Health literacy profiles of medical students in an Australian Doctor of Medicine programme: A cross-sectional study using the Health Literacy Questionnaire.

ISSUE ADDRESSED: With the emerging focus on designing health-literate organisations and health care systems, it is essential to understand the health literacy profiles of the medical workforce including medical students, as medical professionals play a key role in within these systems. Medical professionals contribute to good patient health outcomes through enabling access to appropriate health care, provision of quality health information and collaborative shared decision-making, which are fundamental health literacy competencies. The aim of this study is to identify health literacy strengths and weaknesses of medical students enrolled in an Australian Doctor of Medicine programme. METHODS: Students from all 4 years of an Australian Doctor of Medicine programme were invited to complete an anonymous, online survey in January 2021. Health literacy profiles were identified using the 9-domain, 44-item multi-dimensional Health Literacy Questionnaire, a validated tool which comprehensively evaluates health literacy strengths and weaknesses from diverse perspectives. Demographic characteristics and social attributes were also recorded. The results were compared with Australian Bureau of Statistics data. RESULTS: Eighty-six participants completed the survey. Most participants were female students (57%) who spoke English at home (88%) with tertiary-educated fathers (60%) and resided in locations associated with high socioeconomic status during adolescence (61%). Males scored significantly higher in three domains which explored health information access and appraisal, and ability to actively engage with health care providers. Students' scores were significantly lower than the Australian general population in Domain 6 (Ability to actively engage with health care providers) and Domain 7 (Navigating the health care system). CONCLUSIONS: Medical students' health literacy profiles indicate areas of weakness in their ability to engage with health care providers and to navigate the health system. Medical educators will need to create opportunities to address these weaknesses within medical curricula. Gender differences identified in self-rated ability to access and appraise health information requires further exploration. SO WHAT?: Further understanding of health literacy profiles of medical students may influence design of medical school curricula.

The impact of postgraduate education in transition to practice programmes on new graduate nurses' knowledge and skills: A pre- post survey design.

BACKGROUND: Research indicates that nurses perceive postgraduate education to have a positive effect on their knowledge and practice. Many jurisdictions offer/require new graduate nurses to undertake postgraduate coursework however the consequences of this are not clear. OBJECTIVES: This research aims to determine the impact of completing a postgraduate course in clinical assessment on the capabilities of new graduate nurses. DESIGN: A two group pre/post design with a naturally occurring intervention employing an online questionnaire was used to gather data. SETTINGS: Two metropolitan hospitals in New Zealand delivering new graduate programmes, one inclusive of a postgraduate course and the other not. PARTICIPANTS: Eighty five nurses completed the questionnaire on commencement of the programme and fifty-two on completion of the programme. METHODS: An online questionnaire was administered to two new graduate cohorts, on commencement and completion of their new graduate programme. RESULTS: Results showed significant pre/post increases for four out of five factors for those who had completed a postgraduate course compared to only one significant increase for those who had not. In addition, when comparing the scores of the two groups there was no significant differences between groups on the pre-measures. However, on post measures there were significant differences with the postgraduate group scoring higher on three of the five subscales: Knowledge for Practice, Explaining Practice and Applied Diagnostic Reasoning. CONCLUSION: It is the author's belief that this is the first study that has attempted to quantify new graduate nurses' perceptions of their educational experience in their first year of practice and suggests that the inclusion of the postgraduate course enhanced knowledge for practice and diagnostic reasoning skills.

Nursing students and health literacy: The effect of region and programme level.

Low levels of health literacy have been associated with poor health outcomes. If an organisation does not have a health literate workforce, it cannot be expected to create a healthcare service that supports the development of health literacy among its users. The aim of this cross-sectional study was to determine the health literacy profiles of undergraduate student nurses over year groups and between regions. The collaborative study employed an anonymous online survey using the Health Literacy Questionnaire which investigated the health literacy profiles of 845 undergraduate student nurses from eight universities in four regions from mid-2014 to early 2016 with co-investigators in each of the universities. Results show specific significant changes in health literacy profiles as a function of year level across the four regions; for example, in the Ability to find good health information. Different regions have different health literacy profiles; however, all could be improved. The results from this study provide specific direction to educators on what student health literacy may look like upon graduation as well as challenge current assumptions. Graduating nurse professionals have a role in mediating and sponsoring a health literate health system as well as being part of supporting patients' health literacy.

