Understanding Cancer Screening Intention Among Physically Active Adults Ages 18-49.

Ideal efforts for cancer prevention would include lifestyle modifications along with routine, age-eligible cancer screening. Employing an asset-based approach within vulnerable populations already engaging in at least one healthy behavior (i.e., physical activity) may be an ideal way to further reduce cancer risk across peer groups with low cancer screening rates. Guided by the theory of planned behavior (TPB), the aim of this study was to identify constructs associated with cancer screening intentions among young to middle aged adults for influencing educational and behavioral interventions designed to promote cancer prevention. A cross-sectional, web-based survey was utilized to assess attitudes, subjective norms, perceived behavioral control, and intention to screen for cancer among physically active adults aged 18-49 years. Descriptive and bivariate analyses were conducted to characterize the sample, and hierarchical linear regression analyses were conducted to assess the influence of sociodemographic variables and TPB constructs on cancer screening intentions. Age, female sex, reporting a routine doctor's visit, reported knowledge of physical activity as a lifestyle behavior to reduce cancer risk, and an increased number of motivating factors for engaging in physical activity were significantly associated with higher cancer screening intention (P < 0.001). With the addition of TPB constructs (i.e., subjective norms and perceived behavioral control), the final analytic model accounted for 31% of the variance in intention to screen for cancer. Findings suggest that the TPB could be used to tailor or design asset-based, cancer education interventions to effectively promote age-eligible cancer screenings among physically active adults. Educational content to increase social support for cancer screening and enhance perceived behavioral control to complete screening is essential in this population.

Physically fit with a higher cancer risk? Influences of cervical cancer screening among a sample of physically active women ages 21-49 living in the United States.

To achieve the lowest risk level for various cancers, individuals would engage in several healthy lifestyle behaviors and age-eligible cancer screenings as recommended. Nonetheless, research has largely omitted exploration of concurrent primary and secondary prevention behaviors. This study was designed to explore influences of cervical cancer screening among physically active women who reported participation in recreational sports. U.S. based women between the ages of 21-49, who had never been diagnosed with cancer, were eligible to complete a web-based survey. Logistic regression analyses were conducted using SAS 9.4. On average, women were 31 years of age (N = 394) and self-identified as Black (51.3 %). Although low overall (30.7 %), higher odds of cervical cancer screening were associated with age (OR = 1.06, 95 % CI = 1.03-1.10), employment (OR = 2.43, 95 % CI = 1.14-5.18), knowledge of cancer-related risk behaviors (OR = 4.04, 95 % CI = 1.33-12.28), routine doctor's visit (OR = 4.25, 95 % CI = 1.56-11.54), and team-based vs individual-based sport participation (OR = 1.95, 95 % CI = 1.13-3.34). Our study provides insight into the health profile of physically active women, ages 21-49, as it relates to risks for cervical cancer. Screening uptake among this diverse sample was much lower than the general population and national goals set by Healthy People 2030. Interventions should be tailored to increase knowledge of cancer-related risk behaviors, access to healthcare, and recommended cervical cancer screenings among even assumed-to-be healthy populations.

Producing videotapes for cancer education: methods and examples.

PURPOSE/OBJECTIVES: To describe a systematic process to produce videotapes for cancer education and research. DATA SOURCES: Published research and education articles, patient and health education models, the National Cancer Institute's health communication model, and personal experiences. DATA SYNTHESIS: Videotapes provide a consistent form of teaching, are a familiar medium to most patients, and can communicate concepts in a realistic and visual manner. To enhance the acceptability, relevancy, and understanding of cancer messages, target-audience assessment and learner verification should be given special attention. Practical aspects of preproduction, production, and post-production phases, including budget considerations, script development, talent/narration, and location scouting, are important factors to address in producing videotapes. CONCLUSIONS: Cancer education videotapes can be developed through the use of a systematic process and by addressing practical aspects of video production. Assessment and inclusion of target audience members throughout the development process help to ensure that content meets learners' needs. IMPLICATIONS FOR NURSING PRACTICE: Nurses can produce effective educational videotapes by using a systematic framework to guide their efforts. Attention to practical aspects of production is necessary to create high-quality programs that are effective in terms of time, energy, and money.

