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Lusk P, Ark T, Crowe R, Monson V, Altshuler L, Harnik V, Buckvar-Keltz L, Poag M, Belluomini P, Kalet A. Measuring the development of a medical professional identity through medical school. Med Teach 2024; 46:665-671. [PMID: 37917985 DOI: 10.1080/0142159x.2023.2273218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
PURPOSE The Professional Identity Essay (PIE) is a theory and evidence-based Medical Professional Identity Formation (MPIF) measure. We describe trajectories of PIE-measured MPIF over a 4-year US medical school curriculum. METHODS Students write PIEs at medical school orientation, clinical clerkships orientation, and post-advanced (near graduation) clerkship. A trained evaluator assigns an overall stage score to narrative responses to nine PIE prompts (inter-rater ICC 0.83, 95% CI [0.57 - 0.96], intra-rater ICC 0.85). Distribution of PIE stage scores across time points were analyzed in the aggregate and individual students were classified as Increase, Stable (no score change) or Decrease based on the trajectories of PIE stage scores over time. RESULTS 202 students completed 592 PIEs from 2018-2023. There was a significant change in the proportion of PIEs in stages over time (X2 84.40, p < 0.001), 47% (n = 95) students were categorized in the Increase trajectory, 45.5% (n = 92) as Stable and 7.4% (n = 15) as Decrease. Older age and time-predicted stage scores change within trajectories (p < 0.05). CONCLUSIONS Medical students' PIE stage scores increase over time with three distinctive trajectories. Further study is needed to explore the utility of this method for formative assessment, program evaluation, and MPIF research.
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Affiliation(s)
- P Lusk
- Graduate School of Education, University of Pennsylvania, Philadelphia, PA, USA
| | - T Ark
- The Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Milwaukee,WI, USA
| | - R Crowe
- Office of Medical Education, New York University Long Island School of Medicine, New York, NY, USA
| | - V Monson
- The Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Milwaukee,WI, USA
| | - L Altshuler
- New York University Grossman School of Medicine, New York, NY, USA
| | - V Harnik
- New York University Grossman School of Medicine, New York, NY, USA
| | - L Buckvar-Keltz
- New York University Grossman School of Medicine, New York, NY, USA
| | - M Poag
- New York University Grossman School of Medicine, New York, NY, USA
| | - P Belluomini
- New York University Grossman School of Medicine, New York, NY, USA
| | - A Kalet
- The Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Milwaukee,WI, USA
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Altshuler L, Wilhite JA, Hardowar K, Crowe R, Hanley K, Kalet A, Zabar S, Gillespie C, Ark T. Understanding medical student paths to communication skills expertise using latent profile analysis. Med Teach 2023; 45:1140-1147. [PMID: 36961759 DOI: 10.1080/0142159x.2023.2193303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE To describe patterns of clinical communication skills that inform curriculum enhancement and guide coaching of medical students. MATERIALS AND METHODS Performance data from 1182 consenting third year medical students in 9 cohorts (2011-2019), on a 17-item Clinical Communication Skills Assessment Tool (CCSAT) completed by trained Standardized Patients as part of an eight case high stakes Comprehensive Clinical Skills Exam (CCSE) were analyzed using latent profile analysis (LPA). Assessment domains included: information gathering (6 items), relationship development (5 items), patient education (3 items), and organization/time management (3 items). LPA clustered learners with similar strength/weakness into profiles based on item response patterns across cases. One-way analysis of variance (ANOVA) assessed for significant differences by profile for CCSAT items. RESULTS Student performance clustered into six profiles in three groups, high performing (HP1 and HP2-Low Patient Education, 15.7%), average performing (AP1 and AP2-Interrupters, 40.9%), and lower performing profiles (LP1-Non-interrupters and LP2, 43.4%) with adequate model fit estimations and similar distribution in each cohort. We identified 3 CCSAT items that discriminated among learner's skill profiles. CONCLUSION Clinical communication skill performance profiles provide nuanced, benchmarked guidance for curriculum improvement and tailoring of communication skills coaching.
