Teach-back: A systematic review of implementation and impacts

Nursing's Role in Advancing Care for Rare Genetic Diseases

Rare diseases (RDs) are predominantly genetic in etiology and characterized by low frequency and high medical complexity. Although individually infrequent, the cumulative public health impact of ∼7000 RDs is significant, and patients and families experience significant psychosocial burden. Health disparities stem from delays in diagnosis (diagnostic odyssey), difficulty accessing care, and lack of effective treatments. This article provides an overview of rare genetic diseases and highlights exemplar cases demonstrating nursing's role in advancing comprehensive, person-centered care for rare genetic diseases. Resources and recommendations are provided for nurses to enhance quality care for individuals and families living with RDs.

Considering health literacy in communication about medications between nurses and patients with heart failure: A cross sectional observational study

OBJECTIVES

To explore the content, style, and initiation of medication-related discussions between nurses and patients to understand how nurses support patients with heart failure, especially those with inadequate health literacy.

METHODS

A cross-sectional design was conducted to observe medication-related conversations between nurses and patients with heart failure in four Dutch outpatient clinics. Conversations were audio-recorded and analyzed using MEDICODE, focusing on content, communication style (monologue or a dialogue), and initiation of the content themes. Health literacy was assessed using the NVS-D and the SBSQ. Results between health literacy groups were compared with descriptive analyses.

RESULTS

A total of 56 patients and 14 nurses participated in the study. Patients classified by one or both of the instruments as having inadequate health literacy (n = 33; 59 %) were generally older, had lower educational levels, and were more often accompanied by informal caregivers. Key themes discussed in the medication-related conversations included how the medication was identified ('medication designation), its dosage and instruction, main effects, side effects, attitude or emotions and other ('various') themes. The 'medication designation' theme was significantly more frequently discussed in the group with adequate health literacy, whereas 'attitude or emotions' and 'various themes' were more commonly discussed among those with inadequate health literacy. Most conversations were nurse-initiated and tended to be monologues, with nurses mainly serving as information providers.

CONCLUSIONS

Nurses primarily initiated and dominated medication-related discussions with a focus on factual aspects of medication, while patients initiated more discussions about their concerns regarding medication. While there was overlap in the topics discussed, notable differences emerged between patients with adequate and inadequate health literacy.

PRACTICE IMPLICATIONS

Improving communication strategies, such as structuring conversations and adopting dialogic approaches may improve patients' engagement and understanding of medication use, leading to more effective management of their condition, particularly benefiting patients with lower health literacy.

Effects of Preoperative Mobilization Education Using the Teach-Back Method on Patient Outcomes After Gynecological Surgery: A Randomized-Controlled Study

This study aimed to determine the effects of preoperative mobilization education enhanced with the Teach-Back method on postoperative mobilization, recovery, and satisfaction in patients undergoing gynecological oncology surgery. This was a two-arm parallel-grouprandomized-controlled trial registered at https://www.clinicaltrials.gov (NCT05845086) and reported according to the Consolidated Standards of Reporting Trials checklist. The study was conducted with 102 patients between September 2023 and March 2024. The Patient Mobility Scale, Observer Mobility Scale, Postoperative Recovery Index, and Newcastle Satisfaction with Nursing Care forms were used to collect data. The intervention group received preoperative mobilization education enhanced with the Teach-Back method, besides the usual care; however, the control group received only usual clinical care. The patients in the intervention group exhibited higher levels of mobilization, recovery status, and satisfaction with nursing care than those in the control group. Preoperative mobilization education using the Teach-Back method effectively improved the mobilization process, recovery, and satisfaction of patients undergoing gynecological oncology surgery. Nurses working in the clinic should empower patients with knowledge and use the Teach-Back method in skill-oriented patient education.

Addressing Health Literacy

This JAMA Insights discusses personal and organizational health literacy and offers recommendations on how clinicians and health care institutions can improve their patients’ health literacy skills.

Effects of a theory driven and culturally tailored educational program on promoting cervical cancer screening in rural populations

Urban-rural disparities in the uptake rate of cervical cancer screening are significant, while one major barrier to rural populations completing the screening is a lack of knowledge. Therefore, implementing health education targeted towards rural populations is crucial. This study aimed to investigate the impact of a theory-driven, culture-tailored educational program on promoting cervical cancer screening among rural Chinese women. The study, a two-arm parallel, non-randomized controlled trial, was conducted in 10 villages. A total of 362 rural women aged 25-64 years (Mean = 45.18, SD = 9.11) were recruited and assigned to the intervention arm or the control arm, with 181 participants in each. Both groups received routine local health education on cervical cancer screening, while the intervention arm also participated in a five-session nurse-led educational program based on social cognitive theory and adapted to the rural Chinese sociocultural context. The primary outcome measured was the cervical cancer screening uptake rate, with secondary outcomes including self-efficacy and knowledge of cervical cancer screening. Data analysis was performed using Chi-square and generalized estimating equation (GEE) models. Results indicated that the intervention arm demonstrated significantly greater improvements in self-efficacy and knowledge than the control arm immediately after the intervention and at three months post-intervention (p < 0.001). At six months post-intervention, the screening uptake rate in the intervention arm was significantly higher (p < 0.001). Furthermore, 18 months post-intervention, the self-efficacy and knowledge of the intervention arm remained at relatively high levels (p < 0.001). The study findings demonstrated that the educational program had a positive impact on increasing participation in cervical cancer screening within rural communities. As a result, the theory-driven and culture-tailored educational program could be incorporated into cancer prevention promotion strategies in rural areas. However, further high-quality randomized control trials are necessary to assess and generalize this educational approach more widely.Trial registration Chinese Clinical Trial Registry, ChiCTR2200055954. Registered 29 January 2022, https://www.chictr.org.cn/showprojEN.html?proj=150955 .

Glioblastoma Patient and Caregiver Perspectives of Treatment Side-Effects and Information Provision

Chemoradiotherapy treatment for glioblastoma causes acute and long-term toxicities, negatively impacting quality of life. Patients require evidence-based, yet understandable information regarding treatment-induced toxicities to increase preparedness for treatment. A repeat cross-sectional, qualitative design was used. Semi-structured interviews were conducted with glioblastoma patients and their caregivers at set timepoints: prior to (T1), during (T2), and post (T3) chemoradiotherapy. Interviews were recorded, transcribed verbatim, and thematically analyzed. In total, 19 patients and 12 caregivers were interviewed. Three main themes emerged. (1) Navigating information materials, (2) Lack of awareness and understanding of chemoradiotherapy-induced toxicities, (3) The actual experience and impact of chemoradiotherapy toxicities. There is a discrepancy between the treatment information materials provided and patient expectation and experience of toxicities during and after chemoradiotherapy. Current informational resources do not adequately prepare patients or caregivers for the reality of treatment-induced toxicities. Better tailored resources are needed as individual needs fluctuate across the treatment trajectory. Further cross-center investigation is required to understand how we best create a personalized information pathway for glioma patients.

Identifying mediators of healthy lifestyle adoption after stroke: a focus group study using a Theoretical Domains Framework guided analysis

BACKGROUND

Lifestyle measures in addition to pharmacotherapy are recommended to optimise stroke secondary prevention. Adopting and sustaining good health behaviours after stroke necessitates ongoing motivation, influenced by complex social and cultural factors. This study analysed stroke survivors' experiences of addressing their lifestyle-related risks through a comprehensive theoretical lens addressing cognitive, affective, social, and environmental influences. Patient and public involvement (PPI) enhanced the research quality and transparency.

METHODS

Eight focus group discussions (N = 35 stroke participants; N = 3 family members/informal carers) were facilitated using semi-structured questions co-developed with a PPI panel. Purposive sampling ensured adequate representation (e.g. urban/rural location and stroke-related disabilities). Data were first coded and categorised inductively and mapped to the Theoretical Domains Framework (TDF) deductively to identify relevant constructs and theories of behaviour-change.

RESULTS

Participants reported risk reducing lifestyle changes as largely self-directed activities they figured out themselves. Their experiences mapped to 10 of the 14 theoretical domains of the TDF. The most reported behaviour-change mediators discussed were in the domains of Knowledge and Social Influences, seen as encouraging change and supporting emotional reactions. Goals were discussed in a limited way indicating underutilisation. Reminders, reinforcements, and rules to observe for maintaining healthy behaviours, mapping to the Reinforcement and Behavioural Regulation domains, were valued constructs. Psychosocial challenges, emotional responses and cognitive difficulties (Memory, Attention & Decision Processes and Emotions domains) were strongly evident, resonating with the experiences of our PPI contributor and interfacing with behaviour change processes and knowledge uptake. Health-beliefs, self-identity and perceived ability to change behaviour were considered to assert both positive and negative influences on behaviours, mapping to Social/Professional Role & Identity, Beliefs about Consequences and Beliefs about Capabilities domains. 'Know how' was highlighted as largely lacking for behaviour change, with the associated theoretical domains Intentions, Skills, Environmental context & resources to encourage skills development and Optimism about change notably absent from discussions.

CONCLUSIONS

The TDF proved a valuable tool to link stroke survivors' secondary prevention experiences and unmet needs with recognised constructs for behaviour-change. Results have important theory-driven implications to guide future interventions designed to support individuals in risk reducing behaviours following stroke.