Health literacy of future healthcare professionals: a cross-sectional study among health sciences students in Nepal.

Background: There is an assumption that health literacy is higher among health professionals, allowing them to improve the health literacy of their patients. This study explored health literacy profiles of health science students in Nepal, the future health professionals and educators of health literacy. Methods: The multidimensional Health Literacy Questionnaire and demographic questions were administered online to medical and other health science students at the B. P. Koirala Institute of Health Sciences, Dharan, Nepal. Results: More than half (55.8%) of the participants were male, 68.3% were ≤19 y of age, 62.2% had parents with a university degree, 73.5% were studying undergraduate courses and 61.6% were pursuing medicine. Students reported having moderate support and skills to manage their health. Health was regarded as important to them. They reported a moderate ability to engage with health professionals and the healthcare system. Medical students reported higher scores for all scales except social support for health, which was similar across the groups. Conclusions: Universities should target interventions to improve students' access to health information and to develop students' ability to engage actively with healthcare providers. This will likely produce health professionals with improved health literacy levels who are sensitive to the health literacy needs of their patients from different population groups.

What do Australian & New Zealand caregivers know about children's ibuprofen? The results of an online survey?

BACKGROUND: Children's formulations containing ibuprofen are frequently used to treat pain and fever. These medications, available over-the-counter, have the potential to cause adverse events if usage/safety information is not adhered to. This study aimed to investigate caregivers' knowledge about the safe use of a commonly purchased children's formulation containing ibuprofen. METHODS: A convenience sample of caregivers in Australia and New Zealand, who had purchased Nurofen® for Children, completed an online survey assessing their knowledge of product information and dosage instructions available on/in the product packaging. RESULTS: In total, 219 caregivers (mainly female 95%, mean age ± SD; 35 ± 6.82 years) completed the online survey. Responses suggest limitations in their knowledge about the active ingredients, contraindications and side effect profile associated with the product. Most respondents had a good understanding about the correct dosage to give children based on their weight and/or age, but many lacked a good understanding about the correct interval between doses and the maximum number of daily doses. CONCLUSIONS: These findings suggest that caregivers administering ibuprofen to children have gaps in their product knowledge. Strategies to help improve caregivers' knowledge about the safe administration of these products should be prioritised in an attempt to reduce the likelihood of children experiencing ibuprofen related adverse events. Improving caregiver knowledge to address these gaps is an important issue for all health care providers.

Educating new graduate nurses in their first year of practice: The perspective and experiences of the new graduate nurses and the director of nursing.

New graduate nurses are the future of nursing and the education they receive as they transition into the workforce as a newly registered nurse is critical for building a suitably qualified nursing workforce that will adequately serve the future population. Variation exists in education programmes for new graduate nurses in their first year of practice which is known to impact on transition experience. A qualitative study using focus groups and semi-structured interviews was undertaken to explore the experiences and perceptions of New Graduate Nurses undertaking a new graduate programme and Directors of Nursing supporting them to complete the programme which may or may not have been inclusive of a postgraduate course (Masters Level). The findings of this study are in line with previous research and support the value of new graduate programmes but did reveal a lack of consensus in regards to the structure and content of such programmes. This study revealed some commonalities and challenges between the differing programmes but has identified the need for further research to establish the impact of postgraduate education in the first year of practice and how this impacts on nursing practice and patient care. There are numerous terms in the literature with reference to new graduate programmes; transition to practice programme, nurse entry to practice programme, first year of clinical practice programme, new graduate programme and early career nursing programme. For the purpose of this article the term Nurse Entry to Practice (NETP) will be used in reference to any form of new graduate programme.

Uneven progress in reducing exposure to violence at home for New Zealand adolescents 2001-2012: a nationally representative cross-sectional survey series.

