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Ferreira-Alfaya FJ, Zarzuelo-Romero MJ, Cura Y. Pharmaceutical pictograms to improve textual comprehension: A systematic review. Res Social Adm Pharm 2024; 20:75-85. [PMID: 38030546 DOI: 10.1016/j.sapharm.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Written instructive information for the patient is key in pharmaceutical care. However, the preexisting literature agrees on the discordance between the readability of written medication messages intended for patients. The aim of our work was to systematically review the available evidence on the effect of pharmaceutical pictograms as elements that facilitate understanding of the text in primary or secondary medication packaging. METHODS A parallel systematic search was conducted of the literature covering evidence of the effect of including pictograms in primary or secondary packaging on comprehension by potential users or caregivers up to April 9, 2023. The databases consulted were Scopus, MEDLINE and Web of Science. Only randomized controlled studies, whose main outcome measure was comprehension, were included. RESULTS Only 8 papers met our search criteria. In most of the included studies, the intervention of including pictograms improved participants' performance in comprehending instructions. A debatable methodological quality, and differences in the target population, textual complexity of the materials or the cultural affinity of the pictograms with the target population in each study, could have had a decisive influence on the results. CONCLUSION The heterogeneity in the design of each study poses a significant barrier to establishing commonalities and generalizing the results. This heterogeneity also prevented us from conclusively confirming the usefulness of pictograms complementary to instructional text in improving the comprehension of instructions for the rational use of medicines.
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Affiliation(s)
| | | | - Yasmin Cura
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Granada, Spain
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2
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Choi JY, Ryu EJ, Jin X. Effect of self-management education using pictogram-based content of health information on outcomes in Korean patients with chronic obstructive pulmonary disease: A randomized controlled trial. Geriatr Nurs 2023; 54:324-330. [PMID: 37948887 DOI: 10.1016/j.gerinurse.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES This study aimed to evaluate the effects of pictogram-based self-management education on the symptom experience, self-efficacy, self-management adherence, and health-related quality of life (HRQoL) in individuals with chronic obstructive pulmonary disease (COPD). METHODS Sixty COPD patients were enrolled from a pulmonology clinic at C hospital in southwestern Korea and subsequently randomized into two groups. RESULTS A significant improvement in self-efficacy scores was noted (t = -2.16, p = .035) in the intervention group compared to the control group. No significant differences were observed in symptom experience (t = 0.48, p = .637), self-management adherence (t = -0.33, p = .742), and HRQoL (t = -0.52, p = .608). CONCLUSION Our findings suggest that the utilization of pictogram-based content in self-management education can be an effective tool for enhancing self-efficacy among COPD patients. Further research is required to evaluate the long-term effects on a broader sample size.
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Affiliation(s)
- Ja Yun Choi
- College of Nursing, Chonnam National University Chonnam Research Institute of Nursing Science, Gwangju, 61469, Republic of Korea
| | - Eui Jeong Ryu
- College of Nursing, Chonnam National University, Gwangju, 61469, Republic of Korea
| | - Xin Jin
- School of Medicine & Nursing, HuZhou University, Huzhou, Zhejiang, 313000, China.
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3
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Dowse R, Okeyo S, Sikhondze S, Khumalo N. Methodology of an approach for modifying pictograms showing medication side effects or indication. JOURNAL OF COMMUNICATION IN HEALTHCARE 2023; 16:147-157. [PMID: 37401879 DOI: 10.1080/17538068.2022.2056292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND Pictograms may improve user-friendliness and comprehension of written or verbal health information. This paper describes a method to modify pictograms to improve their visual clarity, appeal and overall interpretive complexity in order to reduce the cognitive load on the viewer during comprehension. METHODOLOGY Nine pictograms previously tested for comprehension were selected for modification. In phase 1, two participatory design workshops were conducted with (a) three limited literacy, first-language isiXhosa-speaking participants and (b) four university students. Opinions and ideas for improving interpretation were discussed. In phase 2, revised visuals were generated by the graphic artist and subsequently modified in an intensive, multistage, iterative process. RESULTS As no guidelines for pictogram modification exist, a modification schema was developed based on the process described in this study. Adopting a participatory approach combined with a systematic, intensive modification process enabled the opinions and preferences of the end-users to be heard, ensuring cultural relevance and contextual familiarity of the final product. Careful scrutiny of all individual visual elements of each pictogram, considerations of space, and thickness of lines all contributed to improving the legibility of visuals. CONCLUSIONS The methodology for designing and modifying existing pictograms using a participatory process resulted in nine final pictograms that were approved by all design team members and considered good candidates for subsequent comprehension testing. The methodological schema presented in this paper provides guidance to researchers intending to design or modify pictograms.
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Affiliation(s)
- Ros Dowse
- Faculty of Pharmacy, Rhodes University, Grahamstown, South Africa
| | - Sam Okeyo
- Faculty of Pharmacy, Rhodes University, Grahamstown, South Africa
| | - Simise Sikhondze
- Faculty of Pharmacy, Rhodes University, Grahamstown, South Africa
| | - Nosihle Khumalo
- Faculty of Pharmacy, Rhodes University, Grahamstown, South Africa
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4
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Wang T, Mazanec SR, Schiltz N, Chhabra N, Rezaee R, Voss JG. Development of a Pictorial Patient Education Handout on Tracheostomy Care: A Mixed-Method Study. West J Nurs Res 2023; 45:144-151. [PMID: 35836367 DOI: 10.1177/01939459221109813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article describes a qualitative and quantitative approach to the development and iterative revision process of producing valid, user-friendly pictorial patient education handouts (infographics) on tracheostomy care. An iterative user-centered design with health professional, patient, and family caregiver panels was used. The authors first developed a new evaluation tool for pictorial education handouts, the Perceived Infographics Usability Measurement (PIUM). The patient education handout, consisting of three A3-size posters with illustrations on key steps of daily tracheostomy care, reached a high consensus among health professional experts (88.3%) and patients and family caregivers (89.1%) on PIUM usability indexes. Patients and family caregivers expressed that the patient education handout would be an understandable teaching tool and procedure reminder, which would help alleviate fears about tracheostomy care. The PIUM demonstrated satisfactory content validity and reliability properties and was a quality tool to guide the transformation of text-based content to a pictorial patient education handout.
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Affiliation(s)
- Tongyao Wang
- School of Nursing, University of Hong Kong, Pokfulam, Hong Kong.,Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Susan R Mazanec
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA.,Seidman Cancer Center, University Hospitals of Cleveland, Cleveland, OH, USA
| | - Nicolas Schiltz
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Nipun Chhabra
- Department of Otolaryngology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.,Section of Otolaryngology, Head & Neck Surgery, Louis Stokes Cleveland Veterans Affairs, Cleveland, OH, USA.,University Hospitals of Cleveland, Ear, Nose & Throat Institute, Cleveland, OH, USA
| | - Rod Rezaee
- Department of Otolaryngology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.,Department of Head and Neck Surgical Oncology and Reconstruction, Ear, Nose and Throat Institute, University Hospitals of Cleveland, Cleveland, OH, USA
| | - Joachim G Voss
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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5
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Feasibility of using Facebook for HIV prevention: Implications for translational research among justice-involved women who use drugs in rural Appalachia. J Clin Transl Sci 2023; 6:e127. [PMID: 36590363 PMCID: PMC9794968 DOI: 10.1017/cts.2022.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/20/2022] [Accepted: 10/30/2022] [Indexed: 11/11/2022] Open
Abstract
Background Justice-involved women from rural Appalachia face significant barriers to the utilization of evidence-based HIV prevention interventions in spite of high rates of injection drug use and risky sexual practices. Adapting evidence-based practices to incorporate the cultural uniqueness of the target population is needed in order to advance translational and clinical science in this area. This study provides a descriptive overview of indicators of feasibility and acceptability of an adapted version of the National Institute on Drug Abuse Standard HIV prevention intervention for delivery using Facebook through a small randomized controlled pilot study with rural Appalachian women. Method Study methods include the random selection of rural Appalachian women from two local jails, screening for study eligibility, baseline data collection, random assignment to study interventions, and follow-up in the community three months post-release. Results Results indicate that the feasibility of the approach was supported through study enrollment of the target population who reported regular Facebook use and HIV risk behaviors including drug use and sex. Acceptability of the intervention was demonstrated through enrollment in the study intervention, engagement in the intervention through Facebook, and indicators of HIV/HCV knowledge. Conclusions Study findings contribute to the critical and unmet need to advance translational science on the delivery of evidence-based prevention interventions in real-world rural Appalachian settings to understudied, vulnerable individuals who are often overlooked in targeted prevention efforts.
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6
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Graphical user interface design to improve understanding of the patient-reported outcome symptom response. PLoS One 2023; 18:e0278465. [PMID: 36693053 PMCID: PMC9873161 DOI: 10.1371/journal.pone.0278465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 10/18/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Symptom monitoring application (SMA) has clinical benefits to cancer patients but patients experience difficulties in using it. Few studies have identified which types of graphical user interface (GUI) are preferred by cancer patients for using the SMA. METHODS This is a cross-sectional study aimed to identify preferred GUI among cancer patients to use SMA. Total of 199 patients were asked to evaluate 8 types of GUIs combining text, icon, illustration, and colors using mixed-methods. Subgroup analyses were performed according to age and gender. RESULTS The mean age of the patients was 57 and 42.5% was male. The most preferred GUI was "Text + Icon + Color" (mean = 4.43), followed by "Text + Icon" (mean = 4.39). Older patients (≥ 60 years) preferred "Text + Icon" than younger patients (p for interaction < 0.01). Simple and intuitive text and icons were the most useful GUI for cancer patients to use the SMA. CONCLUSION Simple and intuitive text and icons were the most useful GUI for cancer patients to use the SMA. Researchers need to be careful when applying realistic face drawings to cancer symptom monitoring applications because they can recall negative images of cancer.