The effectiveness of teach-back health education combined with high-quality nursing in patients with atrial fibrillation receiving anticoagulant treatment

Objective

To explore the efficacy of combining teach-back health education and high-quality nursing in the anticoagulation treatment of patients with atrial fibrillation (AF).

Methods

Clinical data of 110 patients with AF admitted to the Zhangjiakou First Hospital between June 2021 to August 2023 who received anticoagulation therapy were retrospectively analyzed. Among them, 53 patients received routine high-quality nursing care (control group), and 57 patients received teach-back health education combined with high-quality nursing (observation group). Exercise of Self-Care Agency (ESCA) scale scores, treatment adherence, mastery of health knowledge, and nursing satisfaction before and after intervention were assessed.

Results

After the intervention, the scores of self-care skills, self-responsibility, self-concept, and health knowledge in both groups significantly increased compared to pre-intervention and were significantly higher in the observation group compared to the control group (P<0.05). The post-intervention adherence rate of the observation group (96.49%) was higher than that of the control group (84.91%) (P<0.05). Similarly, the mastery of health knowledge and nursing satisfaction in the observation group were significantly higher compared to the control group (94.74% and 92.98% versus 81.13% and 79.25%, respectively; P<0.05).

Conclusions

Implementing teach-back health education combined with high-quality nursing during anticoagulation treatment for patients with AF can deepen the patient's understanding of disease and health knowledge, improve self-care ability and treatment adherence, and increase satisfaction.

What do patients know about their newly prescribed medication: Application of a novel knowledge index

OBJECTIVE

The present study aimed to evaluate patients' knowledge about their newly prescribed medications, contributing factors, and preferred sources of medication-related information.

METHODS

A cross-sectional study using an online survey was conducted among 931 customers of a mail-order pharmacy. Medication-related knowledge was examined using a novel knowledge index (KI) assessing medication dosage, indication, time of administration, and side effects. Patients' preferred sources of information were assessed. Univariate and multivariate regression analyses were performed to investigate predictors of medication-related knowledge.

RESULTS

The average KI score was 2.97 (SD = 0.73); most participants answered correctly when asked about indication (94.2 %), dosage (90.0 %), and time of administration (92.3 %); however, knowledge of medication-related side effects was limited (23.1 %). KI scores were predicted by greater perceived informedness, younger age, and having received a medication plan (all ps < 0.05). Preferred sources of medication-related information included physicians, written information, and information obtained via secure electronic patient records.

CONCLUSION

Knowledge gaps were found for medication-related side effects. Insufficient medication-related knowledge is linked to non-adherence and subsequent personal and economic costs. Electronically issued information could provide a cost-effective solution. Practical applications including "OpenNotes" are discussed.

PRACTICE IMPLICATIONS

Issuing medication plans via platforms such as "OpenNotes" can increase patient understanding and participation, and decrease non-adherence.

Persisting with Purpose: Using Acceptance and Commitment Therapy to Target Comorbid Opioid Use Disorder and Chronic Pain in a Racially and Economically Marginalized Population

Opioid use disorder (OUD) and chronic pain (CP) are commonly comorbid health conditions that cause significant disability, distress, and mortality. Treatment for these conditions is impacted by drop out and presence of other psychiatric conditions. Acceptance and Commitment Therapy is an effective intervention to treat chronic pain and substance use disorders, however this intervention has not been systematically evaluated for treatment of comorbid OUD and CP, especially in a racially and economically marginalized population. In this paper we describe development of such an ACT manual, using an intervention mapping approach. While the manual pays close attention to opioid use and chronic pain, it includes transdiagnostic principles that target overall psychological well-being including a deep emphasis on expanding valued living. We incorporated trauma informed care, cultural humility, and harm reduction principles in the development of nine ACT skills that are easy to understand and scalable. The treatment manual centers economically and racially marginalized patients who are traditionally underrepresented in psychological research. This manual is currently being evaluated in clinical trial NCT05039554 with funding from the NIH HEAL project #RM1DA055437. The treatment manual and handouts are freely available for use and included.

Using human-centered design to advance health literacy in local health department programming: a case study

BACKGROUND

Human-centered design (HCD) and behavioral science are structured, evidence-based methodologies used to develop and evaluate community-driven interventions. While HCD focuses on deeply understanding user needs and co-designing solutions, behavioral science applies empirically tested principles to drive behavior change. Together, these methodologies enable the development of interventions that are both user-centered and behaviorally informed. The Pima County Health Department and project partners leveraged these collaborative methodologies to assemble a Community of Practice to improve health literacy and adherence to COVID-19 public health practices among Hispanic/Latine individuals of childbearing age and ability in Pima County.

METHODS

Human-centered design processes identified and evaluated barriers facing the target population. On the basis of these findings, two pilot interventions were implemented between July 2023 and November 2023: one in a clinical setting with 92 participants and another in a community setting with 207 participants. A mixed-methods approach was used to evaluate the impact of these pilots. Quantitatively, a pre-post evaluation and survey design estimated the effect of an intervention by comparing outcomes before and after implementation using paired t-test and chi-square tests. Qualitatively, structured post intervention interviews were conducted with participants who were randomly selected based upon their initial consent and willingness to participate.

RESULTS

Participants in the clinical and community pilots perceived fewer barriers to health-seeking behaviors after the intervention. Both pilots increased participants' confidence in health-seeking behaviors (p < 0.01). Only the clinical pilot resulted in an increase in health literacy. In the clinical pilot, the number of unvaccinated participants decreased, and the number of participants who reported needing a booster increased. The community pilot did not find a statistically significant difference in COVID-19 vaccine uptake.

CONCLUSIONS

Integrating human-centered design and behavioral science into public health interventions can improve health literacy and confidence in health-seeking behaviors among historically and contemporarily excluded populations. Local health departments can use these methods to develop multicomponent interventions that foster mutual co-invention with communities and improve population health outcomes. Future research should focus on long-term impacts and explore broader applications of these approaches in different contexts.

TRIAL REGISTRATION

This project received University of Arizona IRB review and approval. This study was not considered a randomized controlled trial and did not require registration.

Action research on implementing the BOPPPS model in teaching mechanical prophylaxis techniques for deep vein thrombosis

OBJECTIVE

To explore the application effects of the BOPPPS model in teaching mechanical prophylaxis techniques for deep vein thrombosis (DVT).

METHODS

Following the "Plan-Act-Observe-Reflect" four-step process of action research, continuous improvements were made to the teaching process of DVT mechanical prophylaxis techniques based on the BOPPPS model. Data were collected by designated personnel and the teaching effectiveness was evaluated.

RESULTS

Through three rounds of action research, the overall practical training scores for DVT mechanical prophylaxis techniques among students from the 2019-2021 cohorts were 84.45 ± 4.75, 88.43 ± 3.92, and 91.15 ± 4.58, respectively. The self-evaluation scores for DVT prophylaxis awareness were 95.93 ± 2.78, 97.39 ± 2.54, and 98.47 ± 2.47, all of which were statistically significant (P < 0.01). Cohen's d effect sizes further confirmed substantial improvements.

CONCLUSION

Implementing the BOPPPS model in teaching DVT mechanical prophylaxis techniques helps improve students' knowledge, skills, and prevention awareness. The action research method contributes to the standardization and scientific design of the curriculum.

Evaluation of a Retrieval-Augmented Generation-Powered Chatbot for Pre-CT Informed Consent: a Prospective Comparative Study

This study aims to investigate the feasibility, usability, and effectiveness of a Retrieval-Augmented Generation (RAG)-powered Patient Information Assistant (PIA) chatbot for pre-CT information counseling compared to the standard physician consultation and informed consent process. This prospective comparative study included 86 patients scheduled for CT imaging between November and December 2024. Patients were randomly assigned to either the PIA group (n = 43), who received pre-CT information via the PIA chat app, or the control group (n = 43), with standard doctor-led consultation. Patient satisfaction, information clarity and comprehension, and concerns were assessed using six ten-point Likert-scale questions after information counseling with PIA or the doctor's consultation. Additionally, consultation duration was measured, and PIA group patients were asked about their preference for pre-CT consultation, while two radiologists rated each PIA chat in five categories. Both groups reported similarly high ratings for information clarity (PIA: 8.64 ± 1.69; control: 8.86 ± 1.28; p = 0.82) and overall comprehension (PIA: 8.81 ± 1.40; control: 8.93 ± 1.61; p = 0.35). However, the doctor consultation group showed greater effectiveness in alleviating patient concerns (8.30 ± 2.63 versus 6.46 ± 3.29; p = 0.003). The PIA group demonstrated significantly shorter subsequent consultation times (median: 120 s [interquartile range (IQR): 100-140] versus 195 s [IQR: 170-220]; p = 0.04). Both radiologists rated overall quality, scientific and clinical evidence, clinical usefulness and relevance, consistency, and up-to-dateness of PIA high. The RAG-powered PIA effectively provided pre-CT information while significantly reducing physician consultation time. While both methods achieved comparable patient satisfaction and comprehension, physicians were more effective at addressing worries or concerns regarding the examination.