OBJECTIVE: To explore trends, and identify risk factors, that may explain changes in adolescent exposure to family violence over time. METHODS: Data for this study was drawn from the Youth 2000 series of cross-sectional surveys, carried out with New Zealand high school students in 2001, 2007 and 2012. Latent class analysis was used to understand different patterns of exposure to multiple risks for witnessing violence at home among adolescents. RESULTS: Across all time periods, there was no change in witnessing emotional violence and a slight decline in witnessing physical violence at home. However, significant differences were noted between 2001 and 2007, and 2007 and 2012, in the proportion of adolescents who reported witnessing emotional and physical violence. Four latent classes were identified in the study sample; these were characterised by respondents' ethnicity, concerns about family relationships, food security and alcohol consumption. For two groups (characterised by food security, positive relationships and lower exposure to physical violence), there was a reduction in the proportion of respondents who witnessed physical violence but an increase in the proportion who witnessed emotional violence between 2001 and 2012. For the two groups characterised by poorer food security and higher exposure to physical violence, there were no changes in witnessing of physical violence in the home. Implications for public health: In addition to strategies directly aimed at violence, policies are needed to address key predictors of violence exposure such as social disparities, financial stress and alcohol use. These social determinants of health cannot be ignored.

School-based primary NCD risk reduction: education and public health perspectives.

The rising global burden of noncommunicable diseases (NCDs) has heightened awareness of the necessity for primary risk prevention programmes. These aim to facilitate long-term behaviour changes in children and adolescents that can reduce NCD risk factors and disease onset in later-life. School-based programmes designed to improve childhood and adolescent health behaviours and wellbeing contribute to this; however, design and impact assessment of these is complex. These programmes should be multidisciplinary, utilizing both educational and health expertise. Health outcomes may not be evident in the short term, but may occur with learning-related behaviour modifications, highly effective when sustained over a lifetime. Thus assessment must analyse short-term learning and behaviour impacts as well as long-term capability, behaviour and health outcomes.The focus of assessment measures in the health and education sectors differs and often lacks depth in one or other area. Educators generally focus on identifying evidence of learning related to capability, attitude and/or behaviour changes, while public health practitioners typically focus on health measures (e.g. body mass index (BMI), mental health, or risk behaviours).We argue that multidisciplinary approaches incorporating education and health viewpoints clarify issues relating to the potential value of schools as a setting to facilitate primary NCD risk reduction. To demonstrate this, we need to: 1) build stronger understandings of the features of effective learning for behavioural change and the best way to evaluate these, and 2) convincingly correlate these measures with long-term metabolic health indicators by tracking learner behaviour and health over time.

Acceptability of a mobile health exercise-based cardiac rehabilitation intervention: a randomized trial.

BACKGROUND: Mobile technologies (mHealth) have recently been used to deliver behavior change interventions; however, few have investigated the application of mHealth for treatment of ischemic heart disease (IHD). The Heart Exercise And Remote Technologies trial examined the effectiveness of an mHealth intervention to increase exercise behavior in adults with IHD. As a part of this trial, a process evaluation was conducted. METHODS: One hundred seventy-one adults with IHD were randomized to receive a 6-month mHealth intervention (n = 85) plus usual care or usual care alone (n = 86). The intervention delivered a theory-based, automated package of exercise prescription and behavior change text messages and a supporting Web site. Three sources of data were triangulated to assess intervention participant perceptions: (1) Web site usage statistics; (2) feedback surveys; and (3) semistructured exit interviews. Descriptive information from survey and Web data were merged with qualitative data and analyzed using a semantic thematic approach. RESULTS: At 24 weeks, all intervention participants provided Web usage statistics, 75 completed the feedback survey, and 17 were interviewed. Participants reported reading the text messages (70/75; 93%) and liked the content (55/75; 73%). The program motivated participants to exercise. Several suggestions to improve the program included further tailoring of the content (7/75; 7%) and increased personal contact (10/75; 13%). CONCLUSIONS: Adults with IHD were able to use an mHealth program and reported that text messaging is a good way to deliver exercise information. While mHealth is designed to be automated, programs might be improved if content and delivery were tailored to individual needs.

Women's Initiation of Physical Violence Against an Abusive Partner Outside of a Violent Episode.