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Affiliation(s)
- Lisa Altshuler
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Jeffrey A Wilhite
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Khemraj Hardowar
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Ruth Crowe
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Kathleen Hanley
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Adina Kalet
- Kern Institute, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sondra Zabar
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Colleen Gillespie
- Institute for Innovations in Medical Education, NYU Grossman School of Medicine, New York, NY, USA
| | - Tavinder Ark
- Kern Institute, Medical College of Wisconsin, Milwaukee, WI, USA
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Ark T, Fisher M, Milan F, Kalet AL, Marantz PR, Burgess D, Rodriguez CJ, Burd-Orama L, Samuel M, Gonzalez CM. Heartache or Bellyache? Epigastric Pain, Communication Skills, and Implicit Bias: Can We Uncover an Association in the Simulation Lab? Acad Med 2022; 97:S118. [PMID: 36419761 PMCID: PMC9614548 DOI: 10.1097/acm.0000000000004868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Tavinder Ark
- Author affiliations: T. Ark, A.L. Kalet, Medical College of Wisconsin; M. Fisher, F. Milan, P.R. Marantz, C.J. Rodriguez, L. Burd-Orama, C.M. Gonzalez, Albert Einstein College of Medicine; D. Burgess, University of Minnesota; M. Samuel, New York University Tisch School of the Arts
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Altshuler L, Ark T, Wilhite J, Hardowar K, Crowe R, Hanley K, L Kalet A, Zabar S, Gillespie C. Using Latent Profile Analysis to Describe and Understand Medical Student Paths to Communication Skills Expertise. Academic Medicine 2022; 97:S151. [PMID: 37838883 DOI: 10.1097/acm.0000000000004814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Lisa Altshuler
- Author affiliations: L. Altshuler, J. Wilhite, K. Hardowar, R. Crowe, K. Hanley, S. Zabar, C. Gillespie, NYU Grossman School of Medicine; T. Ark, A.L. Kalet, Medical College of Wisconsin
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Chow BE, Pilarski A, Schmitt J, Decker MC, Ark T, Davis CS. Using Human-Centered Design to Improve a Surgery Resident Well-Being Program. J Surg Res 2022; 277:157-162. [PMID: 35490604 DOI: 10.1016/j.jss.2022.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/07/2022] [Accepted: 02/19/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Surgery resident mental health, burnout, and overall well-being are constantly scrutinized, and improving surgery resident well-being programs continuously requires refinement. We sought to evaluate the effectiveness of human-centered design (HCD) sprints to enhance our surgery resident well-being program. METHODS An HCD sprint was conducted with 34 surgery residents in a single session using seven separate domains, including Mental Health/Reflection and Therapy; Mentoring or Faculty Engagement; Physical Well-being; Retreats; Scheduled Breaks or Free Time; Social Connection; and Well-being Lectures, Emails, or Curriculum. Responses were characterized as: "How might we", Suggestions, Useful, and Not Useful. RESULTS Well-being Lectures, Emails, or Curriculum were overwhelmingly viewed, as Not Useful (77%), as was Mental Health/Reflection and Therapy (42%). Scheduled Breaks or Free Time was viewed as the most Useful (42%). This category also had the most suggestions and "How might we" ideas for improvement (41%). Lastly, Suggestions and "How might we" ideas were also common for improving Mentoring or Faculty Engagement (31% and 29%, respectively). These results were incorporated into multiple strategies to improve surgery resident well-being and also shared in a Department of Surgery Grand Rounds. CONCLUSIONS Surgery resident well-being and a targeted approach by a well-being program are critical to a residency program, particularly with the arduous nature of surgical training during the pandemic resulting in periods of prolonged social isolation. HCD sprints are an effective means to refine a surgery resident well-being program and to involve the residents themselves in that process.