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7
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Schackmann L, van Dijk L, Brabers AEM, Zwier S, Koster ES, Vervloet M. Comprehensibility of a personalized medication overview compared to usual-care prescription drug labels. Front Pharmacol 2022; 13:1004830. [DOI: 10.3389/fphar.2022.1004830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022] Open
Abstract
Poor understanding of prescription drug label (PDL) instructions can lead to medication errors, suboptimal treatment (side) effects, and non-adherence. A personalized medication hard-copy overview listing PDL instructions and visual information may support patients in their medication use. This study aimed to investigate the comprehensibility of PDL instructions on a personalized medication overview compared to usual-care PDL instructions presented on a medication box. A hypothetical-online-experiment was set up, comparing groups of respondents exposed vs not exposed to the medication overview and who received PDL instructions for three, five, or eight medications. Participants were divided randomly in six groups. Online questionnaires were sent to a stratified sample of 900 members from the Nivel Dutch Healthcare Consumer Panel. Outcome measures included comprehension of instructions for medication use, e.g. how often, dose timing, usage advice and warnings for a medication with simple use instructions (omeprazol) and more complex use instructions (levodopa/carbidopa (L/C)). To analyze differences between experimental conditions ANOVA testing was used. 604 respondents (net response 67%) completed the questionnaires. Respondents exposed (E) to the overview gave a higher proportion of correct answers compared to non-exposed (NE) respondents for usage advice (L/C: mean 0.83, SD 0.4 E; 0.03, SD 0.2 NE, p < 0.001; omeprazol: mean 0.85, SD 0.4 E; 0.10, SD 0.3 NE, p < 0.001). Both groups gave the same proportion of correct answers (mean 0.80, SD 0.4, p = 1.0) for dose timing of omeprazol. More NE respondents gave correct answers for how often (mean 0.85, SD 0.4 NE; mean 0.76, SD 0.4 E, p = 0.02) and dose timing (mean 0.92, SD 0.3 NE; mean 0.86, SD 0.4 E, p = 0.04) of L/C. No differences were found regarding number of medications nor were interaction effects found between the number of medications and information type. As a medication overview contains additional information, it can be a good addition in supporting patients in their medication use compared to usual-care PDLs. Future research should focus on identifying patient groups who might benefit more from a medication overview, by testing the effect of such overview on this group.
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8
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Kim MT, Heitkemper EM, Hébert ET, Hecht J, Crawford A, Nnaka T, Hutson TS, Rhee H, Radhakrishnan K. Redesigning culturally tailored intervention in the precision health era: Self-management science context. Nurs Outlook 2022; 70:710-724. [PMID: 35933178 PMCID: PMC9722518 DOI: 10.1016/j.outlook.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/18/2022] [Accepted: 05/27/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Nurse scientists have significantly contributed to health equity and ensuring cultural tailoring of interventions to meet unique needs of individuals. Methodologies for cultural tailoring of self-mangament interventions among marginalized populations have limitedly accommodated intersectionality and group heterogeneity when addressing health needs. PURPOSE Identify methodological limitations in cultural tailoring of interventions among priority populations and issue recommendations on cultural elements that researchers can target to ensure valid cultural tailoring approaches. METHODS Synthesis of literature on health equity, self-management, and implementation and dissemination research. FINDINGS Among priority populations, intersectionality and group heterogeneity has made group-based cultural tailoring approaches less effective in eliciting desirable health outcomes. Precision health methodology could be useful for cultural tailoring of interventions due to the methodology's focus on individual-level tailoring approaches. DISCUSSION We offer ways to advance health equity research using precision health approaches in cultural tailoring through targeting unique elements of culture and relevant psychosocial phenotypes.
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Affiliation(s)
- Miyong T Kim
- The Center for Health Equity Research, School of Nursing, The University of Texas, Austin, TX.
| | - Elizabeth M Heitkemper
- The Center for Health Equity Research, School of Nursing, The University of Texas, Austin, TX
| | - Emily T Hébert
- The Center for Health Equity Research, Health Science Center at Houston, School of Publics Health Austin, The University of Texas, Austin, TX
| | - Jacklyn Hecht
- The Center for Health Equity Research, School of Nursing, The University of Texas, Austin, TX
| | - Alison Crawford
- The Center for Health Equity Research, School of Nursing, The University of Texas, Austin, TX
| | - Tonychris Nnaka
- The Center for Health Equity Research, School of Nursing, The University of Texas, Austin, TX
| | - Tara S Hutson
- The Center for Health Equity Research, School of Nursing, The University of Texas, Austin, TX
| | - Hyekyun Rhee
- The Center for Health Equity Research, School of Nursing, The University of Texas, Austin, TX
| | - Kavita Radhakrishnan
- The Center for Health Equity Research, School of Nursing, The University of Texas, Austin, TX
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9
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Sedeh FB, Arvid Simon Henning M, Mortensen OS, Jemec GBE, Ibler KS. Communicating with patients through pictograms and pictures - a scoping review. J DERMATOL TREAT 2022; 33:2730-2737. [PMID: 35440279 DOI: 10.1080/09546634.2022.2068790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BackgroundCommunication between patients and Health Care Workers (HCW) may on occasion be challenged by disparities in cultural background, age and educational level. Written educational material is commonly used to reduce the risk of miscommunication. However, literacy among patients may also differ and it is therefore speculated that the use of pictograms may improve patients' understanding and adherence.ObjectiveTo evaluate the scientific literature and investigate the effect and practical utility of pictograms in medical settings with focus on dermatological patients.Materials and methodsPubmed, EMBASE, and Cochrane Library were searched July 2021 for studies regarding use of pictograms in medical settings and dermatology.ResultsThe use of pictograms in dermatology is not well characterized, but studies in other fields of medicine report a positive effect of using pictograms in communication. Pictograms have a significant positive effect when presented alongside verbal or written explanations.ConclusionThe quality of the development process is important to ensure the utility of any pictogram. Involving the target population in the design and validation of the pictograms may be critical. In the validation process, testing of transparency and translucency may benefit from international recommendations.
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Affiliation(s)
| | | | - Ole Steen Mortensen
- Department of Occupational and Social Medicine, Holbaek University Hospital, Holbaek, Denmark.,Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
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10
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Stonbraker S, Liu J, Sanabria G, George M, Cunto-Amesty S, Alcántara C, Abraído-Lanza AF, Halpern M, Rowell-Cunsolo T, Bakken S, Schnall R. Clinician Use of HIV-Related Infographics During Clinic Visits in the Dominican Republic is Associated with Lower Viral Load and Other Improvements in Health Outcomes. AIDS Behav 2021; 25:4061-4073. [PMID: 34129143 PMCID: PMC8602767 DOI: 10.1007/s10461-021-03331-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 02/05/2023]
Abstract
We designed an infographic intervention to help clinicians provide health information to persons living with HIV. In this study, we assessed the extent to which our intervention may improve objectively and subjectively measured health outcomes (CD4 count, viral load, and engagement with clinician among others) when integrated into routine visits in the Dominican Republic. In this pretest-posttest study, we followed participants for 9 months at 3-month intervals. Physicians administered the intervention during participants' first 3 visits. Outcome measures, selected using a conceptual model, were assessed at 4 time points. We assessed changes in outcomes over time with general linear regressions and Wilcoxon Signed-Rank tests. Participants (N = 50) were mostly female (56%) and had been living with HIV for a mean of 6.3 years (SD = 6.1). All outcomes, except CD4 count, demonstrated statistically significant improvements by study end. This provides preliminary evidence our intervention may improve outcomes, but further testing is needed.
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Affiliation(s)
- Samantha Stonbraker
- Anschutz Medical Campus, University of Colorado College of Nursing, 13120 E. 19th Ave, Aurora, CO, 80045, USA.
- Clínica de Familia La Romana, La Romana, Dominican Republic.
| | - Jianfang Liu
- Columbia University School of Nursing, New York, NY, USA
| | | | - Maureen George
- Columbia University School of Nursing, New York, NY, USA
| | | | | | | | - Mina Halpern
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | | | - Suzanne Bakken
- Columbia University School of Nursing, New York, NY, USA
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Medina-Córdoba M, Cadavid S, Pérez-Acosta AM, Amaya-Giraldo V. Factors that Facilitate and Hinder the Comprehension of Patient Information Leaflets (PILs): A Brief Scoping Review. Front Pharmacol 2021; 12:740334. [PMID: 34858174 PMCID: PMC8631714 DOI: 10.3389/fphar.2021.740334] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Patient information leaflets (PILs) of medicinal products are informative documents that accompany medicines and explain their components, modes of use, interactions with other medicines, and other relevant issues. When patients do not adequately understand the information in the leaflets, they may engage in behaviors that affect their health (e.g., self-medication). Objective: To identify patient-related factors and characteristics of PILs that can promote cognitive, emotional, and behavioral changes that lead to appropriate drug use practices. Additionally, we aimed to determine strategies that could be implemented to design leaflets that convey adequate information and are easier to understand. Method and Results: We evaluated scientific articles published in databases and containing information on PILs suitability to be used in a patient population. A total of 51 articles were selected as the sample. Certain leaflet factors that favored or hindered understanding were identified (e.g., format in which the leaflets are presented, their structure, their adaptation to the sociodemographic and linguistic characteristics of the population, their wording…). Similarly, we also identified patient factors, such as previous experience taking the drugs referred to in the leaflet; the type of emotions experienced when reading the leaflets; the emphasis on the adverse effects of the medications; sociodemographic variables (i.e., age or educational level); and degree of interest in their own healthcare. Conclusion: Patient and leaflet factors influence the comprehension of information in the PIL; hence, emphasis should be placed on these factors to increase treatment and medication adherence and to reduce health-risk behaviors.
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12
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Estel K, Weber G, Richter L, Hofmann M, Ruckdeschel P, Märdian S, Willy C, Back DA. Acceptance of Supportive Illustrations for Preparation of Patients for an Orthopedic Telemedical Consultation. Front Surg 2021; 8:696721. [PMID: 34631777 PMCID: PMC8492955 DOI: 10.3389/fsurg.2021.696721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 08/05/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Telemedical video consultations are a powerful support for patient–doctor interactions. For optimal digital settings, explanatory illustrations may be helpful for patients. This study analyzed patients' the attitude of patients to illustrations preparing for an orthopedic telemedical consultation (OTC). Methods: A leaflet with eight illustrations was designed and their acceptance and estimated necessity was evaluated among patients who had experienced an OTC (EXP-group) and others who had not (NOV-group) with a 12-item-questionnaire. Results: Sixty patients participated (n = 30 each group). All illustrations were evaluated positively. The EXP-group gave significantly higher ratings than the NOV-group for improved understanding by the given keywords of the illustrations (p = 0.046), preference for being informed by illustrations than by merely by a pure text (p = 0.023), better feeling of preparation for an OTC by the illustrations (p = 0.005), and the impression of a simplified process of the OTC by the illustrations (p = 0.012). Discussion: While the illustrations were well-accepted by the participants, significant differences were revealed between the valuation of single aspects by patients, depending on a previous experience with an OTC. Therefore, a leaflet with explanatory illustrations may be helpful in preparing patients for an OTC to support the digital patient–doctor contact.