Patient Experience at Discharge: A Quality Improvement Study in an Armed Forces Hospital, Saudi Arabia

Over the past decade, the health sector of Saudi Arabia has been undergoing a major transformation. This pilot research aimed to improve the patient experience (PX) at discharge by at least 2 scores within 2 years at a King Abdul Aziz Armed Forces Hospital (KAAB-AFH), Dhahran, in Saudi Arabia. The project was planned, executed, monitored, and closed through five Plan-Do-Study-Act cycles from Q2 2019 to Q2 2023. Discharge planning Include, Discuss, Educate, Assess, and Listen model, Teach Back technique, and Re-Engineered Discharge model, and Patient Education Materials Assessment Tool were used. The mean PX score at discharge improved from 86.80 (SD ±1.89) to 89.72 (SD ±1.77) (P = 0.02), the discharge speed PX score by 4.36 points (P = 0.05), and the PX score for the clearness of instructions at discharge increased by 2.75 points (P = 0.01). This PX quality improvement research project resulted in a significant improvement in patients' understanding of their health status, increased adherence to discharge procedures, and a sustained improvement in the quality of care.

The Effectiveness of Pressure Injury Prevention Education for Patient Care Technicians in an Adult Acute Care Setting: A Quality Improvement Project

PURPOSE

The purpose of this quality improvement project was to determine whether hospital-acquired pressure injuries (HAPIs) could be prevented by implementing an educational tool kit for patient care technicians (PCTs).

PARTICIPANTS AND SETTING

Data were collected from 24 PCTs and 43 patients in a 26-bed inpatient adult acute care unit at an academic medical center in the mid-Atlantic region of the United States.

APPROACH

Outcome data were collected over an 8-week period from September to November 2021. Hospital-acquired pressure injury prevalence was collected using the National Database of Nursing Quality Indicators (NDNQI) survey process. Full- and part-time PCTs' knowledge and attitudes were assessed through modified Pressure Injury Prevention Knowledge and Attitudes towards Pressure Ulcer Prevention Instruments. The PCTs' compliance with prevention strategies was assessed among patients using the modified NDNQI audit scores. Descriptive statistics, Fisher's Exact test, and Mann-Whitney U test were used for analysis.

OUTCOMES

Among the 24 PCTs, 66.7% (n = 16) had received prior education on HAPI prevention strategies. Hospital-acquired or unit-acquired pressure injury prevalence rates did not change significantly following the educational intervention. Mean Pressure Injury Prevention Knowledge scores increased from pre- to post-intervention (92.86; SD 9.63 vs 94.05; SD 12.86). Average Attitude towards Pressure Ulcer Prevention scores decreased from pre- to post-intervention (27.79; SD 4.88 vs 21.0; SD 7.51), indicating poorer attitudes toward pressure injury prevention. The mean NDNQI audit scores significantly improved from pre-implementation (M 1.40; SD 0.82, n = 20) to measurement following the intervention (M 2.35; SD 0.99, n = 23; P = .014).

IMPLICATIONS FOR PRACTICE

An educational curriculum tailored for PCTs increased HAPI prevention strategies. The project site incorporated the HAPI prevention educational tool kit from this quality improvement project into their annual hospital-wide training for all PCTs to learn and implement HAPI prevention strategies in their work setting.

Improving Discharge Education and Outcomes for Patients with Heart Failure

ABSTRACT

The emerging field of implementation science (IS) facilitates the sustainment of evidence-based practice in clinical care. This article, the fourth in a series on applying IS, describes how a nurse-led team at a multisite health system used IS concepts, methods, and tools to implement a discharge education bundle for patients with heart failure at two community hospitals, with the aim of decreasing readmissions and improving patient functioning and satisfaction.

Evaluating the Knowledge and Information-Seeking Behaviors of People Living With Multiple Sclerosis: Cross-Sectional Questionnaire Study

BACKGROUND

The internet has emerged as a primary source of health-related information for people living with multiple sclerosis (MS). However, given the abundance of misinformation found on the web, this behavior may pose a significant threat to internet users.

OBJECTIVE

This study aims to explore the knowledge and information-seeking behavior of people living with MS followed at a specialized MS clinic where education is a cornerstone of care.

METHODS

This cross-sectional survey-based study comprised 20 true or false statements, covering both scientific facts and popular misinformation about MS treatments. A "scientific fact score" and a "misinformation score" were calculated by attributing a scoring system to each point in the survey: +1 point was attributed to correct answers, -1 point was attributed to incorrect answers, and 0 point was attributed to "I don't know." Furthermore, the survey inquired about participants' health-seeking behaviors.

RESULTS

The mean age of the 69 participants was 48.4 (SD 10.9) years, 78% (54/69) were female, 81% (56/69) were highly educated, 90% (62/69) were receiving a disease-modifying therapy, and 52% (30/58) had experimented with alternative therapies. The mean score for answering the scientific and misinformation questions correctly was 69% (SD 2.4%) and 22% (SD 4.5%), respectively (P<.001). Notably, when questioned about misinformation, answering correctly dropped significantly (P<.001), while indecision (P<.001) and answering incorrectly (P=.02) increased. Sociodemographic factors and medical questions were not significantly associated with scientific and misinformation scores (all P>.05); however, misinformation scores did significantly correlate with levels of education (P=.04). The main sources of health-related information were from expert-led MS websites (48/58, 82%) and health care professionals (34/58, 59%). Low-reliability sources were less used; however, word of mouth seemed to be prevalent (14/58, 24%), followed by Facebook (10/58, 17%). On average, people with MS reported having consulted 3 high- to moderate-quality sources and only 1 low-quality source.

CONCLUSIONS

Education at the clinic and consulting primarily moderate- to high-quality sources did not safeguard against misinformation, indicating a need for more misinformation-geared education at the clinic. Notably, there is a need to proactively educate patients about misinformation commonly found on the web, and more importantly, create space for them to discuss the information without prejudice. As novel educational methods may be relatively more time-consuming, implementing change may be challenging. Furthermore, age, sex, education level, and health literacy might not safeguard against misinformation. Herein, we were unable to identify correlations associated with scores obtained on the questionnaire other than educational level. Although the educational level did seem to impact the misinformation score, this did not stop participants from experimenting with alternative therapies. Although studies are exploring novel ways to effectively deal with health misinformation on the web, more research is needed to fully understand this highly complex social phenomenon.

Meeting Parents' Health Literacy Needs-Designing and Feasibility Testing of a Three-Step Intervention in the Childhood Epilepsy Context

AIMS

(1) To codesign a health literacy intervention within a specialist healthcare setting to help the parents of children with epilepsy access, comprehend, use and communicate information and (2) to assess the intervention's feasibility by exploring stakeholders' perspectives on its usefulness, ease of use of trial methods and contextual factors impacting its execution.

DESIGN

A codesign participatory approach followed by a feasibility approach inspired by the OPtimising HEalth LIteracy and Access to Health Services (Ophelia) process for health literacy intervention development.

METHODS

(1) The codesign approach included workshops with (a) multidisciplinary personnel (n = 9) and (b) parents (n = 12), along with (c) an interview with one regional epilepsy specialist nurse (n = 1). The participants discussed parents' health literacy needs on the basis of vignettes and brainstormed service improvements. A three-step intervention was subsequently designed. (2) The intervention's feasibility was assessed via interviews with six parents (n = 6), a focus group interview with study nurses, a short doctors survey and a log of time spent testing the intervention.

RESULTS

(1) The parents of first-time admitted children to a specialist epilepsy hospital were targeted for the intervention. Nurse-parent consultations were central to the intervention, activating parents in codeveloping and executing a tailored education plan. (2) Feasibility: parents (n = 6) experienced consultations and education plans that were beneficial for enhancing their self-efficacy in managing the child's condition. The study nurses (n = 3) acknowledged positive outcomes in streamlining patient education but felt that their training on the intervention methods was insufficient. Both parents and nurses identified limited personnel resources as a significant barrier to executing the intervention.

CONCLUSION

The codesigned intervention engaged nurses and parents in HL development despite system barriers. The parents experience enhanced self-efficacy in managing their child's condition. However, needs refinements and further feasibility tests are needed before future implementation.

REPORTING METHOD

The Consort Statement 2010 extension for reporting non-randomised pilot and feasibility studies was used to ensure the methodological quality of the study. A Consort Statement 2010 checklist is provided as an additional file.

PATIENT OR PUBLIC CONTRIBUTION

The collaboration of parents within the target group, the providers involved and the project's steering committee was crucial in codesigning and evaluating this three-step intervention. Parents and multidisciplinary providers actively contributed through workshops, interviews and in discussion meetings. The study nurses testing the intervention played a key role in defining the documentation process for the codeveloped education plan.

IMPLICATIONS FOR PROFESSIONAL CARE

This three-step health literacy intervention can positively impact parents' self-efficacy in managing their child's condition. Enhancing nurses' communication skills is essential for improving parents' health literacy, making it crucial to allocate resources for such training. The intervention content and strategies to meet parents' health literacy needs require refinement, with more provider involvement to better adapt it to the context. Future studies should focus on further feasibility testing by considering a more flexible time frame.