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Affiliation(s)
- Bonnie E Chow
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alicia Pilarski
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Julia Schmitt
- Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael Chris Decker
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Tavinder Ark
- Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christopher S Davis
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Alevi D, Baiocco PJ, Chokhavatia S, Kotler DP, Poles M, Zabar S, Gillespie C, Ark T, Weinshel E. Teaching the competencies: using observed structured clinical examinations for faculty development. Am J Gastroenterol 2010; 105:973-7. [PMID: 20445506 DOI: 10.1038/ajg.2010.27] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Gastroenterology (GI) training programs must develop the teaching skills of their faculty and provide feedback to their fellows. Many faculty feel uncomfortable offering feedback or identifying specific areas for improvement to the fellows. We developed an Observed Structured Clinical Exam (OSCE) to assess fellows' skills and provided faculty with specific criteria to rate the fellows' performance. We propose that OSCEs can serve as tools for faculty development in delivering effective feedback. METHODS Faculty completed a Web-based training module and received written guidelines on giving feedback. Four OSCE stations were completed by each fellow with faculty using standardized checklists to assess the fellows' skills. Afterwards, faculty rated each program component and assessed their comfort level with feedback. RESULTS Eight faculty members and 10 fellows from 5 GI training programs in NYC participated. 100% of the faculty agreed that feedback is an important learning tool, should include the learner's self-assessment, and that feedback skills could improve with practice. Compared to faculty skills prior to the program, 87.5% of the faculty agreed that they focused more on specific behaviors and 75% agreed that giving negative feedback was now easier. CONCLUSIONS OSCEs can serve as practicums for faculty development in giving constructive feedback.
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Affiliation(s)
- David Alevi
- New York University School of Medicine, New York, New York, USA
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Gillespie C, Paik S, Ark T, Zabar S, Kalet A. Residents' perceptions of their own professionalism and the professionalism of their learning environment. J Grad Med Educ 2009; 1:208-15. [PMID: 21975980 PMCID: PMC2931244 DOI: 10.4300/jgme-d-09-00018.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The competency of professionalism encompasses a range of behaviors in multiple domains. Residency programs are struggling to integrate and effectively assess professionalism. We report results from a survey assessing residents' perceptions of their professional competence and the professionalism of their learning environment. METHODS A survey was developed to assess specific behaviors reflecting professionalism based on the conceptualizations of key accrediting bodies. Residents rated their ability to perform the behaviors and reported the frequency with which they observed their fellow residents failing to perform the behaviors. Eighty-five senior residents in emergency medicine, internal medicine, pediatrics, psychiatry, and surgery specialties completed the survey (response rate = 77%). Differences among domains (and among items within domains) were assessed. Correlations between perceived professionalism and the professionalism of the learning environment were described. RESULTS Cronbach alpha for professionalism competence was .93 and for professionalism in the learning environment it was .86. Residents reported feeling most competent in being accountable (mean score = 51.4%; F = 10.3, p<.001) and in demonstrating respect. Some residents reported having trouble being sensitive to patients (n = 5 to 23). Disrespectful behaviors were the most frequently witnessed professionalism lapse in the learning environment (mean = 41.1%; F = 8.1, p<.001). While serious lapses in professionalism were not witnessed with great frequency in the learning environment, instances of over-representing qualifications were reported. Problems in accountability in the learning environment were negatively associated with residents' perceived competence. CONCLUSIONS Residents reported being able to perform professionally most of the time, especially in terms of accountability and respect. However, disrespect was a feature of the learning environment for many residents and several serious lapses were witnessed by a small number of residents. Accountability in the learning environment may be an important indicator of or influence on residents' professionalism.
