers to create web-based educational resources for people affected by cirrhosis

Objective

To describe the development of multimodal, web-based educational resources about cirrhosis alongside patients and caregivers.

Methods

We used an iterative process that was guided by the Strategy for Patient Oriented Research (SPOR) patient engagement framework in describing patient engagement activities to partner with a team of 16 patients and caregivers (Patient Advisory Team (PAT)). This process included five phases: a) Prioritize and gather content, b) design and build the website and videos, c) gather and integrate feedback, d) improve user accessibility, and e) assess usability and knowledge uptake for users.

Results

This 2-year process resulted in a 55-page website and 78 animated and live-action videos on cirrhosis complications, procedures, nutrition, and exercise. We implemented usability testing through pre-defined tasks and a think-aloud method from individuals with no previous exposure to the website to assess navigation, appearance, and content issues. Following usability testing, we have been gathering quantitative data from each unique page about relevance and ease of use, as well as qualitative data on the value of the content itself.

Conclusions

Collaboration between clinicians, patients, and caregivers is key to developing high-quality digital educational resources. Lessons from our process may help other organizations looking to address disease-specific knowledge gaps. Next steps with www.cirrhosiscare.ca will be continued iterative refinement and structured impact evaluation.

Innovation

This project used a patient-centered approach to develop a comprehensive online educational resource for patients with cirrhosis. By having patients with cirrhosis as a key part of our team, we ensured that the site met the needs of this unique population.

Enhancing effective healthcare communication in Australia and Aotearoa New Zealand: Considerations for research, teaching, policy, and practice

Objective

In this article we present a conceptual framework for enhancing effective healthcare communication in Australia and Aotearoa New Zealand.

Methods

Through an iterative, deliberative dialogue approach, we, as experts from a variety of health professions and academic disciplines, worked together to identify core values and considerations for healthcare communication across numerous health professions and disciplines and within research, teaching, policy, and practice contexts.

Results

The framework developed includes five core values at its centre: equitable, inclusive, evidence-based, collaborative, reflective. Around this are concentric circles showing key elements of collaborators, modality, context, and purpose. Each of these is explored.

Conclusion

This work may support benchmarking for healthcare providers, researchers, policymakers, and educators across a breadth of professions to help improve communication in clinical practice. The framework will also help to identify areas across disciplines that are shared and potentially idiosyncratic for various professions to promote interprofessional recognition, education, and collaboration.

Innovation

This framework is designed to start conversations, to form the foundation of a dialogue about the priorities and key considerations for developing teaching curricula, professional development, and research programs related to healthcare communication, providing a set of values specifically for the unique contexts of Australia and Aotearoa New Zealand. It can also be used to guide interdisciplinary healthcare professionals in advancing research, teaching, policy, and practice related to healthcare communication.

The undue influence of genetic information on senior medical students' treatment decisions

BACKGROUND

Knowledge of the genetic basis of health conditions can influence how the public perceives their own and others' health. When there are known genetic associations for such conditions, genetic essentialist biases facilitate deterministic thinking and an over-emphasis of genetic causality. This study investigates the role that genetic essentialist biases play in medical decision-making.

METHODS

Senior postgraduate medical students (N = 102) read a scenario in which a patient presents with gastroenterological symptoms. Half of the students were told that the patient tested positive for HLADQ2 - a gene implicated in, but not deterministic of, coeliac disease. The other half received no genetic information. Students were assessed on their recommendations for investigation and management using a multiple-choice questionnaire. Twenty-two of these students participated in a qualitative follow-up which used focus groups and semi-structured interviews to explore the reasoning behind students' responses.

RESULTS

Management recommendations differed between the two groups, with those receiving genetic information more likely to recommend a gluten free diet. Recommendations for further investigation did not differ significantly between groups. Interviews suggested that these findings arose despite the students' good understanding of the common non-deterministic nature of genes, such as HLADQ2.

