A systematic review and narrative synthesis of health literacy interventions among Spanish speaking populations in the United States.

BACKGROUND: While many populations struggle with health literacy, those who speak Spanish preferentially or exclusively, including Hispanic, immigrant, or migrant populations, may face particular barriers, as they navigate a predominantly English-language healthcare system. This population also faces greater morbidity and mortality from treatable chronic diseases, such as hypertension and diabetes. The aim of this systematic review was to describe existing health literacy interventions for patients with a Spanish-language preference and present their effectiveness. METHODS: We carried out a systematic review where Web of Science, EMBASE, and PubMed were queried using MeSH terms to identify relevant literature. Included articles described patients with a Spanish-language preference participating in interventions to improve health literacy levels in the United States. Screening and data abstraction were conducted independently and in pairs. Risk of bias assessments were conducted using validated appraisal tools. RESULTS: A total of 2823 studies were identified, of which 62 met our eligibility criteria. The studies took place in a variety of community and clinical settings and used varied tools for measuring health literacy. Of the interventions, 28 consisted of in-person education and 27 implemented multimedia education, with 89% of studies in each category finding significant results. The remaining seven studies featured multimodal interventions, all of which achieved significant results. CONCLUSION: Successful strategies included the addition of liaison roles, such as promotores (Hispanic community health workers), and the use of multimedia fotonovelas (photo comics) with linguistic and cultural adaptations. In some cases, the external validity of the results was limited. Improving low health literacy in patients with a Spanish-language preference, a population with existing barriers to high quality of care, may help them better navigate health infrastructure and make informed decisions regarding their health. REGISTRATION: PROSPERO (available at https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021257655.t ).

Developing and conducting a language inclusivity assessment on a health science library's website, LibGuides, and signage.

Background: A Diversity, Equity, and Inclusion (DEI) Team at a university health science library created a checklist for inclusive language and conducted an assessment of their library's website, LibGuides, and physical and digital signage. Inclusive language was defined as "language that is free from words, phrases or tones that reflect prejudiced, stereotyped or discriminatory views of particular people or groups". Case Presentation: The 32-item checklist facilitated the identification of gendered language, stereotypes, ableist language, racist language, stigmatizing language, slang, acronyms, and out-of-date terminology regarding physical and mental health conditions. From the library's website, 20 instances were noted for which improvements were necessary. Out of the 130 LibGuides reviewed, 23 LibGuides had no changes needed and 107 had changes identified relating to language inclusivity (14 strongly recommended changes and 116 suggested changes). Regarding the signage, one flyer was removed for reprinting. Conclusion: The checklist enabled the team to implement a number of improvements to the library's website and LibGuides. The checklist has been shared with Library Technology Services and the wider campus libraries' Usability Committee for future use, and has also been added to the DEI Team's LibGuide for use by others outside of the university.

Office-based sedation-free transnasal esophagogastroduodenoscopy with biopsies using single-use gastroscopes: A pediatric single-center experience.

Introduction: Unsedated transnasal endoscopy (TNE) as transnasal esophagoscopy (TN-Eso) has emerged as a promising alternative to esophagogastroduodenoscopy (EGD) under sedation to assess eosinophilic esophagitis (EoE). We report our center's experience using single-use gastroscopes to perform sedation-free transnasal EGD (TN-EGD) with biopsies in an office-based setting. Methods: A retrospective review was performed on patients with eosinophilic esophagitis who underwent office-based sedation-free TNE with topical analgesia and virtual reality (VR) procedural dissociation and distraction. A sterile, single-use, ultra-slim 3.5 mm outer diameter, 110 cm long gastroscope with 2 mm working channel (EvoEndo) was used to perform TNE with biopsies/brushings. Data including demographics, procedure success rate, total visit time, biopsy adequacy, procedure time, procedural preference, and complications were collected. Results: Office-based TNE was completed in 8 patients (six males, age range 11-20 years). The endoscope was advanced by an experienced transoral endoscopist successfully through the nares into stomach (transnasal esophagogastroscopy [TN-EG]) in all subjects (100%) and into the duodenum (TN-EGD) in seven subjects (87.5%). Biopsies were obtained from esophagus in all cases and from the stomach/duodenum in five cases. Histological assessment, esophageal brushing, disaccharidase enzyme analysis, or duodenal aspirate analysis were performed as indicated. EoE reevaluation was the primary indication to perform endoscopy in all patients. Visual and histologic findings were all adequate for assessment. There were no significant adverse events. Conclusion: Office-based TN-EGD with VR procedural distraction and dissociation using single-use gastroscopes was effective to monitor EoE, gastritis, and duodenitis in a pediatric practice.