This article explores women's use of physical violence against an abusive male partner, outside of the context of a violence episode. Data were drawn from the New Zealand Violence Against Women Study, a cross-sectional household survey conducted using a population-based cluster-sampling scheme. Logistic regression analysis was used to identify factors associated with women initiating physical violence against their male partners. Of the 845 women who had experienced physical violence perpetrated by their intimate partner, 19% reported physically mistreating their partner at least once outside of a male initiated violent episode, while 81% never initiated violence against their partner. Analyses showed that women's initiation of violence under these circumstances was strongly associated with either or both partners having alcohol problems, her recreational drug use, her number of violent partners, and her mother being hit or beaten by her father when she was a child.

Hitting Back: Women's Use of Physical Violence Against Violent Male Partners, in the Context of a Violent Episode.

This article explores women's use of physical violence in the context of experiencing intimate partner violence (IPV). Data were drawn from the New Zealand Violence Against Women Study, a cross-sectional household survey conducted using a population-based cluster-sampling scheme. Multinomial logistic regression was used to identify factors associated with women's use of physical violence against their partners when they were being physically hurt. Of the 843 women who had experienced physical violence perpetrated by an intimate partner, 64% reported fighting back at least once or twice whereas 36% never fought back. Analyses showed that women's use of violence more than once or twice was associated with experience of severe IPV, IPV that had "a lot of effect" on their mental health, and with children being present when the woman was being physically abused. Women's use of physical violence only once or twice was associated with both partners having alcohol problems and both having been exposed to violence as a child. Of the women who fought back, 66% reported that this did not result in the violence stopping.

The influence of ethnicity on the outcomes of violence in pregnancy.

AIM: To investigate the influence of ethnicity on immediate and long-term (five years post-partum) foetal, maternal and injury-related outcomes. METHODS: A retrospective, population-based study analysing maternal discharge records linked to birth/death certificates for women aged 25 years and under. Discharge records were grouped according to ethnicity (Maori and non-Maori) and as follows: (1) a pregnancy-related hospital admission, but no associated or subsequent assault recorded (pregnant only); (2) an assault-related hospital admission event after the pregnancy, but within five years of the index pregnancy (assault after pregnancy); and (3) an assault recorded within the same hospital admission event as the pregnancy (assault during pregnancy). Generalised linear models for the binomial family were conducted to explore increased risk ratios of pregnancy-related and subsequent injury outcomes depending on ethnicity and group assignment. RESULTS: Compared with the pregnancy-only group, rate ratios (RRs) for maternal and foetal outcomes were higher in the assault after pregnancy group and the assault during pregnancy group. For injury outcomes in the five years after the injury event, RRs for the assault after pregnancy group exceeded both the pregnancy-only and the assault during pregnancy groups. RRs for non-Maori women assaulted after pregnancy were higher for injury hospitalisations, fracture and intracranial injury than those for Maori women. CONCLUSION: Given that Maori women experience a higher prevalence of severe intimate partner violence and more difficulties accessing health care, we suggest that the findings highlight potential problems for health care access for Maori women experiencing violence.

Immediate and long-term outcomes of assault in pregnancy.

OBJECTIVE: We examined the immediate and long-term health outcomes of hospitalised pregnancy-related assault. METHODS: A retrospective review of hospital records was conducted using data from the New Zealand Ministry of Health's National Minimum Data Set of hospital discharges. The hospital records of pregnant women admitted to a public hospital in New Zealand between 2001 and 2006 were included in this investigation. Unique identifiers were used to identify the index pregnancy event, subsequent discharge events and mortality for five years after the index event. Discharge records were grouped as follows: pregnancy-related hospital admission, but no associated or subsequent assault recorded (pregnant only); an assault-related hospital admission event after the pregnancy, but within five years of the index pregnancy (assault after pregnancy); an assault recorded within the same hospital admission event as the pregnancy (assault during pregnancy). Generalised linear models for the binomial family were conducted to explore increased risk ratios of adverse maternal, fetal and subsequent injury outcomes depending on group assignment. RESULTS: Compared with the pregnancy-only group, the assault after pregnancy and assault during pregnancy groups had increased risk ratios for death, preterm labour, antepartum haemorrhage, infectious complication, spontaneous abortion and stillbirth. CONCLUSION: Assault during pregnancy substantially increased the risks for a number of adverse maternal and fetal outcomes. The identification of women who live in a violent relationship and the provision of adequate social support to these women may reduce the risks of subsequent injury and adverse maternal and fetal outcomes.