CONCLUSION

Differences in management recommendations suggest that the inclusion of genetic information unduly biased students towards a premature diagnosis of a serious health condition, coeliac disease. Follow-up interviews introduced the possibility that observed manipulation-based differences may have been based on anticipated expectations of examiners, rather than perceived future clinical practice. Based on the present results it is unclear whether intentional exam-taking strategies fully account for medical students' decisions, or if they contribute in addition to the activation of genetic essentialist biases. Further research in clinical settings may ascertain whether genetic essentialist biases would truly influence medical student and doctors within their clinical practice environment.

Advancing pressure ulcer prevention: evaluating the impact of patient and lay carer education

Decubitus ulcers, also known as bed ulcers or pressure ulcers, result from prolonged pressure on the skin, with contributing factors such as shear forces, friction and excessive moisture. Pressure ulcers have significant physical, social and psychological consequences for patients and impose a substantial financial burden on healthcare providers. Patient and caregiver education has been suggested as a potential approach for preventing pressure ulcers. In order to investigate the potential preventive impact, O'Connor et al (2021) conducted a Cochrane systematic review. Their study aimed to assess the effectiveness of educational interventions for patients and caregivers in preventing pressure ulcers. This commentary aims to critically appraise the methods used within the Cochrane systematic review by O'Connor et al (2022) and expand on the findings in the context of clinical practice.

Lived experience of people with painful hallux valgus: A descriptive qualitative study

OBJECTIVE

Hallux valgus has a detrimental impact on health-related quality of life. Education is crucial for the management of all musculoskeletal conditions, although no previous research has evaluated the sources and quality of education accessed by patients with hallux valgus. Therefore, we aimed to evaluate the perceptions and attitudes of individuals with hallux valgus, including their educational experiences.

METHODS

A qualitative descriptive design was employed to gather data from individuals diagnosed with painful hallux valgus. Semi-structured interviews explored the perceptions, attitudes and educational experiences of participants. Interviews were recorded, transcribed verbatim, and analysed using the Framework Method. Respondent validation was used to ensure the rigour of the study findings.

RESULTS

Ten participants were interviewed, ages 26-72. Data analysis revealed five themes including the impact of hallux valgus, coping with hallux valgus, cause of hallux valgus, health professional support and education received. Hallux valgus was associated with a negative impact on health-related quality of life. Participants described a lack of high quality, accurate and reliable educational resources, and a variable experience with health professionals, which was often characterised by a lack of engagement and commitment and an overemphasis of referrals for specialist opinion.

CONCLUSION

Hallux valgus has a negative influence on well-being, including physical, mental, and social impacts. Health professionals should be responsive to patient needs and strive to implement person-centred care when indicated. There is also a need for the development of high-quality educational resources to help people with hallux valgus make informed decisions about their condition.

Health literacy and pain neuroscience education in an interdisciplinary pain management programme: a qualitative study of patient perspectives

Introduction

Pain neuroscience education is part of interdisciplinary pain management programs (IPMPs). To date, the role of health literacy on patients' understanding of pain neuroscience education has not sufficiently been examined.

Objectives

Drawing on interviews with patients with diverse levels of health literacy, this article explores patient perspectives on pain neuroscience education.

Methods

Purposively sampled patients from an IPMP were interviewed twice (waiting list and after 4 weeks). A directed qualitative content analysis was performed with the Integrated Conceptual Model of Health Literacy as an analytic framework.

Results

Thirteen patients with chronic musculoskeletal pain were interviewed: 4 men and 9 women aged from 21 to 77 years with diverse educational and mostly low health literacy. One participant dropped out after baseline. Some participants gained access to health information actively; others relied on the expertise of their healthcare providers. Most participants did not seem to receive the information in the pain neuroscience education as intended, experienced difficulties with understanding the message, negatively appraised the information, and were not able to apply this in their daily lives. Health literacy levels likely played a role in this.

Conclusions

Pain neuroscience education tailored to patients' health literacy levels, information needs, and learning strategies is needed.