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Affiliation(s)
- Katharina Estel
- Clinic for Traumatology and Orthopedics, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Gordian Weber
- Clinic for Traumatology and Orthopedics, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Luise Richter
- Clinic for Traumatology and Orthopedics, Bundeswehr Hospital Berlin, Berlin, Germany.,Medical Faculty of the Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marko Hofmann
- Institute for Computer Engineering Faculty of Computer Science, University of the Bundeswehr Munich, Neubiberg, Germany
| | - Patrick Ruckdeschel
- Institute for Computer Engineering Faculty of Computer Science, University of the Bundeswehr Munich, Neubiberg, Germany
| | - Sven Märdian
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Willy
- Clinic for Traumatology and Orthopedics, Bundeswehr Hospital Berlin, Berlin, Germany
| | - David Alexander Back
- Clinic for Traumatology and Orthopedics, Bundeswehr Hospital Berlin, Berlin, Germany.,Dieter Scheffner Center for Medical Education and Educational Research, Charité - Universitätsmedizin Berlin, Berlin, Germany
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13
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The Effectiveness and Value of Written Medicine Information Across Asia and Africa: Systematic Review. Drug Saf 2021; 44:1283-1295. [PMID: 34623626 DOI: 10.1007/s40264-021-01114-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 10/20/2022]
Abstract
Reviews on the role, value, effectiveness and desirable content of written medicine information (WMI) mostly include studies from high-income countries. We reviewed studies from Africa and Asia published between January 2004 and December 2019 to determine (1) the effect of WMI on knowledge and behaviour and (2) whether patients value WMI and their preferences for WMI. We included 16 intervention studies involving almost 3500 participants and 27 surveys of patients/public totalling over 11,000 people. Both the quality of the intervention studies and the reporting quality varied. Surveys were mostly localised, many with inadequate sampling strategies, and hence, were poorly representative of wider populations. However, most included a high proportion of participants with low educational levels. Most of the intervention studies reported significant improvements in knowledge and/or adherence after provision of WMI. Many utilised specially developed WMI in local languages, enhanced by pictograms. Provision of verbal information in addition to WMI showed variable impact. The proportion of people who read WMI, used as an indicator of its value, was reported in 15 surveys, with an overall figure of 74%. The most desirable aspects of WMI reported in 12 studies were indication, side effects, dose/instructions for use, contraindications, precautions and interactions. Nine studies reported local language was desirable. The studies suggest that WMI can improve both knowledge and adherence and is highly valued by people in many countries across Africa and Asia. Mechanisms should be considered by regulatory authorities and manufacturers to facilitate the provision of leaflets in local languages using simple terminology, perhaps enhanced by pictograms.This study is registered with PROSPERO, registration number: CRD42019127001.
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Kerr J, Combs R, Ayangeakaa S, Harris L, Bullock N, Sterrett-Hong E, Parker K. Examining Factors that Impact Intentions to Use Pre-Exposure Prophylaxis Among African-American Young Adults. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2933-2941. [PMID: 34637047 PMCID: PMC9007631 DOI: 10.1007/s10508-021-01974-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 06/13/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is a biomedical HIV prevention strategy with potential to reduce racial HIV disparities. However, African-Americans have not received the benefits of PrEP to the same extent as other groups. The theory of planned behavior (TPB) was employed to explain intentions to use PrEP among a sample of African-Americans (age 18-29) in Louisville, Kentucky. Data were derived from the Afya Project, a study examining PrEP-focused HIV prevention for African-American young adults. The sample was developed through respondent-driven sampling and participants (N = 181) completed audio computer-assisted self-interviews assessing demographics and TPB variables. Analysis of variance was used to examine relationships between demographics and PrEP intentions. Linear regressions determined associations between control beliefs, attitudes, norms, and PrEP use intentions. Confidence in using PrEP (p ≤ .0001), perceived HIV risk (p ≤ 0.05), perceived likelihood of acquiring HIV (p ≤ 0.05), and positive norms around PrEP (p ≤ 0.05) were significantly associated with PrEP use intentions. Findings can inform interventions to advance PrEP as a HIV prevention option for African-American populations at higher risk of contracting HIV.
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Affiliation(s)
- Jelani Kerr
- University of Louisville School of Public Health and Information Sciences, 485 E Gray St, Louisville, KY, 40202, USA.
| | - Ryan Combs
- University of Louisville School of Public Health and Information Sciences, 485 E Gray St, Louisville, KY, 40202, USA
| | - Suur Ayangeakaa
- University of Louisville School of Public Health and Information Sciences, 485 E Gray St, Louisville, KY, 40202, USA
| | - Lesley Harris
- Kent School of Social Work at the University of Louisville, Louisville, KY, USA
| | - Nana Bullock
- University of Louisville School of Public Health and Information Sciences, 485 E Gray St, Louisville, KY, 40202, USA
| | - Emma Sterrett-Hong
- Kent School of Social Work at the University of Louisville, Louisville, KY, USA
| | - Kimberly Parker
- University of Louisville School of Public Health and Information Sciences, 485 E Gray St, Louisville, KY, 40202, USA
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15
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Merks P, Cameron J, Bilmin K, Świeczkowski D, Chmielewska-Ignatowicz T, Harężlak T, Białoszewska K, Sola KF, Jaguszewski MJ, Vaillancourt R. Medication Adherence and the Role of Pictograms in Medication Counselling of Chronic Patients: a Review. Front Pharmacol 2021; 12:582200. [PMID: 34489688 PMCID: PMC8417421 DOI: 10.3389/fphar.2021.582200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/19/2021] [Indexed: 11/25/2022] Open
Abstract
Pharmaceutical care requires a patient-centered approach, focusing on the ability of patients to understand drug-related information and follow the instructions delivered by pharmacists as well as other health-care providers included in the circle of care. With the goal of ensuring the prescribed use of medications, called medication adherence, health-care providers have to consider many risk factors such as geography (culture), social economic status, age, and low literacy that may predispose patients to non-adherence, and considerations have to be made for chronic patients living with life-long disease states. The aim of this review is to provide a balanced and comprehensive review outlining a number of different medication counselling and education approaches that have been used to try to improve medication adherence and health outcomes with the use of clear and concise graphic illustrations—called pictograms. By highlighting the current landscape of the general use and efficacy of pharmaceutical pictograms to aid in the knowledge and recall of drug-related information, as well as outlining specific medication adherence outcomes with pharmaceutical pictograms in chronic patients, the current review describes the need for health-care providers to move beyond the traditional didactic methods of oral and verbal communication with patients regarding medication-taking behavior.
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Affiliation(s)
- Piotr Merks
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland.,Department of Pharmaceutical Technology, Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland
| | - Jameason Cameron
- Department of Pharmacy, Children's Hospital of Eastern Ontario, Centre Hospitalier pour Enfants de L'est de L'Ontario, Ottawa, ON, Canada
| | - Krzysztof Bilmin
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
| | - Damian Świeczkowski
- First Department of Cardiology, Medical University of Gdansk, Gdańsk, Poland
| | | | - Tomasz Harężlak
- Department of Pharmaceutical Technology, Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland
| | | | | | | | - Regis Vaillancourt
- Department of Pharmacy, Children's Hospital of Eastern Ontario, Centre Hospitalier pour Enfants de L'est de L'Ontario, Ottawa, ON, Canada
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Bärnighausen K, Geldsetzer P, Matse S, Hettema A, Hughey AB, Dlamini P, Mavuso M, Fakudze D, Kahn K, Bärnighausen T, McMahon SA. Qualitative accounts of PrEP discontinuation from the general population in Eswatini. CULTURE, HEALTH & SEXUALITY 2021; 23:1198-1214. [PMID: 32633617 DOI: 10.1080/13691058.2020.1770333] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 05/13/2020] [Indexed: 06/11/2023]
Abstract
People in receipt of pre-exposure prophylaxis (PrEP) for the prevention of HIV in Sub-Saharan Africa often discontinue taking the medication. We conducted 27 semi-structured interviews with men and women who had started PrEP but did not return to the clinic for a refill after a 1, 2 or 3-month period. These 'discontinuation' clients were enrolled in a PrEP demonstration project for the general population in nurse-led, public-sector, primary-care clinics in Eswatini. Reasons for discontinuation included changes to self-perceived HIV risk such as the end of pregnancy and absent partners. Others described PrEP as inaccessible when working away from home and many described difficulties relating to a daily pill regimen and managing side effects. Female clients described being prohibited from using PrEP by their partners and co-wives. From these results, we recommend that client-centred counselling stresses the prevention-effective adherence paradigm, which promotes PrEP use in risk periods that are identifiable and PrEP discontinuation when the risk period has finished. A national scale up of PrEP may mitigate problems accessing PrEP. Extended counselling and support could assist with adherence and the management of side effects. Education and support for partners and families of PrEP clients may also contribute to better PrEP continuation.
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Affiliation(s)
- Kate Bärnighausen
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Pascal Geldsetzer
- Faculty of Medicine, Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Stanford University School of Medicine, Stanford, CA, USA
| | - Sindy Matse
- Eswatini Ministry of Health, Mbabane, Eswatini
| | - Anita Hettema
- Clinton Health Access Initiative Eswatini, Mbabane, Eswatini
| | | | - Phiwa Dlamini
- Clinton Health Access Initiative Eswatini, Mbabane, Eswatini
| | - Mxolisi Mavuso
- Clinton Health Access Initiative Eswatini, Mbabane, Eswatini
| | - David Fakudze
- Clinton Health Access Initiative Eswatini, Mbabane, Eswatini
| | - Kathleen Kahn
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Till Bärnighausen
- Faculty of Medicine, Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Shannon A McMahon
- Faculty of Medicine, Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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17
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Mbanda N, Dada S, Bastable K, Ingalill GB, Ralf W S. A scoping review of the use of visual aids in health education materials for persons with low-literacy levels. PATIENT EDUCATION AND COUNSELING 2021; 104:998-1017. [PMID: 33339657 DOI: 10.1016/j.pec.2020.11.034] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 11/14/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To conduct a scoping review on the literature on visual aids in health education for persons with low-literacy. METHODS A scoping review methodology was employed. Pre-defined selection criteria identified 47 studies for inclusion. Data were extracted in relation to: (a) definitions of low-literacy and health literacy, (b) population studied, (c) research country, (d) consent procedures, (e) visual aids used, (f) development of visual aids, and (g) targeted outcomes. RESULTS Visual aids developed with persons with low-literacy demonstrated statistically significant improvements in health literacy outcomes, with benefits in medication adherence and comprehension also reported. Pictograms and videos were the most effective visual aids. Only one study adapted consent procedures for low-literacy participants. DISCUSSION Visual aids in health education materials may benefit persons with low-literacy levels, but large gaps in the research base are evident. Experimental research in low- and middle-income countries, with a particular focus on consent for participants with low-literacy is needed. PRACTICE IMPLICATIONS Visual aid design needs to include stakeholders. Consent procedures and decision-making need to be specifically adapted for participants with low-literacy.