Developing community-academic partnerships to enhance breast health among rural and Hispanic migrant and seasonal farmworker women.

PURPOSE/OBJECTIVES: To examine effective strategies for building community-academic partnerships for the promotion of breast cancer education and outreach among rural and Hispanic migrant and seasonal farmworker women, mostly from Mexican descent. DATA SOURCES: Published research and education articles and books, community-education models, personal experiences, and community key informant feedback. DATA SYNTHESIS: Effective community partnerships for enhanced education and outreach include a framework based on a network of partners with common goals, communication processes based on trust, and bilingual/bicultural and culturally competent staff. CONCLUSIONS: A sustainable community partnership can be achieved through systematic but flexible approaches to community planning. Involvement of community members in the development and implementation of education and screening activities helps ensure that community needs are met. Relationships based on mutual respect are key. IMPLICATIONS FOR NURSING PRACTICE: Nurses can act as catalysts through community capacity building to create community-academic partnerships to reach medically underserved populations with cancer screening, outreach, and education through the delivery of strategies that are based on common goals.

Consent forms: how to determine and improve their readability.

This study investigated the reading level estimates of cancer clinical trial consent forms from actively accruing studies at the Medicine Branch and the Clinical Pharmacology Branch of the National Cancer Institute. Forty-four consent forms were analyzed using the SMOG formula. Readability levels ranged from grade 12 to grade 17.5 (mean = 14.3). The conclusion was that these consent forms were written above most subjects' reading levels. The usefulness of consent forms could be improved significantly by using readability formulas, applying rewriting techniques, and being aware of subjects' comprehension levels. This paper suggests a number of strategies that nurses can use to enhance comprehension of the information contained in informed consent documents.

Readability of American Cancer Society patient education literature.

American Cancer Society (ACS) literature commonly used to inform patients about cancer-detection methods, life-style risks, and treatment modalities was examined for readability. Fifty-one booklets obtained from a regional ACS office were evaluated. According to the SMOG formula, the reading level estimates of the booklets ranged from grade 5.8-15.6 (SD = 2.2), with a mean reading level of grade 11.9. The sampled cancer materials may be too difficult for many Americans to read and understand since most of the booklets (55%) were written for individuals with grade 12 or higher reading skills. Only one booklet was written at less than a grade six reading level. Booklets produced since 1985 were written at significantly lower reading levels (p less than 0.05) than those published in earlier years. The nurse's role in cancer education encompasses awareness of patients' diverse reading skills and formulation of a systematic method to develop materials that meet the needs of low-literacy groups.

Strategies to improve cancer education materials.

PURPOSE/OBJECTIVES: To highlight the benefits of creating effective materials for cancer education; to describe strategies to enhance the suitability of materials for all readers, including those with limited literacy skills. DATA SOURCES: Published research and education articles, health education models and theories, the National Cancer Institute Office of Cancer Communications, and personal experiences. DATA SYNTHESIS: Written materials, including visuals, commonly are used to convey cancer life-style risks, detection methods, treatments and procedures, and informed consent information. Such materials are relevant and suitable only when they can be read and understood and are matched to patients' reading abilities. A systematic process to achieve effective written materials includes assessing the target audience, limiting the educational objectives, focusing the content on the desired behaviors, presenting the context of the message first, and planning for reader interaction. The final step is verification of comprehension and suitability with the target audience. CONCLUSIONS: The creation of effective cancer education materials can be achieved by employing strategies that aim to enhance patient understandability, usability, relevancy, and motivation. Learner verification is a quality control process and a technique that helps ensure that materials are suitable for the intended audience and better matched to patients' learning needs. NURSING IMPLICATIONS: Nurses can improve the understandability of cancer education by using a variety of learning enhancement techniques and a set of organized planning steps. Such strategies can serve to improve the communication of cancer information to target groups with diverse literacy skills.