Professionalism and Safety of DPT Students in First, Full-Time Clinical Experiences: Accelerated Hybrid versus Traditional Programs.

PURPOSE: Doctor of Physical Therapy (DPT) education continues to progress with contemporary content and innovative teaching methods. The purpose of this study was to examine clinical assessment data from the Physical Therapist Clinical Performance Instrument (PT-CPI) focused on professionalism and safety in an initial clinical experience between an accelerated-hybrid and traditional DPT program. METHODS: A retrospective analysis was performed on mid-term and final Safety, Professional Behavior, and Communication PT-CPI scores of each program's first clinical experience. The traditional program served as a control group. A total 186 students were examined: 100 from the traditional program and 86 from the accelerated-hybrid program. RESULTS: There was a significant effect of learning environment on final test scores while controlling for midterm scores in Safety (p < 0.001), Professional Behavior (p < 0.001), and Communication (p < 0.001) with students in the accelerated-hybrid program scoring higher. Each program showed improvements from midterm to final PT-CPI, outperforming the set benchmark score with the accelerated-hybrid program showing larger growth in Communication and Safety. CONCLUSION: Students in both DPT programs display acceptable levels of professionalism and safety according to program benchmarks and demonstrate growth in these areas throughout the clinical experiences despite differences in program design.

The Impact of Virtual Laboratories on Student Clinical Education Preparedness: A Mixed-Method Analysis.

INTRODUCTION: The COVID-19 pandemic saw physical therapist (PT) education programs in 2020 add virtual options to prepare students for hands-on clinical skills. The purpose of this research was to investigate student confidence, preparation, and clinical performance based on their choice of virtual or in-person laboratory immersion. Secondary analysis compared 2020 cohort outcomes with the previous cohort in 2019 (prepandemic). REVIEW OF LITERATURE: Virtual skill acquisition has been studied with support for effectiveness in didactic and psychomotor skill acquisition. The impact on clinical education performance is unknown. SUBJECTS: Student records from an accelerated hybrid, PT education program in 2020 (n = 91) and 2019 (n = 86). METHODS: In this mixed-method observational study, researchers analyzed a Qualtrics survey and the PT Clinical Performance Instrument (CPI) to compare student outcomes. Statistical analyses included chi-square, two-way multivariate analysis of variance (MANOVA), and Mann-Whitney U test. MAXQDA software was used to code student and clinical instructor narrative responses from the CPI related to strengths and areas for further development. RESULTS: All students in 2020 attended laboratory virtually for 9 full days, and 24% of students chose virtual laboratory for the remaining 8.5 days; 97% of students reported feeling confident going into their clinical experience (66% inpatient). No statistically significant differences were found based on instructional method (virtual or in-person) or clinical practice setting (inpatient or outpatient) for confidence, preparation, or CPI performance. Themes of wanting more time to prepare and more confidence in clinical decision making emerged from the qualitative analysis. DISCUSSION AND CONCLUSION: Results indicate no statistically significant difference for virtual versus in-person laboratory and no difference compared with the 2019 cohort. Virtual instruction effectively prepared students for their clinical experiences across all settings. Although an in-person laboratory experience may be preferred, it is possible to deliver effective experiences in a virtual setting without compromising student performance. Further research is needed to confirm findings.