The impact of confirmed cases of COVID-19 on residents' traditional Chinese medicine health literacy: A survey from Gansu Province of China

Since the outbreak of the new crown epidemic in China in early 2020, the number of confirmed cases of COVID-19 has continued to increase, and the Chinese government's policy of "static management" in the first round of the epidemic may affect the health behavior adjustment of Chinese residents. Using survey data on the TCM health literacy of 4016 residents in China (Gansu Province), a causal inference approach was used to explore the impact of the emergence of confirmed cases of COVID-19 on residents' TCM health literacy. We found that the emergence of confirmed cases can increase by 3.5%-7.0% in residents' TCM health literacy. Among them, the TCM health literacy of uneducated residents has not improved significantly, and the residents with secondary education have increased significantly by 8%. For those with higher education, the number of residents increased significantly by 6%. At the same time, the emergence of confirmed cases will increase the residents' practical TCM health literacy and decrease theoretical TCM health literacy. Through heterogeneity analysis, we explored the impact mechanism of confirmed cases on residents' TCM health literacy. We believe that the emergence of confirmed cases will make residents more inclined to participate in TCM-free clinics, theme activities, and other ways to acquire TCM knowledge.

Disparities in access to health care in adults with sinusitis in the United States

BACKGROUND

Sinusitis can significantly decrease quality of life, is costly in both health care expenditure and lost productivity, and can lead to complications if treatment is delayed. Our objective was to explore disparities in health care access among adults with sinusitis based on sociodemographic factors.

METHODS

A total of 32,994 participants (representing 244,838,261 US adults) who completed the 2016 National Health Interview Survey (NHIS) were analyzed, of whom 12.17% were diagnosed with sinusitis at least once in the prior 12 months. Multivariate regression analyses were performed.

RESULTS

In regression analyses, female sex (odds ratio [OR], 2.00 [95% confidence interval (CI), 1.79-2.24]; p < 0.001) and older age groups were associated with increased odds of having sinusitis. Within the sinusitis cohort, Asian race (OR, 5.97 [95% CI, 1.61-22.12]; p = 0.008) and Hispanic ethnicity (OR, 6.97 [95% CI, 3.22-15.06]; p < 0.001) were associated with increased odds of obtaining foreign medications. Individuals with Medicaid had decreased odds of delaying care (OR, 0.37 [95% CI, 0.25-0.56]; p < 0.001) or not receiving care due to cost (OR, 0.40 [95% CI, 0.24-0.65]; p < 0.001), but increased odds of delaying care due to transportation barriers (OR, 4.64 [95% CI, 2.52-8.55]; p < 0.001). Uninsured individuals had higher odds for delaying care (OR, 4.97 [95% CI, 3.35-7.38]; p < 0.001) and not receiving care (OR, 5.46 [95% CI, 3.56-8.38]; p < 0.001) due to cost. Income >$100,000 was associated with a nearly 90% reduction in inability to obtain care due to cost (OR, 0.11 [95% CI, 0.05-0.21]; p < 0.001) and an over 99% reduction in inability to obtain care due to transportation issues compared with income < $35,000 (OR, 0.01 [95% CI, 0.00-0.04]; p< 0.001).

CONCLUSION

Significant disparities in health care access based on race, health insurance status, and income exist among adults with sinusitis in the United States.

Racial and Ethnic Differences in Awareness and Prevalence of Unidentified Cardiovascular Risk Factors Among Health System Employees

PURPOSE

To evaluate awareness about cardiovascular (CVD) risk among a racially and ethnically diverse cohort of health system employees.

DESIGN

Cross-sectional study.

SETTING

Voluntary survey of health system employees during an annual CVD awareness and screening event.

SUBJECTS

759 health system employees.