Improving understanding of the informed consent process and document.

OBJECTIVES: To review theoretical perspectives relating to the communication of informed consent and to describe research efforts and strategies to enhance the informed consent process and document. DATA SOURCES: Research studies review articles, education and communication models, and NCI National Working Group on Informed Consent Recommendations. CONCLUSIONS: Information communicated during the informed consent process is difficult to understand, raising ethical concerns about whether informed decision-making has taken place. Empirical research focuses on the nature of patient-provider interactions and the effectiveness of various delivery systems, a need exists to overcome conceptual and methodologic limitations. IMPLICATIONS FOR NURSING PRACTICE: Nurses must ensure that patients understand informed consent information. Several communication strategies are posited.

Approaching the media with confidence.

The media are useful in communicating health information to the public. They are also a powerful way to promote and maintain positive nursing images. This paper examines the past portrayals of nurses in the media, explores the benefits of communicating nursing knowledge to the profession and to the community, and suggests strategies to access the media.

Smoking cessation among pregnant women in an urban setting.

This paper examines a study of a brief contact smoking cessation program among 57 pregnant women at two urban clinics. All subjects were administered either a specially created videotape or a booklet on the topic of smoking. Subjects were then randomly assigned to receive either a nurse counseling message or to receive their usual care at the clinic. There was no statistically significant difference in smoking status among those who received either type of media or nurse counseling intervention. However, smoking cessation at one month after entry in the study was reported by 12% (N = 7) of subjects, by 18% (N = 10) of subjects in the ninth month of pregnancy, and by 9% (N = 5) of subjects at one month post-partum. Over half of the patients attempted to quit smoking in the first month and 68% (39/57) made at least one quit attempt during the entire study period. Our results suggest that future smoking cessation programs and methods need to consider more intensive nursing interventions and supportive measures to produce lasting changes in smoking prevalence.

Patient literacy and the readability of smoking education literature.

This study was designed to determine if primary care clinic patients read at a level congruent to the reading grade level of available smoking literature. Reading estimates of smoking education literature (N = 49) ranged from grade 3 to college level (median = 9.5). Reading skills of 258 smoking patients were estimated by reported years of schooling (median = 10), and by scores on the Wide-Range Achievement Test (median = 6). A serious disparity existed between the reading estimates of smoking education literature and the literacy skills of patients in our sample.

Educating patients with limited literacy skills: the effectiveness of printed and videotaped materials about colon cancer.

We investigated whether printed or videotaped information is more effective in enhancing colon cancer knowledge. Subjects (n = 1100) were randomized into three groups: to receive a booklet, view a videotape, or receive no intervention. Subjects receiving the intervention showed increased knowledge compared with control subjects (booklet = 23% and videotape = 26% vs no intervention = 3%). Findings suggest that personalized educational materials are effective in enhancing colon cancer knowledge.

Improving patient comprehension of literature on smoking.

This study was designed to determine if simplification of smoking literature improved patient comprehension. Subjects (N = 129) were randomized in three groups: to receive no smoking booklet, receive one written at the 5th grade, or the 10th grade reading level. Subjects receiving the 5th grade booklet showed 13 percent better comprehension than those receiving the 10th grade booklet, and 18 percent better than the controls. Comprehension of written smoking materials can be improved by adjustment of the reading grade level.

Improving comprehension for cancer patients with low literacy skills: strategies for clinicians.

This paper provides strategies to improve communication between clinicians and patients, particularly patients who are among the 44 million adult Americans with low literacy skills. Included are insights into the nature of the literacy problem and how it affects patient comprehension of information across the continuum of cancer care. Practical strategies address how to help patients understand medical advice, reduce literacy levels of cancer information, and help patients remember the advice given. A summary of the strategies is included in the Appendix for convenient reference.