Phase II cardiac rehabilitation in rural Northland.

Cardiovascular disease has been identified as a leading cause of mortality in New Zealand. It is therefore of little surprise that the New Zealand Health Strategy has identified cardiovascular health as a target area for improved management. A main contributor to cardiovascular disease is coronary artery disease, which can lead to acute coronary syndromes such as myocardial infarction. Cardiac rehabilitation should be offered to those who have suffered from a coronary event, with the aim of improving quality of life for the client and reducing the incidence of further cardiac episodes. Since hospital stays are, on average, less than one week following a cardiac event such as a myocardial infarction, the majority of such rehabilitation is delivered in the primary care setting. This descriptive, exploratory, qualitative study focused on the perceptions and experiences of nurses involved with the delivery of cardiac rehabilitation in a rural health care setting in a Northland region of New Zealand. The paper draws upon two focus groups the researcher conducted with a total of twelve nurses. A general inductive approach was used to analyse the collected data. Five main themes were identified in relation to cardiac rehabilitation: "foundations of rural cardiac rehabilitation", "focal points", "influencing factors", "here and now", and "future requirements". This study provides insight into how cardiac rehabilitation is approached in one rural setting of New Zealand. Furthermore, it identifies some ideas for the further development of cardiac rehabilitation services.

Family support and weight-loss strategies among adolescents reporting sustained weight loss.

OBJECTIVE: The current research aims to describe the weight-control strategies and family support for young people reporting sustained weight loss in a large, population-based sample. DESIGN: Data were collected as part of Youth'07, a nationally representative survey of the health and well-being of New Zealand youth. SETTING: New Zealand secondary schools, 2007. SUBJECTS: Secondary-school students (n 9107). RESULTS: Among young people who attempted weight loss in the previous year, 51% reported long-term weight loss (lost weight and maintained weight loss for 6 months). Students reporting long-term weight loss were more likely to be male, but did not differ by age, ethnicity, socio-economic deprivation or measured weight status from students who reported temporary/recent weight loss or no weight loss. Students with long-term weight loss also reported healthier weight-control strategies (e.g., exercising, eating fewer fatty foods, eating fewer sweets), high parental support for healthy eating/activity and were less likely to report being teased about their weight by their family and having junk food available at home than students with temporary/recent weight loss or no weight loss. CONCLUSIONS: Approximately 50% of young people attempting weight loss reported sustained weight loss. Young people who reported sustained weight loss appeared to have more family support than those who did not achieve this, suggesting the importance for weight-control services and interventions in adolescents of actively engaging the family.

Prevalence of weight-related concerns and behaviours among New Zealand young people.

AIM: The study aims to describe the prevalence of weight loss behaviours and weight-related concerns among a nationally representative sample of adolescents in New Zealand. METHODS: Data for this study were collected as part of Youth'07, a nationally representative survey of the health and well-being of 9107 secondary school students in New Zealand. RESULTS: More than one third of males and 65% of females tried to lose weight in the past year. Approximately 10% of males and 29% of females reported using at least one of the unhealthy weight control behaviours in the past year (fasted, skipped meals, smoked, vomited, diet pills). Among females and males, using unhealthy weight control behaviours was most prevalent among those who were older, overweight and lived in high-deprivation areas. CONCLUSION: Unhealthy weight control behaviours among New Zealand adolescents are common and warrant future research and discussion to understand why so many young people use unhealthy weight loss strategies.

Economic incentives to promote healthier food purchases: exploring acceptability and key factors for success.

Despite increasing interest, little is known about the beliefs and views of the public in relation to the use of economic incentives as a means to promote healthy eating. This study explores views of ethnically and socioeconomically diverse shoppers regarding acceptability of economic incentives to promote healthier food purchases, and factors likely to affect the success of such schemes. Six focus groups (n = 36 participants; 14 Maori, 12 Pacific, 10 non-ethnic specific low income), were held in Auckland, New Zealand, in October 2009. A general inductive approach was used to identify common themes. The single most important reported food purchasing influence was cost. Focus group participants viewed the concept of economic incentives to promote healthy eating positively, as long as such schemes provided worthwhile incentives, and were simple and convenient to use. The preferred option for delivery was a pre-loaded electronic swipe card. Fruit and vegetables were the food group most participants said they would like to see incentivized. There was marked variability in the incentive amount thought sufficient to promote participation in such a scheme. Our findings suggest economic incentives hold promise as a means to promote healthier household food purchases, and their effectiveness should be evaluated using robust, randomized trials.