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Affiliation(s)
- Colleen Gillespie
- Corresponding author: Colleen Gillespie, PhD, New York University School of Medicine, VA New York Harbor Health System, 423 East 23rd Street, 15 Floor North (15028AN), New York, NY 10010, 212.263.4247,
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Zabar S, Ark T, Gillespie C, Hsieh A, Kalet A, Kachur E, Manko J, Regan L. Can unannounced standardized patients assess professionalism and communication skills in the emergency department? Acad Emerg Med 2009; 16:915-8. [PMID: 19673703 DOI: 10.1111/j.1553-2712.2009.00510.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The authors piloted unannounced standardized patients (USPs) in an emergency medicine (EM) residency to test feasibility, acceptability, and performance assessment of professionalism and communication skills. METHODS Fifteen postgraduate year (PGY)-2 EM residents were scheduled to be visited by two USPs while working in the emergency department (ED). Multidisciplinary support was utilized to ensure successful USP introduction. Scores (% well done) were calculated for communication and professionalism skills using a 26-item, behaviorally anchored checklist. Residents' attitudes toward USPs and USP detection were also surveyed. RESULTS Of 27 USP encounters attempted, 17 (62%) were successfully completed. The detection rate was 44%. Eighty-three percent of residents who encountered a USP felt that the encounter did not hinder daily practice and did not make them uncomfortable (86%) or suspicious of patients (71%). Overall, residents received a mean score of 60% for communication items rated "well done" (SD +/- 28%, range = 23%-100%) and 53% of professionalism items "well done" (SD +/- 20%, range = 23%-85%). Residents' communication skills were weakest for patient education and counseling (mean = 43%, SD +/- 31%), compared with information gathering (68%, SD +/- 36% and relationship development (62%, SD +/- 32%). Scores of residents who detected USPs did not differ from those who had not. CONCLUSIONS Implementing USPs in the ED is feasible and acceptable to staff. The unpredictability of the ED, specifically resident schedules, accounted for most incomplete encounters. USPs may represent a new way to assess real-time resident physician performance without the need for faculty resources or the bias introduced by direct observation.
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Affiliation(s)
- Sondra Zabar
- New York University School of Medicine, NY, USA.
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Jay M, Kalet A, Ark T, McMacken M, Messito MJ, Richter R, Schlair S, Sherman S, Zabar S, Gillespie C. Physicians' attitudes about obesity and their associations with competency and specialty: a cross-sectional study. BMC Health Serv Res 2009; 9:106. [PMID: 19552823 PMCID: PMC2705355 DOI: 10.1186/1472-6963-9-106] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 06/24/2009] [Indexed: 01/30/2023] Open
Abstract
Background Physicians frequently report negative attitudes about obesity which is thought to affect patient care. However, little is known about how attitudes toward treating obese patients are formed. We conducted a cross-sectional survey of physicians in order to better characterize their attitudes and explore the relationships among attitudes, perceived competency in obesity care, including report of weight loss in patients, and other key physician, training, and practice characteristics. Methods We surveyed all 399 physicians from internal medicine, pediatrics, and psychiatry specialties at one institution regarding obesity care attitudes, competency, including physician report of percent of their patients who lose weight. We performed a factor analysis on the attitude items and used hierarchical regression analysis to explore the degree to which competency, reported weight loss, physician, training and practice characteristics explained the variance in each attitude factor. Results The overall response rate was 63%. More than 40% of physicians had a negative reaction towards obese patients, 56% felt qualified to treat obesity, and 46% felt successful in this realm. The factor analysis revealed 4 factors–Physician Discomfort/Bias, Physician Success/Self Efficacy, Positive Outcome Expectancy, and Negative Outcome Expectancy. Competency and reported percent of patients who lose weight were most strongly associated with the Physician Success/Self Efficacy attitude factor. Greater skill in patient assessment was associated with less Physician Discomfort/Bias. Training characteristics were associated with outcome expectancies with newer physicians reporting more positive treatment expectancies. Pediatric faculty was more positive and psychiatry faculty less negative in their treatment expectancies than internal medicine faculty. Conclusion Physician attitudes towards obesity are associated with competency, specialty, and years since postgraduate training. Further study is necessary to determine the direction of influence and to explore the impact of these attitudes on patient care.