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Affiliation(s)
- Njabulo Mbanda
- Centre for Augmentative and Alternative Communication, University of Pretoria, South Africa
| | - Shakila Dada
- Centre for Augmentative and Alternative Communication, University of Pretoria, South Africa.
| | - Kirsty Bastable
- Centre for Augmentative and Alternative Communication, University of Pretoria, South Africa
| | | | - Schlosser Ralf W
- Centre for Augmentative and Alternative Communication, University of Pretoria, South Africa; Department of Communication Sciences and Disorders, Northeastern University, USA
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18
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Knowledge of Antiretroviral Treatment and Associated Factors in HIV-Infected Patients. Healthcare (Basel) 2021; 9:healthcare9040483. [PMID: 33923916 PMCID: PMC8073643 DOI: 10.3390/healthcare9040483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/06/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022] Open
Abstract
This study aimed to assess the knowledge of antiretroviral (ARV) treatment and the associated factors in HIV-infected patients in Vietnam. We conducted a cross-sectional descriptive study of 350 human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients being treated with ARV at outpatient clinics at Soc Trang, Vietnam, from June 2019 to December 2019. Using an interview questionnaire, patients who answered at least eight out of nine questions correctly, including some required questions, were considered to have a general knowledge of ARV treatment. Using multivariate logistic regression to identify factors associated with knowledge of ARV treatment, we found that 62% of HIV-infected patients had a general knowledge of ARV treatment, with a mean score of 8.2 (SD 1.4) out of 9 correct. A higher education level (p < 0.001); working away from home (p = 0.013); getting HIV transmitted by injecting drugs or from mother-to-child contact (p = 0.023); the presence of tension, anxiety, or stress (p = 0.005); self-reminding to take medication (p = 0.024); and a high self-evaluated adherence (p < 0.001) were found to be significantly associated with an adequate knowledge of ARV treatment. In conclusion, education programs for patients, as well as the quality of medical services and support, should be strengthened.
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Nualdaisri P, Corlett SA, Krska J. Provision and Need for Medicine Information in Asia and Africa: A Scoping Review of the Literature. Drug Saf 2021; 44:421-437. [PMID: 33666901 PMCID: PMC7994240 DOI: 10.1007/s40264-020-01038-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/23/2022]
Abstract
Published reviews of written medicine information (WMI) have mainly drawn on studies published in high-income countries, including very few Asian or African studies. We therefore set out to scope the research literature to determine the extent and type of studies concerning WMI for patients/consumers across these two continents. We sought empirical studies published between January 2004 and December 2019, conducted in any Asian or African country, as defined by the United Nations, in English or with an English abstract. The majority of the 923 papers identified were from high-income countries. We retained 26 papers from Africa and 99 from Asia. Most African studies (n = 20) involved patients in the development of PILs, in the assessment of the effectiveness of PILs or in surveys. In contrast, the highest proportion of Asian studies concerned the content of WMI (n = 42). WMI is desired, but needs to be in local languages, and there needs to be more use made of pre-tested pictograms. Existing WMI frequently does not meet local regulatory requirements, particularly locally manufactured products. A number of studies reported potentially positive impacts of providing WMI on knowledge and medicine use behaviours. Provision of medicine information is essential for safe use of medicines in all countries. Internationally agreed guidelines, incorporating good design principles, are needed to ensure the optimal content and design of WMI. The World Health Organization should support African and Asian regulatory bodies to share best practice in relation to WMI for patients/consumers and to develop and implement pan-continental guidelines that take into account consumer needs and preferences.
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Affiliation(s)
- Pitchaya Nualdaisri
- Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hatyai, Thailand
- Medway School of Pharmacy, Universities of Kent and Greenwich, Chatham Maritime, Kent, UK
| | - Sarah A Corlett
- Medway School of Pharmacy, Universities of Kent and Greenwich, Chatham Maritime, Kent, UK
| | - Janet Krska
- Medway School of Pharmacy, Universities of Kent and Greenwich, Chatham Maritime, Kent, UK.
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20
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Wang T, Voss JG. Effectiveness of pictographs in improving patient education outcomes: a systematic review. HEALTH EDUCATION RESEARCH 2021; 36:9-40. [PMID: 33331898 DOI: 10.1093/her/cyaa046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/20/2020] [Accepted: 10/14/2020] [Indexed: 06/12/2023]
Abstract
The objective of this review was to investigate process of pictograph development and the effectiveness of pictographs in patient education. We conducted searches in Medline/PubMed, CINAHL with full text, PsycInfo, ERIC and Cochrane Library with keywords: (pictograph or pictorial) AND (patient education) NOT (children or adolescent or youth or child or teenagers). After excluding manuscripts that did not meet inclusion criteria, 56 articles were included between the time of the last review on this topic (January 2008) and May 2019. There are 17 descriptive studies, 27 randomized control trial studies, 9 quasi-experimental studies and 2 unique literatures in the systematic review. Major goals of the studies are pictograph development or validation. The majority of manuscripts (n = 48) supported the approach. However, six studies did not find significant differences in the outcome. Differences in patient population, pictograph designs and author-developed outcome measurements made it difficult to compare the findings. There is a lack of evidence on validating information outcome measurements. This review demonstrated that implementing pictographs into patient education is a promising approach for better information understanding and health management. Pictographic interventions need to be carefully developed and validated with both the targeted patient population and the clinical experts.
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Affiliation(s)
- Tongyao Wang
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Joachim G Voss
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
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21
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Stonbraker S, Flynn G, George M, Cunto-Amesty S, Alcántara C, Abraído-Lanza AF, Halpern M, Rowell-Cunsolo T, Bakken S, Schnall R. Feasibility and acceptability of using information visualizations to improve HIV-related communication in a limited-resource setting: a short report. AIDS Care 2021; 34:535-541. [PMID: 33565321 PMCID: PMC8353010 DOI: 10.1080/09540121.2021.1883517] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Infographics (visualizations that present information) can assist clinicians to offer health information to patients with low health literacy in an accessible format. In response, we developed an infographic intervention to enhance clinical, HIV-related communication. This study reports on its feasibility and acceptability at a clinical setting in the Dominican Republic. We conducted in-depth interviews with physicians who administered the intervention and patients who received it. We conducted audio-recorded interviews in Spanish using semi-structured interview guides. Recordings were professionally transcribed verbatim then analyzed using descriptive content analysis. Physician transcripts were deductively coded according to constructs of Bowen et al.'s feasibility framework and patient transcripts were inductively coded. Three physicians and 26 patients participated. Feasibility constructs endorsed by physicians indicated that infographics were easy to use, improved teaching, and could easily be incorporated into their workflow. Coding of patient transcripts identified four categories that indicated the intervention was acceptable and useful, offered feedback regarding effective clinical communication, and recommended improvements to infographics. Taken together, these data indicate our intervention was a feasible and acceptable way to provide clinical, HIV-related information and provide important recommendations for future visualization design as well as effective clinical communication with similar patient populations.
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Affiliation(s)
- Samantha Stonbraker
- College of Nursing, University of Colorado, Denver, CO, USA.,Clínica de Familia La Romana, La Romana, Dominican Republic
| | - Gabriella Flynn
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Maureen George
- School of Nursing, Columbia University, New York, NY, USA
| | | | | | | | - Mina Halpern
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | | | - Suzanne Bakken
- School of Nursing, Columbia University, New York, NY, USA
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22
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Dowse R. Pharmacists, are words enough? The case for pictograms as a valuable communication tool. Res Social Adm Pharm 2020; 17:1518-1522. [PMID: 33139214 DOI: 10.1016/j.sapharm.2020.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/27/2020] [Accepted: 10/24/2020] [Indexed: 10/23/2022]
Abstract
Despite living in a visually saturated world, with visual content permeating seemingly every aspect of our lives, an area in which visuals are still under-represented is health communication. Written health information, including medicines information, has generally been reported as being reader-unfriendly, offering challenges and barriers to even the most literate of readers with its often lengthy, detailed documents, use of medical jargon, and densely packed small text. The inclusion of visual content in the form of pictograms offers the potential to enhance the attractiveness and reader-friendliness of the information as well as improving comprehension and recall of medicines and general health information. This commentary presents the case of pictograms as a valuable tool in medicines information, urging pharmacists to consider their adoption in practice, but also sounding a note of caution when using pictograms.
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Affiliation(s)
- Ros Dowse
- Faculty of Pharmacy, Rhodes University, P O Box 91, Makhanda/Grahamstown, 6140, South Africa.
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23
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Zuge SS, Paula CCD, Padoin SMDM. Effectiveness of interventions for adherence to antiretroviral therapy in adults with HIV: a systematic review. Rev Esc Enferm USP 2020; 54:e03627. [PMID: 33111738 DOI: 10.1590/s1980-220x2019009803627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 11/07/2019] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To identify the best available evidence of intervention effectiveness for adherence to antiretroviral therapy for HIV in adults. METHOD The methodology proposed by the Cochrane Collaboration was used, with search in the databases: PubMed, Embase, LILACS, CINAHL, Web of Science and SCOPUS. Randomized clinical trials of interventions to promote adherence to antiretroviral therapy for HIV, in the ≥ 18-year-old population, published from 2010 onward, were considered. The eligibility, inclusion and extraction of results were developed by two independent researchers. RESULTS The five studies included in the quantitative analysis were effective interventions that developed educational actions with the patient, especially mediated by software, the use of medication schedule reminders and the inclusion of treatment supporters that also received educational actions to develop such role. CONCLUSION The combination of interventions strengthens the promotion of adherence. There is a need for investment in the implementation of educational actions with patients, such as the inclusion of supporters, in addition to counseling and electronic devices for reminders, which must be offered in the services in an articulated and continuous manner.