TRIAL REGISTRATION

Open Science Framework: https://osf.io/fg9c7/.

'But Because I Don't Know About It, That's Why I Haven't Done It': Experiences of Access to Preventive Sexual and Reproductive Health Care for Refugee Women from Iraq and Syria Living in Melbourne, Australia-A Qualitative Study

Women from Syria and Iraq constitute two of the largest groups of humanitarian visa entrants to Australia in the past 10 years. Barriers to and enablers of preventive sexual and reproductive health (SRH) for these women are poorly understood. The aim of this study was to establish the preventive SRH care needs and experiences of women from refugee backgrounds from Syria and Iraq living in Australia. A qualitative study using semi-structured interviews was conducted with women from Syria and Iraq living in Melbourne, Australia. Caseworkers assisted with recruitment and volunteer interpreters with interviews. Between 1 December 2021 and 17 May 2022, interviews were conducted in English or in Arabic with a volunteer interpreter. Audio recordings of English dialogue were transcribed verbatim. Reflexive thematic analysis was used to analyse and report data. Eighteen women were interviewed. Six themes were identified: (1) Awareness and knowledge about preventive SRH, (2) Perceptions about the need for preventive SRH care seeking, (3) Self-care and lack of motivation to seek preventive SRH care, (4) Health information seeking, and (5) Barriers to and enablers of preventive SRH care. Complex factors were found to influence access to preventive SRH care. Enhancing educational initiatives, improving accessibility to reliable health information, and addressing structural and motivational barriers are important for fostering better preventive SRH outcomes.

The role of health literacy in intervention studies targeting children living with overweight or obesity and their parents-a systematic mixed methods review

Background

Excess weight and obesity are increasing among children. Health literacy has been suggested as a feasible concept for enabling informed health choices in weight management interventions for children and their parents. Knowledge of the skills necessary for a child to maintain new health behaviors is limited and the role of health literacy remains unclear. Thus, there is a need to summarize the effects of and experiences with interventions that include health literacy components to guide the development of effective, future weight-related interventions.

Aim

This review aims to identify how health literacy is integrated into studies of interventions targeting children with excess weight or obesity and/or their parents and to appraise the identified literature.

Methods

We conducted a systematic mixed methods review, with searches in Medline, CINAHL, Cochrane, EMBASE, ERIC, PsycINFO, and Web of Science. We included studies of interventions published after 2013 that targeted children under 19 years with excess weight or obesity and/or their parents, where health literacy played a role. Results from the included studies were integrated using qualitative data transformation techniques, followed by a narrative summary.

Results

We identified 7,910 citations. Four reports met our inclusion criteria and were included for review. These reports included a total of 402 children. Health literacy was assessed at baseline in two studies and measured as an outcome over time in one study. Methodological quality varied among the retained reports, with differences observed in study design, risk of bias and data collection methods. The reports highlight the need to adapt weight management treatments to the individual level of health literacy in children and their families to first ensure active participation in their treatment and second ensure long-term compliance with necessary lifestyle-related changes.

Discussion

Surprisingly, little attention has been paid to the importance of health literacy in weight management programs targeting children and their families. Seemingly, treatments tailored to the individual level of health literacy have not been prioritized in research. Addressing health literacy in children's weight management continues to be a multifaceted and ambitious mission. Future research should focus on integrating health literacy into weight management interventions in a systematic and theory-driven manner, ensuring that these interventions are tailored to the specific needs of children and their families and can sustain behavior change over time.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=478957, identifier: CRD42023478957.

Autonomy support in prenatal consultation: A quantitative observation study in maternity care

INTRODUCTION

Maternity care professionals need to guide women through an increasing number of decision-making processes during pregnancy. Professionals tend to focus more on providing information than on decision support. According to the self-determination theory (SDT), professionals could help women make their own choices by fulfilling their three basic psychological needs: autonomy, competence, and relatedness through autonomy-supportive interactions. This study aimed to quantify autonomy-supportive and autonomy-thwarting interactions that professionals use during prenatal consultations and their association with women's perceptions of the healthcare climate during consultations.

METHODS

A quantitative observation study with a cross-sectional design was conducted in the Netherlands from March to October 2020. Twenty-three maternity care professionals in 2 hospitals and 16 midwifery practices were purposefully sampled. During 104 prenatal consultations, professional interactions were audiotaped and coded using the Coding and Observing Need-Supportive Consultation in Maternity Care Consultations. The woman's perceived healthcare climate was assessed using the Healthcare Climate Questionnaire.

RESULTS

We observed that professionals derive their autonomy-supportive interactions from a small repertoire. They tend to use more autonomy-supportive interactions (mean=2.31, SD=0.58) that give room to the woman than interactions that stimulate active engagement (mean=1.41, SD=0.80). During structuring interactions, they tend to use more informative (mean=1.81, SD=0.59) than supportive interactions (mean=0.94, SD=0.55). Women generally perceived the healthcare climate as positive.

CONCLUSIONS

Women were rarely stimulated to be actively engaged in the consultations, while active woman engagement is vital in offering women-centered decision-making support. Professionals could improve their autonomy-supportive consultation climate by paying explicit attention to interactions involving women and offering structure.

Psychometric Properties of the TWente Engagement with Ehealth Technologies Scale (TWEETS) Among Patients with Hypertension in Italy

INTRODUCTION

Engagement with mobile health (mHealth) technologies among patients with hypertension is linked to reduced blood pressure and improved patient understanding of the condition.

AIM

This study aimed to evaluate the psychometric properties (validity and reliability) of the TWente Engagement with Ehealth Technologies Scale (TWEETS) in an Italian cohort with hypertension. This study is the first attempt to evaluate the psychometric characteristics of the TWEETS in this population.

METHODS

The study was conducted in three phases. The first phase encompassed the translation and cultural adaptation of the TWEETS to the Italian setting. The second phase involved an expert panel evaluating the instrument's face and content validities. The third phase was a cross-sectional study aiming to test construct validity and reliability. Adults diagnosed with hypertension were eligible for participation. Additional inclusion criteria included stable antihypertensive treatment for at least 2 weeks before enrolment and the provision of written informed consent. Patients were taught how to use two mHealth devices using the teach-back method.

RESULTS

A total of 131 patients were enrolled. Exploratory and confirmatory factor analyses revealed that the TWEETS had a one-factor structure and a good level of fit. Cronbach's alpha coefficients suggested good internal consistency.

CONCLUSIONS

The findings indicate that the TWEETS is a valuable tool for assessing the engagement of patients with hypertension with mHealth devices. Further assessment is needed in various cohorts to confirm the psychometric equivalence of the construct across different groups with hypertension.

Evaluating the Effectiveness of Using the Teach-Back Method to Improve the Health Literacy of Individuals in the Community

PURPOSE

The purpose was to evaluate the effectiveness of the teach-back method in improving communication between registered nurses and people receiving healthcare services in a community-based setting to address the issue of low health literacy.

DESIGN

A quasi-experimental study, pre- and post-test design with an intervention group and a comparison group was conducted to study the teach-back method and the quality of communication between registered nurses and people receiving healthcare services in a community-based setting.

METHODS

For the intervention group, the registered nurses integrated the teach-back method into the delivery of healthcare services to enhance communication with people who received services at various community-based sites. The comparison group received healthcare services at various community-based sites, without the teach-back method. A retrospective pre- and post-test questionnaire was administered to the participants in the study to measure communication with registered nurses.

FINDINGS

The post-test mean score (M = 5.58, SD = .743) of the intervention group was significantly higher than their mean pre-test score (M = 5.17, SD = 1.195), t(434) = -7.727, p < .001, Cohen's d = .371. The difference between the pre- and post-test mean scores of the comparison group was not statistically significant.

CONCLUSIONS

The findings confirmed the effectiveness of the teach-back method for improving patient communication among people receiving healthcare services in a community-based setting.

CLINICAL EVIDENCE

Community health nurses can utilize the teach-back method while delivering healthcare services to improve patient communication and address health literacy among people in the community.

Enhancing older Veterans' care: Insights from medication reviews and deprescribing interventions

BACKGROUND

Patient experience during and after health care is a critical indicator of quality of care that encompasses effective communication, respect, dignity, and emotional support. However, qualitative studies exploring the experiences of older adults after deprescribing interventions are sparse, highlighting a knowledge gap. This project seeks to address this gap by exploring Veterans' experiences during and after a deprescribing intervention provided by a pharmacist. This study aims to: 1. Assess Veteran's experience of the process of their Comprehensive Medication Review and deprescribing intervention visit; 2. Assess the Veteran's experience with the outcomes of their Comprehensive Medication Review and deprescribing intervention.

METHOD

Data was collected from 17 Veterans through semi-structured interviews using an interview guide. The Veteran Affairs study site utilizes the VIONE polypharmacy risk calculator to identify high-risk Veterans; the majority of these Veterans were on at least 10 medications. The interview transcripts were analyzed using inductive content analysis. Two research team members independently coded the data for categories and themes. Similarities were identified, and any divergence was discussed and resolved. To enhance the validity of the findings, member checking was performed with Veterans to confirm the results.