Protocol for a randomised controlled trial of nasal high flow oxygen therapy compared to standard care in patients following cardiac surgery: the HOT-AS study.

BACKGROUND: Postoperative respiratory complications following cardiac surgery may increase morbidity, mortality and length of stay. Non-invasive respiratory support therapies can be used prophylactically or curatively to reduce respiratory complications. One system, nasal high flow oxygen therapy, is in use in many intensive care units (ICUs) however there is a lack of information regarding its clinical utility and efficacy. OBJECTIVES: This paper outlines the study protocol and methodology for a study designed to determine if the prophylactic use of nasal high flow oxygen therapy can improve pulmonary function in patients following cardiac surgery. METHODS/DESIGN: A prospective randomised controlled trial will be conducted of adult patients scheduled for cardiac surgery and admitted to the Cardiothoracic Intensive Care Unit of a tertiary hospital. Study participants will be assigned to receive either nasal high flow or standard oxygen therapy (oxygen therapy at 2-4 L/min via either simple facemask or nasal cannulae) at extubation. The primary outcome measure is improved pulmonary function demonstrated by SpO2/FiO2 ratio >445 on post-operative day 3. Secondary outcome measures include atelectasis score on chest X-ray; spirometry; readmission to ICU for respiratory causes; ICU and hospital length of stay; mortality and incidence of respiratory complications at day 28; oxygenation variables; use of adjunctive respiratory support therapies; escalation of respiratory support; adverse events and patient comfort during administration of oxygen therapy. SAMPLE SIZE: It was calculated that 340 patients will be required--170 per arm of study--to give a 90% power to detect a 15% treatment effect. RESULTS: This study started recruiting in March 2011. It is anticipated that enrollment will be complete in April 2012 and results available towards the end of 2012. CONCLUSION: This study will provide evidence of any benefits in the use of prophylactic nasal high flow therapy in post-operative cardiac surgical patients. TRIAL REGISTRATION: This trial is registered with the Australian New Zealand Clinical Trials Registry www.anzctr.org.au (ACTRN12610000973011).

A pragmatic randomized controlled trial of computerized CBT (SPARX) for symptoms of depression among adolescents excluded from mainstream education.

BACKGROUND: Adolescents excluded from mainstream education have high mental health needs. The use of computerized Cognitive Behavioural Therapy (cCBT) has not been investigated with this group. AIMS: To test the efficacy of the SPARX cCBT programme for symptoms of depression among adolescents in programmes for students excluded or alienated from mainstream education. METHOD: Adolescents (32; 34% Maori, 38% Pacific Island, 56% male) aged 13-16 with Child Depression Rating Scale Revised (CDRS-R) scores indicating possible through to almost certain depressive disorder were randomized to SPARX to be completed over the following 5 weeks (n = 20) or to waitlist control (n = 12). Assessments were at baseline, 5 weeks and 10 weeks. Those in the wait condition were invited to complete SPARX after the 5 week assessment. RESULTS: Most participants (n = 26, 81%) completed at least 4 levels of SPARX and 22 (69%) completed all 7 levels. Among the 30 (94%) participants who began treatment as randomized and provided 5-week data, significant differences were found between cCBT and wait groups on the CDRS-R (baseline to 5-week mean change -14.7 versus -1.1, p<.001), remission (78% vs. 36%, p = .047) and on the Reynolds Adolescent Depression Scale (-4.6 vs. +3.2 p = .05) but not on other self-rating psychological functioning scales. In intent-to-treat analyses CDRS-R changes and remission remained significant. Gains were maintained at 10-week follow-up. CONCLUSIONS: SPARX appears to be a promising treatment for students with symptoms of depression who are in alternative schooling programmes for those excluded from mainstream education.