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24
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Schubbe D, Scalia P, Yen RW, Saunders CH, Cohen S, Elwyn G, van den Muijsenbergh M, Durand MA. Using pictures to convey health information: A systematic review and meta-analysis of the effects on patient and consumer health behaviors and outcomes. PATIENT EDUCATION AND COUNSELING 2020; 103:1935-1960. [PMID: 32466864 DOI: 10.1016/j.pec.2020.04.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Assess the effect of pictorial health information on patients' and consumers' health behaviors and outcomes, evaluate these effects in lower health literacy populations, and examine the attributes of the interventions. METHODS We included randomized controlled trials (RCTs) that assessed the effect of pictorial health information on patient and consumer health behaviors and outcomes. We conducted a meta-analysis of RCTs that assessed knowledge/understanding, recall, or adherence, and a subgroup analysis of those outcomes on lower health literacy populations. We narratively reviewed characteristics of pictorial health interventions that significantly improved outcomes for lower health literacy populations. RESULTS From 4160 records, we included 54 RCTs (42 in meta-analysis). Pictorial health information moderately improved knowledge/understanding and recall overall, but largely increased knowledge/understanding for lower health literacy populations (n = 13), all with substantial heterogeneity. Icons with few words may be most helpful in conveying health information. CONCLUSION Our results support including pictures in health communication to improve patient knowledge. Our results should be interpreted with caution considering the significant heterogeneity of the meta-analysis outcomes. PRACTICE IMPLICATIONS Future research should assess which types and characteristics of pictures that best convey health information and are most useful and the implementation and sustainability in healthcare contexts. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018084743.
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Affiliation(s)
- Danielle Schubbe
- The Dartmouth Institute for Health Policy & Clinical Practice, 1 Medical Center Drive (WTRB, Level 5), Lebanon, NH 03756, USA
| | - Peter Scalia
- The Dartmouth Institute for Health Policy & Clinical Practice, 1 Medical Center Drive (WTRB, Level 5), Lebanon, NH 03756, USA
| | - Renata W Yen
- The Dartmouth Institute for Health Policy & Clinical Practice, 1 Medical Center Drive (WTRB, Level 5), Lebanon, NH 03756, USA
| | - Catherine H Saunders
- The Dartmouth Institute for Health Policy & Clinical Practice, 1 Medical Center Drive (WTRB, Level 5), Lebanon, NH 03756, USA
| | | | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, 1 Medical Center Drive (WTRB, Level 5), Lebanon, NH 03756, USA
| | - Maria van den Muijsenbergh
- Radboudumc University Medical Center, Nijmegen, The Netherlands; Pharos, Center of Expertise on Health Disparities, Utrecht, The Netherlands
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, 1 Medical Center Drive (WTRB, Level 5), Lebanon, NH 03756, USA.
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Sletvold H, Sagmo LAB, Torheim EA. Impact of pictograms on medication adherence: A systematic literature review. PATIENT EDUCATION AND COUNSELING 2020; 103:1095-1103. [PMID: 31924384 DOI: 10.1016/j.pec.2019.12.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/17/2019] [Accepted: 12/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The aim of this systematic review was to investigate the potential effect of pictograms on patient adherence to medication therapies. METHOD PubMed, MEDLINE, Embase, CINAHL, and CENTRAL were searched for relevant articles. Experimental studies testing the use of pictograms in patient counselling regarding medication therapy, which quantitatively measured adherence, were included. RESULTS Seventeen studies were identified that fulfilled our inclusion criteria. These were heterogeneous with respect to study setting, population size, and the medication regimen tested. All the studies had methodological quality limitations. The pictogram interventions differed with respect to complexity, intervention length, and the measured adherence outcome. Ten studies (58.8 %) reported a statistically significant effect, of the pictogram intervention in question, on patient adherence to medication therapies. Of these, 80 % involved populations at elevated risk for non-adherence. CONCLUSION AND PRACTICE IMPLICATIONS Pictograms used in combination with written and/or oral information can have a positive impact on patient populations that are highly at risk for non-adherence when counselled on the proper use of medicines.
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Affiliation(s)
- Hege Sletvold
- Faculty of Nursing and Health Sciences, Nord University, Norway.
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26
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Jarernsiripornkul N, Nakboon S, Anarj K, Wongtaweepkij K. Survey of healthcare professionals' practices, expectations, and attitudes towards provision of patient information leaflets in Thailand. Int J Clin Pharm 2020; 42:539-548. [PMID: 31955382 DOI: 10.1007/s11096-020-00965-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 01/07/2020] [Indexed: 11/30/2022]
Abstract
Background Patient information leaflets are an important source of medicine information for patients. In Thailand, there is a lack of studies exploring activities of healthcare professionals and their attitudes towards provision of patient information leaflets. Objectives This study aimed to survey healthcare professionals' practices on provision of medicine information, expectations of, attitudes towards provision of patient information leaflets and factors influencing these. Setting Two university hospitals in Thailand. Methods A self-completion questionnaire was distributed to chiefs of departments for further distribution to staff. A stratified sample of physicians and nurses was invited, while all pharmacists were invited to ensure sufficient numbers for comparison. Main outcome measure Healthcare professionals' practices on provision of medicine information, expectations of, attitudes towards provision of patient information leaflets. Results Of the total 981 healthcare professionals invited, 493 responded (50.3% response rate). The number of respondents aware of patient information leaflets was 270 (57.6%). Of these, only 44.4% had ever given patient information leaflets to patients. Pharmacists provided patient information leaflets more frequently than other healthcare professionals. The expectation for patient information leaflets to be available was high; mean score 7.9 ± 2.31 of possible 10. Most respondents had positive attitudes towards providing patient information leaflets to patients (58.2%). Respondents who were aware of patient information leaflets availability were more likely to have a positive attitude (OR 0.543, p = 0.002). Level of education, time spent in direct care and being aware of patient information leaflets were factors associated with healthcare professionals' attitudes. Conclusion Limited number of healthcare professionals had provided patient information leaflets to patients but most had positive attitudes regarding the usefulness of patient information leaflets for patients. Increased availability and use of patient information leaflets should be promoted.
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Affiliation(s)
- Narumol Jarernsiripornkul
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand.
| | - Sireerat Nakboon
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Kobkaew Anarj
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Kamonphat Wongtaweepkij
- Department of Clinical Pharmacy, Faculty of Pharmacy, Srinakharinwirot University, Nakhon Nayok, Thailand
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Stonbraker S, Halpern M, Bakken S, Schnall R. Developing Infographics to Facilitate HIV-Related Patient-Provider Communication in a Limited-Resource Setting. Appl Clin Inform 2019; 10:597-609. [PMID: 31412382 DOI: 10.1055/s-0039-1694001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Productive patient-provider communication is a recognized component of high-quality health care that leads to better health outcomes. Well-designed infographics can facilitate effective communication, especially when culture, language, or literacy differences are present. OBJECTIVES This study aimed to rigorously develop infographics to improve human immunodeficiency virus (HIV)-related patient-provider communication in a limited-resource setting. A secondary purpose was to establish through participant feedback that infographics convey intended meaning in this clinical and cultural context. METHODS We adapted a participatory design methodology, developed in a high-resource setting, for use in the Dominican Republic. Initially, content to include was established using a data-triangulation method. Then, infographics were iteratively generated and refined during five phases of design sessions with three stakeholder groups: (1) 25 persons living with HIV, (2) 8 health care providers, and (3) 5 domain experts. Suggestions for improvement were incorporated between design sessions and questions to confirm interpretability of infographics were included at the end of each session. RESULTS Each participant group focused on different aspects of infographic designs. Providers drew on past experiences with patients and offered clinically and contextually relevant recommendations of symbols and images to include. Domain experts focused on technical design considerations and interpretations of infographics. While it was difficult for patient participants to provide concrete suggestions, they provided feedback on the meaning of infographics and responded clearly to direct questions regarding possible changes. Fifteen final infographics were developed and all participant groups qualitatively confirmed that they displayed the intended content in a culturally appropriate and clinically meaningful way. CONCLUSION Incorporating perspectives from various stakeholders led to the evolution of designs over time and generated design recommendations that will be useful to others creating infographics for use in similar populations. Next steps are to assess the feasibility of using infographics to improve clinical communication and patient outcomes.
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Affiliation(s)
- Samantha Stonbraker
- Columbia University School of Nursing, New York, New York, United States.,Clínica de Familia La Romana, La Romana, Dominican Republic
| | - Mina Halpern
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | - Suzanne Bakken
- Columbia University School of Nursing, New York, New York, United States.,Department of Biomedical Informatics, Columbia University, New York, New York, United States
| | - Rebecca Schnall
- Columbia University School of Nursing, New York, New York, United States
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Schatz E, Seeley J, Negin J, Weiss HA, Tumwekwase G, Kabunga E, Nalubega P, Mugisha J. "For us here, we remind ourselves": strategies and barriers to ART access and adherence among older Ugandans. BMC Public Health 2019; 19:131. [PMID: 30704445 PMCID: PMC6357505 DOI: 10.1186/s12889-019-6463-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 01/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Very little is known about the barriers and facilitators to antiretroviral therapy (ART) access and adherence among older Africans. Most studies on ART have focused on individuals who are 15-49 years of age. METHODS We used in-depth interviews with 40 persons living with HIV, aged 50 to 96 years, who had either initiated ART (n = 26) or were waiting to initiate ART (n = 14), to explore barriers and facilitators to ART access and adherence in rural Uganda. RESULTS Guided by the Andersen Behavior Model, thematic content analysis highlighted 21 primary factors related to environment, patient and health behavior. Nine of the factors were common to both access and adherence, the remaining 12 were evenly split between access and adherence. Transportation costs, food insecurity, and healthcare workers' knowledge, attitudes and behaviors were key barriers. CONCLUSIONS These barriers were similar to those outlined for younger populations in other studies, but were compounded by age. Despite barriers, either due to the exceptional nature of HIV care or overreporting, both ART access and self-reported adherence were better than expected. Older persons living with HIV highlighted health care needs for non-HIV-related illnesses, suggesting while HIV care is adequate, care for the ailments of "old age" is lagging.