MEASURES

We performed initial CVD screening measurements (blood pressure, body mass index) and collected patient-reported answers to questions about their own CVD risk factors (hypertension, high cholesterol, diabetes, overweight, smoking, physical inactivity and family history of CVD) and whether or not they believed that CVD is preventable. Subjects were offered in-depth follow-up CVD screening (lipid panel, hs-CRP, hemoglobin A1c), if interested.

ANALYSIS

Continuous measures were compared across sex and racial/ethnic subsets using a t test and analysis of variance technique. Univariable and multivariable logistic regression models were used to estimate the employee's willingness to undergo further comprehensive screening.

RESULTS

African American, Hispanic, and Asian employees were younger than white employees (P < .0001). More than one-quarter of African Americans reported a history of hypertension, a higher rate than for other subgroups (P = .001). The rate of self-reported diabetes was highest in African American and Asian employees (P = .001). African Americans had a 54% reduced odds of electing to pursue follow-up CVD screening (odds ratio: .46, 95% confidence interval = .24-.91, P = .025).

CONCLUSION

Presence of CVD risk factors and knowledge of their importance differ among racial and ethnic groups of health system employees in our cohort as does interest in pursuing follow-up screening once risk factors are identified. Development of evidence-based customization strategies by racial and ethnic group may improve understanding of and interest in CVD risk factors and advance prevention. The data from this study will inform future research and strategies for employee health promotion.

The quality of online information on Legg-Calvé-Perthes disease: can we do better?

INTRODUCTION

As patients increasingly utilize the Internet to obtain health-related information, the accuracy and usability of information prove critical, especially for patients and parents seeking care for relatively common orthopedic childhood disorders such as Legg-Calvé-Perthes (LCP) disease. Therefore, the purpose of this study is to evaluate available online health information regarding LCP disease. The study specifically seeks to (1) examine the accessibility, usability, reliability, and readability of online information, (2) compare the quality of sites from different sources, and (3) determine whether Health on the Net Foundation Code (HON-code) certification guarantees higher quality of information.

MATERIALS AND METHODS

Websites from a query of both Google and Bing were compiled and scored using the Minervalidation tool (LIDA), an appraisal tool quantifying website quality, along with the Flesch-Kinkaid (FK) analysis, a metric assessing readability of content. All sites were organized based on source category [academic, private physician/physician group, governmental/non-profit organization (NPO), commercial, and unspecified] and HON-code certification.

RESULTS

Physician-based and governmental/NPO sites had the highest accessibility, the unspecified site group were the most reliable and usable, and the physician-based group was found to require the least education to comprehend. Unspecified sites had a significantly higher rating of reliability than physician sites (p = 0.0164) and academic sites (p < 0.0001). HON-code-certified sites were found to have greater scores across quality domains along with being easier to read compared to sites without certification, with significantly higher reliability scoring (p < 0.0001).

CONCLUSIONS

As a whole, information on the Internet regarding LCP disease is of poor quality. However, our findings also encourage patients to utilize HON-code-certified websites due to their significantly higher reliability. Future studies should analyze methods of improving this publicly available information. Additionally, future analyses should examine methods for patients to better identify reliable websites, as well as the best mediums for optimized patient access and comprehension.

How do (false) positively screened patients experience a screening programme for liver cirrhosis or fibrosis in Germany? A qualitative study

OBJECTIVE

This study aimed to explore psychosocial consequences of (false) positive liver screening results and to identify influencing factors for perceived strain within a multistage screening programme for liver cirrhosis and fibrosis in Germany.

METHODS

Between June 2018 and May 2019, all positively screened patients were asked to participate in the study (n = 158). N = 11 telephone interviews and n = 4 follow-up interviews were conducted. Semi-structured telephone interviews were carried out. The analysis followed a structuring content analysis approach. Thereby, categories were first defined deductively. Second, the categories were revised inductively based on the data.

RESULTS

The main themes found regarding the consequences of the screening were categorised in emotional reactions and behavioural reactions. Few respondents described negative emotional consequences related to screening. Those seem to be mostly driven by suboptimal patient-provider communication and might be worsened when transparent information transfer fails to happen. As a result, patients sought information and support in their social environment. All patients reported positive attitudes towards liver screening.