RESULT AND DISCUSSION

Most Veterans viewed the process of the pharmacists' visits and recommendations positively. They expressed confidence in pharmacists' knowledge and instructions. They appreciated the clarity of information pharmacists provided about the purpose, proper administration, and interactions of their medications. These enhanced the Veterans' ability to manage their medication regime. They also desired an increased frequency of interactions with their pharmacist due to these positive interactions. Veterans appreciated interprofessional collaboration between pharmacists, physicians, and other providers. Veterans expressed how pivotal lab test results were for evaluating medication recommendations and effectiveness. Most Veterans reported positive outcomes and/or indicated there were no negative effects as a result of their recent medication changes. Some reported seeking additional information from their providers regarding suggested medication changes to validate recommendations. There was some uncertainty about whether there would be follow-up visits with the professional after the medication change and who should initiate this. A minority indicated problems associated with prior medication discontinuation before the deprescribing intervention and how this limited their openness to future opportunities of deprescribing.

CONCLUSION

This exploration of Veterans' experiences with the process and outcomes of a deprescribing service affirms its importance and overall success in this site as part of the unique publicly funded Veteran healthcare system in the US. Equally important, the positive Veteran response suggests the value of exploring its potential to benefit patients experiencing polypharmacy across a range of other sites and systems.

Responsibility of follow-up regarding medical recommendations in primary care and challenging patients: The perspective of doctors, nurses, pharmacists, and administrative staff

OBJECTIVE

This study examines the way healthcare staff describe challenging patients and perceive responsibility for follow-up of patients with chronic conditions.

METHODS

Interviews were conducted with 46 healthcare staff (15 primary care physicians/12 nurses/15 administrative staff/4 pharmacists) at 12 clinics in Israel. They were audiotaped, transcribed, and thematically analyzed using Atlas qualitative data analysis software.

RESULTS

Participants defined patients as "challenging" either because they are less likely to follow medical recommendations or are felt to overconsume care. Staff believed that patients did not follow medical recommendations because they were indifferent, unaware, in denial about deteriorating medical condition, or fear of the unknown. Participants generally perceived a shared responsibility for follow-up between the staff and the patient. Staff who endorsed closer relationships with staff members expressed empathy toward challenging patients and felt responsible for follow-up.

CONCLUSIONS

Healthcare staff perceive themselves as partially responsible for helping patients follow up with medical recommendations. Cohesive staff relationships may promote higher levels of empathy toward challenging patients and may contribute to helping patients follow up with recommended care. Practice implications To improve follow-up with medical recommendations, there is a need to develop and test interventions to promote more cohesive ties among clinic staff.

A qualitative exploration of perioperative subjective experiences of colorectal cancer patients undergoing fast-track surgery

Colorectal cancer significantly impacts patient quality of life and burdens healthcare systems globally. Fast-track surgery (FTS) aims to alleviate some of these impacts by expediting recovery and reduce the physiological stress associated with traditional surgical approaches. Despite the clinical efficiency of FTS, there exists a gap in the literature concerning patients' subjective experiences during the perioperative period. This study seeks to fill that gap by qualitatively exploring the perioperative experiences of patients undergoing FTS for colorectal cancer, focusing on their emotional, psychological, and informational journeys. We purposively sampled 12 colorectal cancer patients. Data were collected through semi-structured interviews and analyzed using thematic analysis to uncover the emotional and psychological nuances of the patients' experiences. Findings revealed that patients often felt under-informed and overwhelmed, impacting their psychological preparedness and satisfaction with the surgery. Despite FTS' clinical benefits, patients reported mixed emotions post-surgery, including relief and ongoing anxiety about cancer recurrence. Our findings highlight the need for enhanced patient-centered care practices, suggesting that healthcare providers should integrate more effective preoperative education and support systems to better align clinical efficiency with patient satisfaction.

The impact of self-care training using the teach-back method on health anxiety in patients with coronary artery disease: A randomized controlled clinical trial

BACKGROUND

Coronary artery disease (CAD) is the most prevalent heart disease and a leading cause of death among both men and women. It is worth noting that anxiety is highly prevalent among patients with CAD, and it can significantly affect their overall performance and well-being. This study aimed to determine the impact of self-care training, specifically using the teach-back method, on health anxiety in patients with CAD.

MATERIALS AND METHODS

In this randomized controlled clinical trial, a total of 50 patients with coronary artery disorders were selected from the coronary care unit of Rasool Hospital in Ferdows City, Iran, in 2022. The participants were randomly assigned to two groups. The intervention group received self-care training based on the teach-back method, which consisted of three individual sessions lasting 30-45 minutes each, conducted over the course of one week. However, the control group received routine care. To collect data, the researchers utilized Salkovskis et al.'s (2002) health anxiety questionnaire. The collected data were analyzed using the Chi-square test, Fisher's exact test, independent t-test, and paired t-test at a significance level of P < 0.05.

RESULTS

Most participants in the control and intervention groups were female. The mean ages of the intervention and control groups were 47.1 ± 12.83 and 48.1 ± 44.81 years, respectively, with no statistically significant difference (P = 0.67). The results indicated that there was a statistically significant difference in the total mean score (P = 0.000) and mean scores of subscales of health anxiety (awareness of bodily sensations or changes (P = 0.001), feared consequences of having an illness (P = 0.001), and worry about health (P = 0.008)) between the two groups.

CONCLUSIONS

The self-care training based on the teach-back method reduced health anxiety in patients with CAD. Therefore, it is recommended to incorporate the teach-back method as an educational approach by nursing team to effectively reduce health anxiety in patients with CAD.

Teach back educational strategy on knowledge about breast cancer among low health literate women

BACKGROUND

This randomized controlled trial examines the effectiveness of a "teach-back" educational strategy in increasing knowledge about breast cancer among women with low health literacy.

METHODS

Data collection for this study was conducted at the Farabi Comprehensive Health Services Center in Sanandaj, Iran, between December 2020 and October 2022. In this randomized controlled trial, 84 women who had low health literacy were randomly allocated into groups of the study (teach back, and control groups). The educational intervention focused on increasing knowledge of breast cancer risk factors, signs and symptoms, early detection methods (including breast self-examination), and the importance of regular screening. The intervention group received 3 face to face education within three weekly sessions, each lasting 20 min. The Health Literacy Instrument for Adults (HELIA), breast cancer knowledge was measured by valid tool and compared in the two groups before and eight weeks after the interventions.

RESULTS

Mean scores of breast cancer knowledge revealed significant differences between intervention group and control group (P < 0.001) eight weeks after intervention. There were significant differences between baseline and follow-up measurement scores demonstrating that there were differences in the participants' breast cancer knowledge (P < 0.001), and diagnosis technique knowledge (P < 0.008), between the intervention and control groups.

CONCLUSION

Teach Back educational strategy increased knowledge breast cancer among low health literacy women. Teach Back educational strategy seems to be effective for women with low health literacy.

Investigating various interventions to improve the quality of life of children and adolescents suffering from chronic diseases - a systematic review

INTRODUCTION

The transition from childhood to adulthood is an ups-and-down experience determined by increased independence, formation, and development of personal identity. Children with chronic diseases compared to their peers, face more challenges during this period that can exacerbate their symptoms and negatively affect their quality of life. This research aims to review the studies that have investigated the ways to improve the quality of life of children and adolescents with chronic diseases in Iran.

CONTENT

In this study, a search was done in the international databases of PubMed, Scopus, web of Science, Google Scholar, and the internal databases of Magiran and SID with related keywords including children, adolescents, chronic diseases, quality of life, health, nursing interventions were carried out from 2010 to July 2024. Exclusion criteria included summaries of conference articles and foreign articles other than Persian and English.

SUMMARY AND OUTLOOK

In the primary search, 363 articles were found. After removing duplicates and unrelated items, and finally, 36 articles (52.77 % in English, 47.22 % in Persian) were examined in line with the objectives of the present study. The results of the study indicate that non-pharmacological interventions can significantly improve the quality of life of adolescents with chronic diseases. Nursing interventions appear to have a positive and significant effect on the quality of life of children and adolescents with chronic illness.

Impact of a health literacy sensitive model of care in outpatient nephrology dietetic clinics

BACKGROUND

Inadequate health literacy in people with chronic kidney disease is associated with poorer disease management and greater complications. Adherence to the renal diet is known to be suboptimal and patient feedback about the renal diet suggests that patients leave nephrology clinics feeling confused. The present study aimed to evaluate the impact of a health literacy sensitive model of care (MOC) in outpatient nephrology dietetic clinics.

METHODS

This quasi-experimental non-randomised pre-post study recruited adults attending three renal dietitian clinics. The revised MOC consisted of a renal diet question prompt sheet, teachback, and plain language materials and instructions. Outcomes assessed included clinical, dietary, patient-reported satisfaction and quality of life. Differences between and within groups were analysed using paired t-tests, independent sample t-tests (or non-parametric equivalent), chi-squared and McNemar's tests. Linear mixed models evaluated change in total diet quality score, fruit, vegetable, protein and dairy intake with time as a fixed effect and a random subject specific effect.