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Affiliation(s)
- Enid Schatz
- Department of Health Sciences, University of Missouri, Columbia, 535 Clark Hall, Columbia, MO, 65211, USA.
| | - Janet Seeley
- Department of Global Health, London School of Hygiene and Tropical Medicine, London, UK.,Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Joel Negin
- School of Public Health, University of Sydney, Sydney, Australia
| | - Helen A Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Grace Tumwekwase
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Elizabeth Kabunga
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Phiona Nalubega
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Joseph Mugisha
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
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Jose J, AlHajri L. Potential negative impact of informing patients about medication side effects: a systematic review. Int J Clin Pharm 2018; 40:806-822. [PMID: 30136054 DOI: 10.1007/s11096-018-0716-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 08/09/2018] [Indexed: 01/04/2023]
Abstract
Background Pharmacovigilance, as it is carried out primarily by healthcare professionals is more focused on being very objective in nature. Acknowledging the importance of the subjective experience of patients in pharmacovigilance was underpinned by its unique ability to bring about a more holistic understanding through the deep information unraveled by the patients. Medication safety-related information has to be shared with patients to allow them to be actively involved in their therapy and pharmacovigilance. Despite the advantages of sharing information, it stands to reasons whether sharing information related to possible side effects would negatively affect patients and impinge upon their treatment plan and process. Aim of the Review The purpose of this systematic review was to critically assess the potential negative impact of informing patients about medication side effects by written and/or oral information on medication compliance, occurrence/development of suspected side effects and clinical outcomes. Method A comprehensive search was conducted in PubMed, and Cochrane library to identify potential records between the year 1975 and 2017; then titles, abstracts, and full texts were screened using the inclusion criteria to filter out irrelevant studies. The data extraction, and the results were narratively synthesized and presented in tables. Results A total of 2012 articles were screened for inclusion, 32 full-text articles were assessed for eligibility and finally resulting in the inclusion of 17 randomized control studies which met the set criteria. Findings unraveled that the educational intervention did not result in increased occurrence/reporting of side effects in most of the evaluated studies; except 4 studies, and no significant impact on compliance to medications and negative clinical outcome was observed. Apprehension of negative events to medications were observed in two of the four studies which evaluated these parameters. Conclusion The present review did not find enough evidence to support the over concerns on the potential negative impact of sharing of information on the adverse effects to patients, though the influence could manifest as nocebo-effect. The various components and methods employed for this information sharing process can influence the potential impact of this activity. These concerns about the undesirable effects should not deter the active involvement of patients in pharmacovigilance activities. There is a definite need to have more studies in this area, where much of concern still does exist among the various stakeholders of drug safety information.
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Affiliation(s)
- Jimmy Jose
- School of Pharmacy, University of Nizwa, Birkat Al Mouz, P.O. Box 33, 616, Nizwa, Sultanate of Oman.
| | - Lamia AlHajri
- Health Sciences Division, Higher College of Technology, P.O. Box 16062, Dubai, United Arab Emirates.,Department of Health Research, Lancaster University, Lancaster, UK
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Merandy K, Morgan MA, Lee R, Scherr DS. Improving Self-Efficacy and Self-Care in Adult Patients With a Urinary Diversion: A Pilot Study. Oncol Nurs Forum 2018. [PMID: 28635980 DOI: 10.1188/17.onf.e90-e100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To evaluate the feasibility and acceptability of a multimodality educational intervention for improving self-efficacy (SE) and self-care in patients with a new urinary diversion (UD).
. DESIGN Two-arm randomized, controlled trial.
. SETTING Academic medical center in New York.
. SAMPLE 8 adults diagnosed with bladder cancer requiring UD.
. METHODS A multimodality educational intervention consisting of video, Microsoft PowerPoint® slides, and medical illustrations was developed. SE was assessed pre- and postintervention related to care of the UD. Education scale scores provided evidence for intervention acceptability and assessment of UD self-care skills.
. MAIN RESEARCH VARIABLES Feasibility, acceptability, results of SE, and self-care scales.
. FINDINGS Enrollment and retention was 100%. All participants took part in every aspect of the study. No issues were apparent with administration of the study; however, a lack of self-care independence was noted between the study arms. The control group was younger in age than the intervention group.
. CONCLUSIONS A supplemental multimethod educational intervention is acceptable in this population and feasible to integrate into hospital care or into an appropriately powered study.
. IMPLICATIONS FOR NURSING A need exists for ongoing postdischarge support and education in this population. Additional studies are needed to determine the best approach for this.
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Affiliation(s)
| | | | - Richard Lee
- New York Presbyterian Hospital/Weill Cornell Medical College
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31
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Browne SH, Barford K, Ramela T, Dowse R. The impact of illustrated side effect information on understanding and sustained retention of antiretroviral side effect knowledge. Res Social Adm Pharm 2018; 15:469-473. [PMID: 29803539 DOI: 10.1016/j.sapharm.2018.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/18/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Prompt management of side effects is critical to supporting adherence to antiretroviral (ARV) medication. OBJECTIVE This study examines the impact of presenting side effect information using simple text combined with pictograms on sustained knowledge of ARV side effects over three months. METHOD Previously designed side effect pictograms, combined with simple text, were incorporated into a side effects panel within an ARV information leaflet. In a randomised controlled study, 116 limited literacy HIV patients taking ARVs were randomly allocated to either control (standard care) or intervention groups (standard care plus illustrated information). Side effect knowledge was assessed at baseline, and intervention patients received the illustrated leaflet. Knowledge was re-tested at one and three months. Interpretation of side effect pictograms was evaluated at one month. RESULTS In intervention patients, mean side effect knowledge increased from 45.9% (baseline) to 95.7% (three months; p<0.0001), and pictogram interpretation was good. Knowledge did not change significantly in the control group. All found the pictograms clear and useful, and endorsed their routine use. CONCLUSIONS Providing patients with simple written information containing pictograms on ARV side effects significantly improved side effect knowledge, sustained over time, in limited literacy, rural South African HIV patients.
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Affiliation(s)
- Sara Hope Browne
- Center for AIDS Research (CFAR), School of Medicine, University of California at San Diego, United States; Specialists in Global Health, Encinitas, CA, United States
| | - Kirsty Barford
- Faculty of Pharmacy, Rhodes University, Grahamstown, South Africa
| | - Thato Ramela
- Faculty of Pharmacy, Rhodes University, Grahamstown, South Africa
| | - Ros Dowse
- Faculty of Pharmacy, Rhodes University, Grahamstown, South Africa.
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32
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The extent and effects of patient involvement in pictogram design for written drug information: a short systematic review. Drug Discov Today 2018; 23:1312-1318. [PMID: 29747003 DOI: 10.1016/j.drudis.2018.05.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 04/16/2018] [Accepted: 05/02/2018] [Indexed: 11/23/2022]
Abstract
This short review provides insight into the extent and effectiveness of patient involvement in the design and evaluation of pictograms to support patient drug information. Pubmed, CINAHL, Cochrane Library, Embase, PsycINFO, Academic Search Premier and Web of Science were searched systematically; the 73 included articles were evaluated with the MMAT. We see that, usually, non-patient end-users are involved in the design of pharmaceutical pictograms - patients are more commonly involved in the final evaluation of pictogram success. Repeated involvement of (non-)patients aids the design of effective pharmaceutical pictograms, although there is limited evidence for such effects on patient perception of drug information or health behaviour.
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33
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Galea JT, Wong M, Muñoz M, Valle E, Leon SR, Díaz Perez D, Kolevic L, Franke M. Barriers and facilitators to antiretroviral therapy adherence among Peruvian adolescents living with HIV: A qualitative study. PLoS One 2018; 13:e0192791. [PMID: 29447226 PMCID: PMC5813958 DOI: 10.1371/journal.pone.0192791] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 01/30/2018] [Indexed: 12/23/2022] Open
Abstract
AIDS deaths among adolescents are increasing globally. This qualitative study investigated the barriers and facilitators to cART adherence among Peruvian adolescents living with HIV. Guided by a social ecological model, we analyzed transcripts from 24 psychosocial support groups for HIV-positive adolescents aged 13–17 years and 15 individual, in-depth interviews with cART providers and caregivers to identify the barriers and facilitators to cART adherence at the individual, family/caregiver and hospital levels. Most barriers and facilitators to cART adherence clustered at the individual and family/caregiver levels, centering on support provided to adolescents; history of declining health due to suboptimal cART adherence; side effects from antiretroviral drugs; and cART misinformation. Interventions to support adolescent HIV cART adherence should begin at the individual and family/caregiver levels and include an educational component. No adolescent living with HIV should die from AIDS in an era of accessible cART.
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Affiliation(s)
- Jerome T. Galea
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Socios En Salud, Lima, Peru
- * E-mail:
| | | | | | | | | | | | | | - Molly Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
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Roy M, Czaicki N, Holmes C, Chavan S, Tsitsi A, Odeny T, Sikazwe I, Padian N, Geng E. Understanding Sustained Retention in HIV/AIDS Care and Treatment: a Synthetic Review. Curr HIV/AIDS Rep 2017; 13:177-85. [PMID: 27188300 DOI: 10.1007/s11904-016-0317-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Sustained retention represents an enduring and evolving challenge to HIV treatment programs in Africa. We present a theoretical framework for sustained retention borrowing from ecologic principles of sustainability and dynamic adaptation. We posit that sustained retention from the patient perspective is dependent on three foundational principles: (1) patient activation: the acceptance, prioritization, literacy, and skills to manage a chronic disease condition, (2) social normalization: the engagement of a social network and harnessing social capital to support care and treatment, and (3) livelihood routinization: the integration of care and treatment activities into livelihood priorities that may change over time. Using this framework, we highlight barriers specific to sustained retention and review interventions addressing long-term, sustained retention in HIV care with a focus on Sub-Saharan Africa.