CONCLUSION

To reduce the potential occurrence of psychosocial consequences during the screening process, medical screening should be performed in the context of transparent information. Regular health communication on the side of health professionals and increasing patients' health literacy might contribute to avoiding negative emotions in line with screening.

PATIENT OR PUBLIC CONTRIBUTION

This study recognises the wide-ranging patients' perspectives regarding the consequences of liver screening which should be taken into consideration when implementing a new screening programme to ensure a patient-centred approach.

Affordance-based practice: An ecological-enactive approach to chronic musculoskeletal pain management

BACKGROUND

The biomedical understanding of chronic musculoskeletal pain endorses a linear relationship between noxious stimuli and pain, and is often dualist or reductionist. Although the biopsychosocial approach is an important advancement, it has a limited theoretical foundation. As such, it tends to be misinterpreted in manners that lead to artificial boundaries between the biological, psychological, and social, with fragmented and polarized clinical applications.

OBJECTIVE

We present an ecological-enactive approach to complement the biopsychosocial model. In this approach, the disabling aspect of chronic pain is characterized as an embodied, embedded, and enactive process of experiencing a closed-off field of affordances (i.e., shutting down of action possibilities). Pain is considered as a multi-dimensional, multicausal, and dynamic process, not locatable in any of the biopsychosocial component domains. Based on a person-centered reasoning approach and a dispositional view of causation, we present tools to reason about complex clinical problems in face of uncertainty and the absence of 'root causes' for pain. Interventions to open up the field of affordances include building ability and confidence, encouraging movement variability, carefully controlling contextual factors, and changing perceptions through action according to each patient's self-identified goals. A clinical case illustrates how reasoning based on an ecological-enactive approach leads to an expanded, multi-pronged, affordance-based intervention.

CONCLUSIONS

The ecological-enactive perspective can provide an overarching conceptual and practical framework for clinical practice, guiding and constraining clinicians to choose, combine, and integrate tools that are consistent with each other and with a true biopsychosocial approach.

Developing a male-specific counselling curriculum for HIV treatment in Malawi

Men living with HIV in sub-Saharan Africa have sub-optimal engagement in antiretroviral therapy (ART) Programs. Generic ART counselling curriculum in Malawi does not meet men's needs and should be tailored to men. We developed a male-specific ART counselling curriculum, adapted from the Malawi Ministry of Health (MOH) curriculum based on literature review of men's needs and motivations for treatment. The curriculum was piloted through group counselling with men in 6 communities in Malawi, with focus group discussion (FGD) conducted immediately afterward (n=85 men) to assess knowledge of ART, motivators and barriers to care, and perceptions of the male-specific curriculum. Data were analysed in Atlas.ti using grounded theory. We conducted a half-day meeting with MOH and partner stakeholders to finalize the curriculum (n=5). The male-specific curriculum adapted three existing topics from generic counselling curriculum (status disclosure, treatment as prevention, and ART side effects) and added four new topics (how treatment contributes to men's goals, feeling healthy on treatment, navigating health systems, and self-compassion for the cyclical nature of lifelong treatment. Key motivators for men were embedded throughout the curriculum and included: family wellbeing, having additional children, financially stability, and earning/keeping respect. During the pilot, men reported having little understanding of how ART contributed to their personal goals prior to the male-specific counselling. Men were most interested in additional information about treatment as prevention, benefits of disclosure/social support beyond their sexual partner, how to navigate health systems, and side effects with new regimens. Respondents stated that the male-specific counselling challenged the idea that men were incapable of overcoming treatment barriers and lifelong medication. Male-specific ART counselling curriculum is needed to address men's specific needs. In Malawi context, topics should include: how treatment contributes to men's goals, navigating health systems, self-compassion/patience for lifelong treatment, and taking treatment while healthy.