RESULTS

Fail to attend rates at the initial appointments were lower in the revised MOC (21.5% vs. 9.1%). The revised MOC was associated with significantly improved fruit (p = 0.03) and vegetable (p = 0.003) intake and an improved proportion with adequate diet quality (p = 0.03). These impacts were of moderate effect size (d = 0.5, 95% confidence interval = 0.0-1.0). The revised MOC was also associated with greater satisfaction at baseline (p = 0.04) and higher acceptability scores for all questions at the review appointments. Quality of life improved clinically but not significantly in the revised MOC (p = 0.92).

CONCLUSIONS

This low-cost health literacy sensitive intervention is a promising strategy to improve fruit and vegetable intake in adults attending renal dietitian clinics. Further research to determine fidelity of teachback use and cost utility analysis would be beneficial. Larger scale trials powered to detect changes in quality of life would also be informative.

Reasoning about reasoning - using recall to unveil clinical reasoning in stroke rehabilitation teams

PURPOSE

The study objective was to investigate how health care providers in stroke teams reason about their clinical reasoning process in collaboration with the patient and next of kin.

MATERIALS AND METHODS

An explorative qualitative design using stimulated recall was employed. Audio-recordings from three rehabilitation dialogs were used as prompts in interviews with the involved staff about their clinical reasoning. A thematic analysis approach was employed.

RESULTS

A main finding was the apparent friction between profession-centered and person-centered clinical reasoning, which was salient in the data. Five themes were identified: the importance of different perspectives for a rich picture and well-informed decisions; shared understanding in analysis and decision-making - good intentions but difficult to achieve; the health care providers' expertise directs the dialog; the context's impact on the rehabilitation dialog; and insights about missed opportunities to grasp the patient perspective and arrive at decisions.

CONCLUSIONS

Interprofessional stroke teams consider clinical reasoning as a process valuing patient and next of kin perspectives; however, their professional expertise risks preventing individual needs from surfacing. There is a discrepancy between professionals' intentions for person-centeredness and how clinical reasoning plays out. Stimulated recall can unveil person-centered practice and enhance professionals' awareness of their clinical reasoning.

Sharing Genomic Tumor Sequencing Results With Patients: Experiences of Advanced Practice Oncology Providers

Background

Patients with cancer routinely undergo genomic tumor sequencing, a component of molecular profiling (MP), to better characterize their cancer and identify potential targetable alterations. Targeted treatments potentially confer higher response rates and better efficacy. With increasing complexity, patients may require detailed explanations of MP results. Patient understanding of MP results increases the likelihood that eligible patients receive targeted treatment. Advanced practice providers (APPs), defined as nurse practitioners, physician assistants, and pharmacists, frequently review and discuss MP results with patients. Purpose: The aim of this study is to understand APP experiences discussing MP results with adult cancer patients.

Methods

A qualitative study was conducted through virtual semi-structured interviews with APPs recruited via study invitation shared through the Advanced Practitioner Society for Hematology and Oncology (APSHO). Eligibility criteria included APPs with > 1 year of oncology experience and involvement in discussing MP results. Data were analyzed utilizing a constant comparative analysis and coded in three stages: open, axial, and selective.

Results

Thirteen participants were enrolled from across the United States. Participants discussed learning to understand and explain MP findings primarily through on-the-job experiences. Barriers to patient education were also described. Initially coded participant statements (open codes) produced six themes (axial codes).

Conclusions

With MP now standard practice in oncology, APPs frequently discuss these results with patients. This study highlights that additional and continuing education related to MP is needed in communicating complex results. Patient educational tools, specific to patients' MP findings and tailored to their preferences and literacy levels, are critically needed.

Hospital Discharge Process: Context-Sensitive Care

The transition from hospital to home after surgery is a vulnerable time for all cardiac surgical patients, particularly older adults. This postoperative phase presents multiple physical, physiological, emotional, and socioeconomic challenges, not only for patients but also for their families and informal caregivers, who often describe this period as stressful and overwhelming. Health-care professionals, particularly nurses, play an integral role in a patient's discharge process; the challenges can be ameliorated through timely discharge planning and effective discharge education. The context-sensitive solutions shared in this paper propose enhancing nurses' discharge practices to provide individualized care and to facilitate the hospital-to-home transition.

Interpreter-mediated neuropsychological assessment: Clinical considerations and recommendations from the European Consortium on Cross-Cultural Neuropsychology (ECCroN)

OBJECTIVE

With increasing international migration, societies have become increasingly diverse worldwide. Although neuropsychological assessment is influenced by several diversity characteristics, language barriers have repeatedly been identified as one of the main challenges to cross-cultural neuropsychological assessment in migrant populations. Importantly, neuropsychologists are often required to conduct interpreter-mediated neuropsychological assessments without any graduate training or continuing education on the topic. To address this gap, the objective of this paper is to provide guidelines for interpreter-mediated neuropsychological assessment.

METHOD

A European Consortium on Cross-Cultural Neuropsychology (ECCroN) task force conducted a conceptual literature review and provided recommendations for good practice and working principles to inform the preparation and administration of interpreter-mediated assessments.

RESULTS

ECCroN takes the position that it is the responsibility of neuropsychologists, as well as the institutions or organizations that employ them, to ensure effective communication between themselves and their patients. This may be accomplished by preparing for an interpreter-mediated assessment by engaging an appropriate interpreter, which in most circumstances will be a professional in-person interpreter speaking the same language(s) or dialect(s) as the patient, and considering practical, language, and cross-cultural issues. During the assessment, reasonable steps should be taken to proactively manage the proceedings and adopt a communication style that facilitates effective patient-directed communication, and when interpreting test data and determining formulations and diagnoses, the limitations of interpreter-mediated assessment should be carefully considered.

CONCLUSION

Adhering to the provided recommendations and working principles may help neuropsychologists provide competent interpreter-mediated neuropsychological assessments to linguistically diverse patients.

Cultural competence training of dieticians: development and preliminary evaluation

INTRODUCTION

Training can improve healthcare providers' cultural competence and increase their awareness of bias and discrimination in medical decision-making. Cultural competences training is lacking in the education of dieticians in the Netherlands. The aim of this study was to describe the pilot-implementation of a cultural competence training for dieticians and preliminary evaluation of the training.

METHODS

A training was developed based on Seeleman's cultural competence framework and previously held interviews with migrants, dieticians, and experts. The training consisted of a mixture of didactic and experiential methods, alternating knowledge transfer with exercises to increase awareness, reflection, and feed-back on recorded consultations, and communication training with migrant training actors. The training was piloted in 8 participating dieticians and preliminary mixed-method evaluation was done using a Cultural Competence Questionnaire, Experience Evaluation Questionnaire, and consultation observations.

RESULTS

The questionnaires showed that dieticians were positive about the training. They found it valuable and educational. Participants reported an increase in self-perceived cultural competence and attitudes. Knowledge and skills remained approximately the same. The observations showed that dieticians applied the teach-back method and discussed treatment options more often after training. There was no increase in the use of visual materials.

CONCLUSION

The training was well appreciated and, although a small-scale pilot, this mixed-method study suggests an ability to change cultural competence. The combination of a self-assessment instrument and consultation observations to evaluate cultural competence was highly valuable and feasible. These encouraging results justify a broader implementation of the training.

The effect of teach-back method training on the prevention behaviors of reproductive age women against sexually transmitted diseases

The aim of this research was to examine the effect of teach-back method-based training provided to reproductive-age women to protect them from sexually transmitted diseases (STDs) on their protective behaviors. Sexually transmitted diseases cause significant health problems for many women every year. The transmission of sexually transmitted diseases can be prevented through health education, which is among the preventive health services. Nurses are the leading health educators. Nurses should learn new education systems and models and use them in their practice. This study has a randomized controlled design. The teach-back method and face-to-face training were provided to women of reproductive age experimentally for protection from sexually transmitted diseases. In this research, the teach-back method in which there were 42 participants in each group, an identifying information form for women in three groups who were provided face-to-face training and not trained, the Behavioral Scale for Protection from Sexually Transmitted Diseases were applied pre-training, fifteen days and three months after the training. Participants' socio-demographic data in the intervention and control groups were compared. The mean age of the teach-back group had been 30.64 ± 5.73, the average age of the face-to-face group had been 29.83 ± 5.49, and the mean age of the non-trained group had been 28.16 ± 5.09. These groups had displayed similar characteristics. The mean score of the Behavioral Scale for Protection from Sexually Transmitted Diseases was found to be 75.57 ± 12.78 pre-training, 82.54 ± 9.59 fifteen days after the training and 81.85 ± 9.28 three months after the training in women who were trained with the teach-back method; 76.92 ± 10.03 pre-training, 80.78 ± 8.72 fifteen days after the training and 80.21 ± 8.77 three months after the training in women who received face-to-face training, while it was found in women who did not receive face-to-face training to be 75.73 ± 6.14 pre-training, 75.61 ± 6.01 fifteen days after the training and 75.54 ± 6.09 three months after the training and there was a statistically significant relationship between them (F = 6.736; p < 0.001). As a result of the research, it was found that the training provided to women with the teach-back method had a positive effect on women's behaviors and was more effective than face-to-face training.