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Affiliation(s)
- Monika Roy
- University of California San Francisco, San Francisco, USA.
| | | | - Charles Holmes
- Centre for Infectious Diseases Research Zambia, Zambia, Africa.,Johns Hopkins University, Baltimore, USA
| | - Saurabh Chavan
- University of California San Francisco, San Francisco, USA
| | | | - Thomas Odeny
- Kenya Medical Research Institute, Center for Microbiology Research, Nairobi, Kenya.,University of Washington, Seattle, USA
| | | | - Nancy Padian
- University of California Berkeley, Berkeley, USA
| | - Elvin Geng
- University of California San Francisco, San Francisco, USA
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35
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Monroe AK, Pena JS, Moore RD, Riekert KA, Eakin MN, Kripalani S, Chander G. Randomized controlled trial of a pictorial aid intervention for medication adherence among HIV-positive patients with comorbid diabetes or hypertension. AIDS Care 2017; 30:199-206. [PMID: 28793785 DOI: 10.1080/09540121.2017.1360993] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
As the HIV-infected population ages and the burden of chronic comorbidities increases, adherence to medications for HIV and diabetes and hypertension is crucial to improve outcomes. We pilot-tested a pictorial aid intervention to improve medication adherence for both HIV and common chronic conditions. Adult patients with HIV and diabetes (DM) and/or hypertension (HTN) attending a clinic for underserved patients and at risk for poor health outcomes were enrolled. Patients were randomized to receive either a pictorial aid intervention (a photographic representation of their medications, the indications, and the dosing schedule) or a standard clinic visit discharge medication list. Adherence to antiretroviral therapy (ART) for HIV and therapy for DM or HTN was compared. Predictors of ART adherence at baseline were determined using logistic regression. Medication adherence was assessed using medication possession ratio (MPR) for the 6-month interval before and after the intervention. Change in adherence by treatment group was compared by ANOVA. Among the 46 participants, there was a trend towards higher adherence to medications for HIV compared with medications for hypertension/diabetes (baseline median MPR for ART 0.92; baseline median MPR for the medication for the comorbid condition 0.79, p = 0.07). The intervention was feasible to implement and satisfaction with the intervention was high. With a small sample size, the intervention did not demonstrate significant improvement in adherence to medications for HIV or comorbid conditions. Patients with HIV are often medically complex and may have multiple barriers to medication adherence. Medication adherence is a multifaceted process and adherence promotion interventions require an approach that targets patient-specific barriers.
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Affiliation(s)
- A K Monroe
- a Division of General Internal Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - J S Pena
- a Division of General Internal Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - R D Moore
- a Division of General Internal Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - K A Riekert
- b Division of Pulmonary and Critical Care Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - M N Eakin
- b Division of Pulmonary and Critical Care Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - S Kripalani
- c Division of General Internal Medicine and Public Health , Vanderbilt University Medical Center , Nashville , TN , USA
| | - G Chander
- a Division of General Internal Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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36
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Schade AT, Mendes da Costa T, Gollogly J, Monsell F. Design of a patient information leaflet in a surgical centre in Cambodia. Trop Doct 2017; 47:279-282. [PMID: 28162047 DOI: 10.1177/0049475516689211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hand deformities cause a large surgical burden on Cambodian society. They significantly affect the quality of life, limit hand function and can cause severe mental health issues. The visited surgical centre provides free rehabilitative surgery in Phnom Penh for those unable to afford private or public healthcare. As part of the postoperative care provided, a team of local Khmer physiotherapists help patients with early mobilisation, passive and active movements, and functional exercises. Leaflets are widespread in high-income countries, but are scarce in low-income countries. This study suggests a patient information leaflet to help with patient education after their discharge from hospital. The main challenges identified during the creation of such a leaflet were the low levels of education, low literacy and poor understanding of the disease process. A simple visual leaflet was created and will help reduce the anxiety and stress associated with hand disfigurement in this region.
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Affiliation(s)
- Alexander Thomas Schade
- 1 Academic foundation Doctor, Royal Stoke University Hospital, Trauma and Orthopaedics, Stoke-on-Trent, Staffordshire, UK
| | | | - Jim Gollogly
- 3 Orthopaedic Surgeon, Children's Surgical Centre, P.O. Box 1060, Phnom Penh, Cambodia
| | - Fergal Monsell
- 4 Paediatric Orthopaedic Consultant, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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37
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Okeyo I, Dowse R. Community care worker perceptions of their roles in tuberculosis care and their information needs. Health SA 2016. [DOI: 10.1016/j.hsag.2016.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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38
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Winchester MS, McGrath JW, Kaawa-Mafigiri D, Namutiibwa F, Ssendegye G, Nalwoga A, Kyarikunda E, Birungi J, Kisakye S, Ayebazibwe N, Walakira EJ, Rwabukwali C. Routines, Hope, and Antiretroviral Treatment among Men and Women in Uganda. Med Anthropol Q 2016; 31:237-256. [PMID: 27159357 DOI: 10.1111/maq.12301] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 04/28/2016] [Accepted: 05/04/2016] [Indexed: 11/25/2022]
Abstract
Antiretroviral treatment programs, despite biomedical emphases, require social understanding and transformations to be successful. In this article, we draw from a qualitative study of HIV treatment seeking to examine the drug-taking routines and health-related subjectivities of men and women on antiretroviral treatment (ART) at two sites in Uganda. We show that while not all participants in ART programs understand clinical protocols in biomedical terms, they adopt treatment-taking strategies to integrate medication into daily practices and social spaces. In turn, these embedded practices and understandings shape long-term hopes and fears for living with HIV, including the possibility of a cure. More significant than new forms of citizenship or sociality, we suggest that quotidian dimensions of treatment normalization shape the long-term experience of medication and outlook for the future.
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Affiliation(s)
- Margaret S Winchester
- Department of Health Policy and Administration, Pennsylvania State University.,Center for Social Science Research on AIDS (CeSSRA), Makerere University, Kampala, Uganda and Case Western Reserve University
| | - Janet W McGrath
- Department of Anthropology, Case Western Reserve University.,Center for Social Science Research on AIDS (CeSSRA), Makerere University, Kampala, Uganda
| | - David Kaawa-Mafigiri
- Department of Anthropology, Case Western Reserve University.,Center for Social Science Research on AIDS (CeSSRA), Makerere University, Kampala, Uganda
| | - Florence Namutiibwa
- Center for Social Science Research on AIDS (CeSSRA), Makerere University, Kampala, Uganda.,Case Western Reserve University
| | - George Ssendegye
- Center for Social Science Research on AIDS (CeSSRA), Makerere University, Kampala, Uganda.,Case Western Reserve University
| | - Amina Nalwoga
- Center for Social Science Research on AIDS (CeSSRA), Makerere University, Kampala, Uganda.,Case Western Reserve University
| | - Emily Kyarikunda
- Center for Social Science Research on AIDS (CeSSRA), Makerere University, Kampala, Uganda.,Case Western Reserve University
| | - Judith Birungi
- Center for Social Science Research on AIDS (CeSSRA), Makerere University, Kampala, Uganda.,Case Western Reserve University
| | - Sheila Kisakye
- Center for Social Science Research on AIDS (CeSSRA), Makerere University, Kampala, Uganda.,Case Western Reserve University
| | - Nicholas Ayebazibwe
- Center for Social Science Research on AIDS (CeSSRA), Makerere University, Kampala, Uganda.,Case Western Reserve University
| | - Eddy J Walakira
- Department of Social Work and Social Administration, Makerere University, Kampala.,Center for Social Science Research on AIDS (CeSSRA), Makerere University, Kampala, Uganda
| | - Charles Rwabukwali
- Center for Social Science Research on AIDS (CeSSRA), Makerere University, Kampala, Uganda.,Department of Sociology and Anthropology, Makerere University, Kampala, Uganda
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Klinger A, Asgary R. Perceptions and attitudes regarding sexually transmitted infection and family planning among adolescents in Northern Madagascar. Women Health 2016; 57:599-613. [PMID: 27093243 DOI: 10.1080/03630242.2016.1178684] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The prevalence of sexually transmitted infections (STIs) and early pregnancy are high among adolescents in Madagascar. We applied a qualitative descriptive approach to evaluate perceptions, attitudes, and misconceptions regarding STIs and contraception among female and male adolescents ages 15-19 years (n = 43) in Northern Madagascar in 2014 using focus group discussions with open-ended questions. Data were coded and analyzed for major themes. Participants were in grades 6 to 12 in school; 53% were female. Despite high levels of awareness, significant stigma against and misconceptions about STIs, condom use, and sexual practices existed. Many participants did not know how to use condoms and felt uncomfortable suggesting condoms with regular partners, despite acknowledging infidelity as a frequent problem. Male participants were more willing to use condoms as contraception for unwanted pregnancy than for prevention of STIs. Most participants held misconceptions about side effects of contraceptives, including infertility, cancer, and preventing bad blood from leaving the woman's body. Systematic and community-wide health education and formal reproductive health curricula in schools may improve attitudes and stigma regarding STIs and family planning. These strategies need to be developed and employed via collaboration among faith-based, community, and non-governmental organizations, schools, and governmental health and social service agencies.
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Affiliation(s)
- Amanda Klinger
- a Department of Internal Medicine , Beth Israel Deaconess Medical Center , Boston , Massachusetts , USA
| | - Ramin Asgary
- b Departments of Population Health and Medicine , New York University School of Medicine , New York , New York , USA
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40
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Jarernsiripornkul N, Phueanpinit P, Pongwecharak J, Krska J. Experiences of and attitudes towards receiving information about non-steroidal anti-inflammatory drugs: a cross-sectional survey of patients in Thailand. Expert Opin Drug Saf 2016; 15:417-26. [PMID: 26742855 DOI: 10.1517/14740338.2016.1139571] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine sources of information about NSAIDs used by out-patients, factors related to receipt of information and patient attitudes towards receiving safety information. RESEARCH DESIGN AND METHODS Cross-sectional survey, using self-completed questionnaires distributed directly to 500 outpatients prescribed any NSAIDs from an orthopaedic clinic in Thailand, over a 4-month period. RESULTS There were 548 patients approached and 474 completed questionnaires returned (94.8%). The most frequent aspects of medicines information that were provided related to administration (97.2%), mostly provided by pharmacists, and indication (85.8%), mostly provided by physicians. Information on identifying, monitoring and managing adverse effects was received by fewer than 50% of patients. Safety information was received significantly more frequently by younger patients (P<0.01), those using non-selective COX-2 inhibitors (P<0.001), intermittent NSAIDs (P<0.05) and fewer concomitant medicines (P<0.05). Only 14.1% patients used additional information sources. Attitudes towards receiving medicines safety information were positive. Most patients agreed they should know about ADRs (98.1%) and receive information leaflets with first prescription (96.8%). CONCLUSIONS Patients received medicines information mostly from healthcare professionals, but safety information was limited. Type of NSAIDs, regularity of NSAID use and age affected receipt of safety information about NSAIDs. Provision of more medicine information is needed, particularly written documents.