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Affiliation(s)
- Melanie Jay
- Division of General Internal Medicine, New York University School of Medicine, New York, NY, USA.
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Chander B, Kule R, Baiocco P, Chokhavatia S, Kotler D, Poles M, Zabar S, Gillespie C, Ark T, Weinshel E. Teaching the competencies: using objective structured clinical encounters for gastroenterology fellows. Clin Gastroenterol Hepatol 2009; 7:509-14. [PMID: 19041733 DOI: 10.1016/j.cgh.2008.10.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Revised: 10/24/2008] [Accepted: 10/26/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND AIMS Objective structured clinical encounters (OSCEs) are used widely to educate and assess the competence of medical students and residents; they generally are absent from fellowship training. The Accreditation Council for Graduate Education has cited OSCEs as a best practice for assessing the 6 core competencies. This article reports on the use of an OSCE to assess the competence of second-year gastroenterology fellows in the difficult-to-assess core competencies: interpersonal and communication skills and professionalism. METHODS We developed a 4-station, faculty-observed OSCE with 4 standardized patients. Information gathering, relationship development, patient education, and counseling skills were assessed. Professionalism skills assessed included obtaining informed consent, delivering bad news, managing difficult situations, and showing interdisciplinary respect. In each station, faculty and standardized patients completed an 18- to 24-item checklist evaluating fellows' performance and provided feedback to the fellows. Nine fellows and 5 faculty from 4 gastroenterology training programs in NYC participated. RESULTS Fellows and faculty generally highly rated the realism of the OSCE and favorably rated the OSCE for its difficulty and their overall experience. Across all cases, fellows were rated as receiving "well dones" for 56.4% of the communication items (SD, 18.3%) and for 79.1% of the professionalism items (SD, 16.4%). CONCLUSIONS Integrating OSCEs into gastroenterology fellowship training may help enhance communication skills and prepare fellows for dealing with difficult clinical situations and provides mechanisms for constructive feedback. OSCEs developed collaboratively can assist in program self-evaluation and reduce costs by sharing resources, in addition to fulfilling Accreditation Council for Graduate Education mandates.
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Affiliation(s)
- Bani Chander
- Division of General Internal Medicine, NYU School of Medicine, New York, New York 10010, USA
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Jay M, Adams J, Herring SJ, Gillespie C, Ark T, Feldman H, Jones V, Zabar S, Stevens D, Kalet A. A randomized trial of a brief multimedia intervention to improve comprehension of food labels. Prev Med 2009; 48:25-31. [PMID: 19022282 DOI: 10.1016/j.ypmed.2008.10.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Revised: 10/02/2008] [Accepted: 10/03/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Food label use is associated with better food choices, an essential part of the management of many chronic diseases. Previous studies suggest lack of comprehension of food labels. We studied a multimedia intervention to improve food label comprehension in a sample of low income patients in New York City. METHODS This randomized study took place at Gouverneur Healthcare Services from 2005 until 2007. The intervention group (n=29) received a Nutrition Facts Label pocket card and viewed a video explaining card use. The control group (n=27) received written materials. Participants completed a 12-item pre- and post-intervention nutrition food label quiz. Quiz scores were analyzed using repeated measures analysis of variance. RESULTS The intervention group had greater improvement on the quiz than the control group (p<0.001). There was a three way interaction by time with health literacy and treatment group where the greatest improvement occurred in patients with adequate health literacy in the intervention group (p<0.05). There was no improvement in patients with limited health literacy. CONCLUSION A multimedia intervention is an effective way to improve short-term food label comprehension in patients with adequate health literacy. Further research is necessary to improve understanding of food labels in patients with limited health literacy.
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Affiliation(s)
- Melanie Jay
- Division of General Internal Medicine, New York University School of Medicine, New York, 10010, USA.
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