Severe Overt Hypothyroidism-Induced Rhabdomyolysis Complicated by Acute Renal Impairment

Musculoskeletal symptoms in hypothyroidism are often vague and non-specific, but in rare cases, rhabdomyolysis may develop as a serious complication. Here, we report a case of a 25-year-old man with a known history of Hashimoto's thyroiditis who presented with symptoms of rhabdomyolysis complicated by renal impairment secondary to severe overt hypothyroidism in the context of medication non-compliance. He presented with symptoms of generalised myalgia and fatigue. Laboratory investigations were consistent with severe overt hypothyroidism with thyroid-stimulating hormone (TSH) 531.4 mIU/L and free thyroxine (T4) 0.9 pmol/L (0.07 ng/dL). Creatine kinase (CK) levels were elevated at 1052 U/L with associated acute renal impairment, creatinine 129 μmol/L (1.49 mg/dL). Our patient was managed with the recommencement of thyroxine therapy and intravenous hydration. Over the course of hospitalisation, the patient's myalgias gradually improved, with an improvement in CK levels and renal function. Our case highlights the potential consequences of prolonged non-compliance. Clinicians should remain vigilant in monitoring patients' medication adherence and be aware of the possible complications from non-compliance. Early recognition and prompt management of such cases can lead to successful recovery and prevent long-term sequelae.

Using the Disclosure Decision-Making Model to Examine Patient Confusion Disclosure

The disclosure decision-making model (DD-MM) has been heavily explored within its initially proposed scope. Fewer known studies have tested the DD-MM's boundaries by assessing the model's application beyond close personal relationships, and none have explored it in a context outside of long-term health conditions. The current study investigates the disclosure decision-making process of patients to their healthcare providers when they experience situational confusion. A primarily quantitative online survey analyzed data from 251 U.S. adults who felt confusion during a recent appointment with their healthcare provider. Findings indicate that, although stigma and perceived disclosure efficacy impacted patient confusion disclosure as anticipated, anticipated response and relational quality (i.e., receiver assessments) did not play a significant role in disclosure. Stigma, anticipated response, and perceived disclosure efficacy were all related to remaining patient confusion as expected. This study contributes to our understanding of the scope of disclosure decision-making model as well as the to-date overlooked nuances of situational patient confusion: what impacts confusion disclosure and its likelihood to remain beyond the appointment's end. Limitations, implications, and future directions are discussed.

It's a spiral staircase, not just two steps: An iterative approach to assessing patient capacity for medical decision-making

The assessment of medical decision-making capacity as part of the process of clinical informed consent has been considered a bioethical housekeeping matter for decades. Yet in practice, the reality bears little resemblance to what is described in the medical literature and professed in medical education. Most literature on informed consent refers to medical decision-making capacity as a precondition to the consent process. That is, a clinician must first determine if a patient has capacity, and only then may the clinician engage with the patient for the rest of informed consent. The problem with this two-step approach is that it makes no sense in actual practice. We see the assessment of medical decision-making capacity within the process of informed consent as a spiral staircase, not just two steps, requiring clinicians to keep circling up and around, making progress, until they get to where they need to be: 1. Clinicians start with a general presumption of capacity for most adults, sometimes having a provisional appraisal of capacity based on prior patient contact. 2. Then, they begin performing informed consent for the current situation and intervention options. 3. Next, they must reassess capacity during this process. 4. After that, they continue with informed consent. 5. If capacity is not yet clear, they repeat 1-4.

Categorizing Extremely Positive Five-Star Online Reviews for Orthopedic Foot and Ankle Surgeons: A Retrospective Study

Background Multiple studies have emphasized the increased use of physician rating websites by patients when searching for surgeons to perform elective procedures. This study aimed to analyze the comments associated with online five-star patient reviews for orthopedic foot and ankle surgeons. Methods A retrospective analysis of five-star online reviews and corresponding comments using Vitals.com in 2024 was completed. Surgeons were included if they could be found on Vitals.com, were within a 10-mile radius of one of the top 10 largest cities in the United States, and if they had at least one review with one corresponding comment. Comments were further stratified into the following categories: good outcomes, well-controlled pain, correct diagnosis, clear plan, bedside manner/patient experience, staff compliment, wait time, nice facility, and offering a nonsurgical option. Results In a sampling of 2,425 orthopedic foot and ankle surgeons, 148 physicians (6.1%) had at least one review with one comment. Ultimately, 1,833 five-star reviews comprising 3,215 comments were included in the final analysis. Comments stratified by category revealed the most common comments being related to good outcomes (n = 940; 29.2%) and bedside manner/patient experience (n = 921; 28.6%). From the comments related to bedside manner/patient experience (p < 0.001) and presence of a clear plan (p < 0.001), a significantly higher proportion of comments in the nonoperative group was found relative to the operative group. Conversely, from the comments related to well-controlled pain (p < 0.001), a significantly higher proportion of comments in the operative group was found relative to the nonoperative group. Conclusions The most common reasons behind five-star patient comments for orthopedic foot and ankle surgeons were related to good outcomes and bedside manner/patient experience. Comments from surgical patients were most likely to include mention of well-controlled pain, whereas comments from patients who underwent nonoperative care were more likely to center on bedside manner/patient experience and presence of a clear plan.

Health Literacy and Medication Adherence Among Patients with Type 2 Diabetes in Jordan: A Cross-Sectional Study

Background

Improving health literacy has been found to play a significant role in enhancing medication adherence in patients with type 2 diabetes.

Purpose

The present study aims to evaluate health literacy and its association with medication adherence among diabetic patients in Jordan.

Patients and Methods

This cross-sectional study included 400 diabetic patients, predominantly female (68.8%), with a median age of 58 years, attending the endocrinology outpatient clinic at Albasheer Hospital in Amman, Jordan, between August and December 2023. Patients were recruited using convenience sampling, including those aged 18 and older, literate, diagnosed with T2DM for at least one year, and on at least one medication for T2DM. Sample size was calculated based on the Events Per Variable (EPV) criterion to ensure sufficient power for logistic regression analysis. Data were collected using two validated instruments: the Jordanian Diabetic Health Literacy Questionnaire (JDHLQ), assessing health literacy, and the Medication Adherence Report Scale (MARS-5), measuring medication adherence. A binary logistic regression model was constructed to identify variables associated with adherence levels.

Results

The study enrolled 400 diabetic patients (females =68.8%). While most of the participants (70.3%) reported high adherence levels, results revealed a window for health literacy improvement as the median for the JDHLQ score was 22 (ranging from 18 to 25) out of a maximum possible score of 32. More than half of the participants replied "never" to "I forget to take my medications", followed by "I stop taking my medications for a while".

Conclusion

The binary regression model revealed that a higher JDHLQ score significantly increased the odds of a high adherence level. The significant association between improved health literacy and medication adherence necessitates the implementation of educational campaigns for enhancing literacy and hence medication adherence among patients with type 2 diabetes.

Recommendations to Address Barriers to Patient Portal Use Among Persons With Diabetes Seeking Care at Community Health Centers: Interview Study With Patients and Health Care Providers

BACKGROUND

Community health centers (CHCs) are safety-net health care facilities in the United States that provide care for a substantial number of low-income, non-English speaking adults with type 2 diabetes (T2D). Whereas patient portals have been shown to be associated with significant improvements in diabetes self-management and outcomes, they remain underused in CHCs. In addition, little is known about the specific barriers to and facilitators of patient portal use in CHCs and strategies to address the barriers.

OBJECTIVE

The objectives of this qualitative study were to explore the barriers to and facilitators of the use of patient portals for managing diabetes in 2 CHCs from the perspective of adults with T2D and clinicians (community health workers, nurses, nurse practitioners, and physicians) and to make recommendations on strategies to enhance use.

METHODS

A qualitative description design was used. A total of 21 participants (n=13, 62% clinicians and n=8, 38% adults with T2D) were purposively and conveniently selected from 2 CHCs. Adults with T2D were included if they were an established patient of one of the partner CHCs, aged ≥18 years, diagnosed with T2D ≥6 months, and able to read English or Spanish. Clinicians at our partner CHCs who provided care or services for adults with T2D were eligible for this study. Semistructured interviews were conducted in either Spanish or English based on participant preference. Interviews were audio-recorded and transcribed. Spanish interviews were translated into English by a bilingual research assistant. Data were collected between October 5, 2022, and March 16, 2023. Data were analyzed using a rapid content analysis method. Standards of rigor were implemented.

RESULTS

Themes generated from interviews included perceived usefulness and challenges of the patient portal, strategies to improve patient portal use, and challenges in diabetes self-management. Participants were enthusiastic about the potential of the portal to improve access to health information and patient-clinician communication. However, challenges of health and technology literacy, maintaining engagement, and clinician burden were identified. Standardized implementation strategies were recommended to raise awareness of patient portal benefits, provide simplified training and technology support, change clinic workflow to triage messages, customize portal notification messages, minimize clinician burden, and enhance the ease with which blood glucose data can be uploaded into the portal.

CONCLUSIONS

Adults with T2D and clinicians at CHCs continue to report pervasive challenges to patient portal use in CHCs. Providing training and technical support on patient portal use for patients with low health literacy at CHCs is a critical next step. Implementing standardized patient portal strategies to address the unique needs of patients receiving care at CHCs also has the potential to improve health equity and health outcomes associated with patient portal use.