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Affiliation(s)
| | | | | | - Janet Krska
- c Medway School of Pharmacy , Universities of Greenwich and Kent , Kent , UK
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Contemporary issues on the epidemiology and antiretroviral adherence of HIV-infected adolescents in sub-Saharan Africa: a narrative review. J Int AIDS Soc 2015; 18:20049. [PMID: 26385853 PMCID: PMC4575412 DOI: 10.7448/ias.18.1.20049] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 07/10/2015] [Accepted: 08/12/2015] [Indexed: 12/25/2022] Open
Abstract
Introduction Adolescents are a unique and sometimes neglected group in the planning of healthcare services. This is the case in many parts of sub-Saharan Africa, where more than eight out of ten of the world's HIV-infected adolescents live. Although the last decade has seen a reduction in AIDS-related mortality worldwide, largely due to improved access to effective antiretroviral therapy (ART), AIDS remains a significant contributor to adolescent mortality in sub-Saharan Africa. Although inadequate access to ART in parts of the subcontinent may be implicated, research among youth with HIV elsewhere in the world suggests that suboptimal adherence to ART may play a significant role. In this article, we summarize the epidemiology of HIV among sub-Saharan African adolescents and review their adherence to ART, emphasizing the unique challenges and factors associated with adherence behaviour. Methods We conducted a comprehensive search of online databases for articles, relevant abstracts, and conference reports from meetings held between 2010 and 2014. Our search terms included “adherence,” “compliance,” “antiretroviral use” and “antiretroviral adherence,” in combination with “adolescents,” “youth,” “HIV,” “Africa,” “interventions” and the MeSH term “Africa South of the Sahara.” Of 19,537 articles and abstracts identified, 215 met inclusion criteria, and 148 were reviewed. Discussion Adolescents comprise a substantial portion of the population in many sub-Saharan African countries. They are at particular risk of HIV and may experience worse outcomes. Although demonstrated to have unique challenges, there is a dearth of comprehensive health services for adolescents, especially for those with HIV in sub-Saharan Africa. ART adherence is poorer among older adolescents than other age groups, and psychosocial, socio-economic, individual, and treatment-related factors influence adherence behaviour among adolescents in this region. With the exception of a few examples based on affective, cognitive, and behavioural strategies, most adherence interventions have been targeted at adults with HIV. Conclusions Although higher levels of ART adherence have been reported in sub-Saharan Africa than in other well-resourced settings, adolescents in the region may have poorer adherence patterns. There is substantial need for interventions to improve adherence in this unique population.
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Dyrehave C, Rasmussen DN, Hønge BL, Jespersen S, Correia FG, Medina C, Wejse C, Rodkjaer L. Nonadherence is Associated with Lack of HIV-Related Knowledge: A Cross-Sectional Study among HIV-Infected Individuals in Guinea-Bissau. J Int Assoc Provid AIDS Care 2015; 15:350-8. [PMID: 26297492 DOI: 10.1177/2325957415599211] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Poor treatment adherence is a main barrier for effective antiretroviral therapy (ART) globally. HIV-related knowledge may affect understanding and utilization of HIV medical information, hence limited health literacy is a known barrier to treatment adherence. DESIGN AND METHODS A cross-sectional study included 494 HIV-infected individuals from the Bissau HIV Cohort in Guinea-Bissau. They completed a questionnaire designed for assessment of adherence and HIV-related knowledge. RESULTS A majority were female, 41% were illiterate, 25% did not take the medicine during the last 4 days, and 23% skipped their medicine during weekends. The most frequent reasons for not taking medicine were simply forgetting, side effects, lack of food, and being too ill to attend the clinic. Nonadherent patients had a lower level of HIV-related knowledge. CONCLUSION Main barriers for nonadherence were side effects, food insecurity, and simply forgetting. Lack of HIV-related knowledge about ART and HIV may be a barrier to nonadherence.
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Affiliation(s)
- Charlotte Dyrehave
- Bandim Health Project, In-depth Network, Bissau, Guinea-Bissau Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Dlama Nggida Rasmussen
- Bandim Health Project, In-depth Network, Bissau, Guinea-Bissau Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Bo Langhoff Hønge
- Bandim Health Project, In-depth Network, Bissau, Guinea-Bissau Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Sanne Jespersen
- Bandim Health Project, In-depth Network, Bissau, Guinea-Bissau Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Faustino Gomes Correia
- Centro de Tratamento Ambulatorio(CTA), Hospital Nacional Simão Mendes, Bissau, Guinea-Bissau
| | - Candida Medina
- Centro de Tratamento Ambulatorio(CTA), Hospital Nacional Simão Mendes, Bissau, Guinea-Bissau
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark Centro de Tratamento Ambulatorio(CTA), Hospital Nacional Simão Mendes, Bissau, Guinea-Bissau Centres of Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Lotte Rodkjaer
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
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Caillet C, Sichanh C, Syhakhang L, Delpierre C, Manithip C, Mayxay M, Lapeyre-Mestre M, Newton PN, Roussin A. Population awareness of risks related to medicinal product use in Vientiane Capital, Lao PDR: a cross-sectional study for public health improvement in low and middle income countries. BMC Public Health 2015; 15:590. [PMID: 26116373 PMCID: PMC4483223 DOI: 10.1186/s12889-015-1948-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 06/18/2015] [Indexed: 11/10/2022] Open
Abstract
Background While essential medicines have been made more available in all but the most remote areas in low and middle income countries (L/MICs) over the past years, inappropriate and incorrect use of good quality medicines remains a key impediment for public health. In addition, as medicines have a potential to cause harm (medicine risks), adequate awareness by medicine users of the risks of adverse reactions is essential, especially as self-medication is common in L/MICs. This study aimed to investigate the awareness of Lao residents regarding medicine risks in Vientiane Capital, Lao People’s Democratic Republic. Methods Face-to-face interviews using structured questionnaires of 144 residents older than 16 years were carried out in 12 randomly selected villages out of the 146 villages of Vientiane Capital with at least one health facility. Results The respondents were mainly (85.0 %) the heads of households or their husband/spouse . The majority of the respondents were unaware (61.8 %) of medicine risks. Compared to residents living in the urban district of Xaysetha, living in peri-urban and even more in rural areas were identified as factors associated with being unaware of medicine risks [adjusted odds ratio (aOR) =3.3, 95 % Confidence Interval (CI) = 1.1–9.4]) and aOR =7.5 (95 % CI = 2.3–24.2), respectively]. In addition, more than half of the respondents had never heard of poor quality medicines, with a higher rate in rural/peri-urban compared to urban districts (55.6 % vs 38.9 %, respectively, p = 0.02). Finally, approximately one third of all respondents thought that traditional medicines could not cause harm. Conclusions Overall, these results suggest a lack of awareness about medicinal product risks. Differences according to the place of residence are apparent and could be partly explained by a lower level of training of healthcare providers in contact with the population in the rural districts in particular. Communication on medicinal product risks to patients through well-trained healthcare providers could probably make a valuable contribution towards the appropriate use of medicines in L/MICs.
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Affiliation(s)
- Céline Caillet
- Faculté de Médecine, Equipe de Pharmacoépidémiologie UMR 1027 INSERM-Université de Toulouse III, Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.
| | - Chanvilay Sichanh
- WorldWide Antimalarial Resistance Network, University of Oxford, Wellington Square, OX1 2JD, Oxford, UK.
| | - Lamphone Syhakhang
- Food and Drug Department, Ministry of Health, Simuang Road, Vientiane Capital, Lao People's Democratic Republic.
| | - Cyrille Delpierre
- Faculté de Médecine, Cancer et maladies chroniques, UMR1027 INSERM- Université de Toulouse III, 37 Allées Jules Gusede, 31000, Toulouse, France.
| | - Chanthanom Manithip
- Faculty of Pharmacy, University of Health Sciences, P.O.Box 7444, Samsenthai Road, Vientiane, Lao People's Democratic Republic.
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, FaNgum Rd, Vientiane, Lao People's Democratic Republic. .,Faculty of Postgraduate Studies, University of Health Sciences, P.O.Box 7444, Samsenthai Road, Vientiane, Lao People's Democratic Republic.
| | - Maryse Lapeyre-Mestre
- Faculté de Médecine, Equipe de Pharmacoépidémiologie UMR 1027 INSERM-Université de Toulouse III, Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.
| | - Paul N Newton
- WorldWide Antimalarial Resistance Network, University of Oxford, Wellington Square, OX1 2JD, Oxford, UK. .,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, FaNgum Rd, Vientiane, Lao People's Democratic Republic. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Wellington Square, OX1 2JD, Oxford, UK.
| | - Anne Roussin
- Faculté de Médecine, Equipe de Pharmacoépidémiologie UMR 1027 INSERM-Université de Toulouse III, Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.
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Abstract
Tuberculosis (TB) researchers and clinicians, by virtue of the social disease they study, are drawn into an engagement with ways of understanding illness that extend beyond the strictly biomedical model. Primers on social science concepts directly relevant to TB, however, are lacking. The particularities of TB disease mean that certain social science concepts are more relevant than others. Concepts such as structural violence can seem complicated and off-putting. Other concepts, such as gender, can seem so familiar that they are left relatively unexplored. An intimate familiarity with the social dimensions of disease is valuable, particularly for infectious diseases, because the social model is an important complement to the biomedical model. This review article offers an important introduction to a selection of concepts directly relevant to TB from health sociology, medical anthropology and social cognitive theory. The article has pedagogical utility and also serves as a useful refresher for those researchers already engaged in this genre of work. The conceptual tools of health sociology, medical anthropology and social cognitive theory offer insightful ways to examine the social, historical and cultural dimensions of public health. By recognizing cultural experience as a central force shaping human interactions with the world, TB researchers and clinicians develop a more nuanced consideration of how health, illness and medical treatment are understood, interpreted and confronted.
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Li S, Fang L, Zhou Y, Pan L, Yang X, Li H, Wang Q, Jiang F, Zhang N, Han M, Jia C. Mediation of smoking abstinence self-efficacy on the association of nicotine dependence with smoking cessation. Eur J Public Health 2014; 25:200-4. [PMID: 25395394 DOI: 10.1093/eurpub/cku183] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Suyun Li
- 1 Department of Epidemiology and Biostatistics, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Liyi Fang
- 2 Department of Health Administration, Shandong Medical College, Jinan, Shandong Province, People's Republic of China
| | - Yunping Zhou
- 1 Department of Epidemiology and Biostatistics, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Lulu Pan
- 1 Department of Epidemiology and Biostatistics, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Xiaorong Yang
- 1 Department of Epidemiology and Biostatistics, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Huijie Li
- 1 Department of Epidemiology and Biostatistics, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Qiang Wang
- 1 Department of Epidemiology and Biostatistics, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Fan Jiang
- 1 Department of Epidemiology and Biostatistics, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Nan Zhang
- 1 Department of Epidemiology and Biostatistics, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Mingkui Han
- 1 Department of Epidemiology and Biostatistics, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Chongqi Jia
- 1 Department of Epidemiology and Biostatistics, Shandong University, Jinan, Shandong Province, People's Republic of China
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