Effects of the teach-back method on the health status of patients with chronic obstructive pulmonary disease: a real-world community-based cluster-randomized controlled trial

Background

The teach-back method (TBM), also known as the "show-me" method, is a technique for verifying patients' understanding of health-related information that has been recommended for improving health literacy. However, the research on TBM effect on the outcomes of chronic obstructive pulmonary disease (COPD) patients is limited. Therefore, the aim of this study was to examine the effect of a TBM intervention on the health status of COPD patients.

Methods

This real-world community-based cluster-randomized controlled trial enrolled 1,688 patients with COPD from 18 communities in China. Participants received either TBM plus usual care (UC) or UC only. General practitioners were trained in TBM before the intervention. The primary outcomes were depression and anxiety symptoms, as measured by the Hospital Anxiety and Depression Scale (HADS). The secondary outcomes were health-related quality of life and dyspnea, as measured by the COPD Assessment Test (CAT). Dyspnea was assessed using the modified Medical Research Council (mMRC) dyspnea scale. Data on acute exacerbations and deaths were extracted from medical records. Lung function was expressed as the forced expiratory volume in 1 second as a percentage of the predicted value [FEV1 (% pred)].

Results

In total, 336 of the 853 COPD patients in the intervention group (TBM plus UC) had comorbid depression, compared with 329 of the 835 in the control group (UC only). The TBM group showed a significantly greater improvement in HADS depression and anxiety subscale scores (HADS-D and HADS-A, respectively) than the UC group at12 months (t =8.34, P<0.001; t=12.18, P<0.001). The CAT and mMRC scores were significantly lower in the TBM than UC group at 12 months (t=8.43, P<0.001; t=7.23, P<0.001). The numbers of acute exacerbations and deaths were significantly lower in the TBM than UC group at 12 months (mean MCF values were 0.35 and 0.56, respectively [difference of 0.22; 95% confidence interval (CI): -0.41, -0.02; χ2=9.63, P<0.001]. The FEV1 (% pred) was significantly higher in the TBM than UC group at 12 months (t=7.45, P<0.001).

Conclusions

General practitioners can use TBM interventions to effectively reduce anxiety, depression, and dyspnea symptoms, decrease the frequency of exacerbations and likelihood of death, and improve health-related quality of life and pulmonary function in patients with COPD.

Trial Registration

The trial was registered on the Chinese Clinical Trials Registry (reference: ChiCTR-TRC-12001958).

A Digital Communication Intervention to Support Older Adults and Their Care Partners Transitioning Home After Major Surgery: Protocol for a Qualitative Research Study

BACKGROUND

Older adults (aged ≥65 years) account for approximately 30% of inpatient procedures in the United States. After major surgery, they are at high risk of a slow return to their previous functional status, loss of independence, and complications like delirium. With the development and refinement of Enhanced Recovery After Surgery protocols, older patients often return home much earlier than historically anticipated. This put a larger burden on care partners, close family or friends who partner with the patient and guide them through recovery. Without adequate preparation, both patients and their care partners may experience poor long-term outcomes.

OBJECTIVE

This study aimed to improve and streamline recovery for patients aged ≥65 years by exploring the communication needs of patients and their care partners. Information from this study will be used to inform an intervention developed to address these needs and define processes for its implementation across surgical clinics.

METHODS

This qualitative research protocol has two aims. First, we will define patient and care partner needs and perspectives related to digital health innovation. To achieve this aim, we will recruit dyads of patients (aged ≥65 years) who underwent elective major surgery 30-90 days prior and their respective care partners (aged ≥18 years). Participants will complete individual interviews and surveys to obtain demographic data, characterize their perceptions of the surgical experience, identify intervention targets, and assess for the type of intervention modality that would be most useful. Next, we will explore clinician perspectives, tools, and strategies to develop a blueprint for a digital intervention. To achieve this aim, clinicians (eg, geriatricians, surgeons, and nurses) will be recruited for focus groups to identify current obstacles affecting surgical outcomes for older patients, and we will review current assessments and tools used in their clinical practice. A hybrid deductive-inductive approach will be undertaken to identify relevant themes. Insights from both clinicians and patient-care partners will guide the development of a digital intervention strategy to support older patients and their care partners after surgery.

RESULTS

This study has been approved by the Massachusetts General Hospital and Harvard Institutional Review Boards. Recruitment began in December 2023 for the patient and care partner interviews. As of August 2024, over half of the interviews have been performed, deidentified, and transcribed. Clinician recruitment is ongoing, with no focus groups conducted yet. The study is expected to be completed by fall 2024.

CONCLUSIONS

This study will help create a scalable digital health option for older patients undergoing major surgery and their care partners. We aim to enhance our understanding of patient recovery needs; improve communication with surgical teams; and ultimately, reduce the overall burden on patients, their care partners, and health care providers through real-time assessment.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/59067.

Compromised informed consent due to functional health literacy challenges in Chinese hospitals

BACKGROUND

Medical informed consent stands as an ethical and legal requisite preceding any medical intervention. Hospitalized patients face functional health literacy (FHL) challenges when dealing with informed consent forms (ICFs). The legitimacy of ICFs and informed consent procedures in China remains substantially undisclosed. The study's aim was to investigate if Chinese patients have adequate FHL to be truly informed before providing medical consent.

METHODS

In this cross-sectional, structured interview-based study, FHL was assessed within the context of the informed consent scenarios in two teaching hospitals (a 1500-bed general tertiary hospital and a 700-bed cancer hospital) affiliated with Shantou University Medical College. Twenty-seven patients admitted across clinical departments, along with their relatives (n = 59), were enrolled in the study after obtaining informed consent. The participants underwent a three-step assessment with two selected ICFs -teach-back skills, perceived understanding (perception), and informed knowledge (cognizance), with each component carrying a maximum score of 10. Data were analyzed with SPSS (version 22.0) for descriptive and inferential statistics, with consideration of significant P values as < 0.05.

RESULTS

The median age (IQR and range) of participants was 35.5 (28 - 49 and 13 - 74) years. Most participants had only high school education (24.4%, 21/86) or below high school education (47.7%, 41/86). The median score (IQR) of FHL assessments-teach-back, perception, and cognizance-was 4.0 (2.5, 5.8), 8.0 (6.8, 8.8), and 6.5 (5.5, 8.0) out of 10, respectively. A moderate correlation was observed between the scores of cognizance and teach-back (r = 0.359, P = 0.002) or perception (r = 0.437, P < 0.001). Multivariate linear regression analysis predicted being a patient and having lower education levels as independent risk factors of inadequate FHL (Ps = 0.001). Lack of patient-centeredness in ICFs, time constraints, and poor clinical communication were identified as barriers impeding informed consent.

CONCLUSIONS

This study demonstrates inadequacy in personal FHL and impaired organizational HL, resulting in compromised informed consent in Chinese teaching hospitals. As a remedy, we propose improving the quality of ICFs and institutionally mandated outcome-focused training on informed consent for all concerned clinicians to enhance medical ethics, ensure quality health care, address patient values, and mitigate potential medical conflicts.

Cultural considerations in gastroenterology: barriers to care and a call for humility and action

Culture is a broadly defined term and patients' cultural identity may show up in the medical setting in visible and invisible ways. In this paper, we aim to discuss cultural considerations in gastrointestinal (GI) care. Our definition of "culture" reflects the commonly ascribed race and ethnicity and will also discuss other minority groups such as sexual and gender minorities (SGMs). We will review what is known about rates of GI conditions across various cultural groups, acknowledging that our data reflect inequity in representation. While the healthcare system has overall shown an increased awareness of the role that systemic and institutional racism plays in affecting patient care, this has not been widely studied in the context of GI though has a profound impact. Multiple factors affect the interaction between patients' cultural identities and engagement in and quality of GI care. Stigma related to cultural factors or cultural intersection has the capacity to shape if, when, and how medical care is approached, received and applied. Conditions and symptoms in GI are often complicated; health literacy (HL) is the ease with which patients can navigate getting from diagnosis to treatment and engage in self-management and also interacts with cultural context. Some aspects of a patient's experience, background and skill are imperceptible and require the healthcare provider to attend to treatment with humility, respect and self-reflection if they wish to effectively engage. We introduce the concept of cultural humility to GI and offer practical suggestions for those providing clinical care. We also call for future investment in a diverse healthcare delivery system and continued legislation to promote social equity.

Optimising Transitional Care Following a Heart Failure Hospitalisation in Australia

Hospitalisations for heart failure (HF) are associated with high rates of readmission and death, the most vulnerable period being within the first few weeks post-hospital discharge. Effective transition of care from hospital to community settings for patients with HF can help reduce readmission and mortality over the vulnerable period, and improve long-term outcomes for patients, their family or carers, and the healthcare system. Planning and communication underpin a seamless transition of care, by ensuring that the changes to patients' management initiated in hospital continue to be implemented following discharge and in the long term. This evidence-based guide, developed by a multidisciplinary group of Australian experts in HF, discusses best practice for achieving appropriate and effective transition of patients hospitalised with HF to community care in the Australian setting. It provides guidance on key factors to address before and after hospital discharge, as well as practical tools that can be used to facilitate a smooth transition of care.