Worth the paper they are printed on? Findings from an independent evaluation of the understandability of patient information leaflets for antiseizure medications.

OBJECTIVE: The Patient Information Leaflet (PIL) is an authoritative document that all people with epilepsy in the EU receive when prescribed antiseizure medication (ASM). We undertook the first independent, comprehensive assessment to determine how understandable they are. Regulators state that when patients are asked comprehension questions about them, ≥80% should answer correctly. Also, recommended is that PILs have a maximum reading requirement of US grade 8. METHODS: Study 1: We obtained 140 current ASM PILs written in English. "Readability" was assessed using four tests, with and without adjustment for influence of familiar, polysyllabic words. A total of 179 online materials on epilepsy were also assessed. Study 2: Two PILs from Study 1 were randomly selected (Pregabalin Focus; Inovelon) and shown to 35 people from the UK epilepsy population. Their comprehension was assessed. Study 3: To understand whether the student population provides an accessible alternative population for future examination of ASM PILs, Study 3 was completed, using the same methods as Study 2, except that participants were 262 UK university students. RESULTS: Study 1: No PIL had a reading level of grade 8. Median was grade 11. Adjusting for context, the PILs were still at grade 10.5. PILs for branded ASMs were most readable. PILs were no more readable than (unregulated) online materials. Study 2: Users struggled to comprehend the PILs' key messages. The eight questions asked about pregabalin were typically answered correctly by 54%. For Inovelon, it was 62%. Study 3: Most student participants comprehended the PILs' key messages. The questions about Inovelon were answered correctly by 90%; for pregabalin it was 86%. SIGNIFICANCE: This is the first independent and comprehensive examination of ASM PILs. It found that PILs being used fail to meet recommendations and regulatory requirements and risk not being understandable to a substantial proportion of users. In finding that people from the epilepsy population differ markedly in comprehension of PILs compared to students, this study highlights the importance of completing user testing with the target population.

Cancer-related fatigue: benefits of information booklets to improve patients' knowledge and empowerment.

PURPOSE: To investigate cancer patients' knowledge and attitudes regarding fatigue and the potential benefits and acceptability of a brief information booklet. METHODS: The CARPE DIEM study assessed knowledge and attitudes regarding fatigue in a diverse group of 50 cancer patients before (T0) and about one (T1) and four months (T2) after reading the booklet. At T1, participants additionally rated its usefulness. RESULTS: At baseline, 37.5% of respondents did not know the term "fatigue" or what it meant. Those who already knew something about fatigue mainly had obtained their information from booklets, books, or articles (63.3%) and/or the internet (46.7%). Overall, knowledge gaps existed, particularly about potential fatigue treatment options and whether fatigue is an indicator of cancer progression. Furthermore, 56.4% felt poorly informed, and 46.1% reported feeling helpless in the face of fatigue. Lower knowledge at baseline was significantly associated with lower education and older age. At T1 and T2, there were significant improvements in several knowledge questions and attitudes. Patient-reported benefits included getting new information about fatigue (91.1%), awareness of not being alone with their problems (89.7%), taking appropriate actions (72.9%), and encouragement to talk about their fatigue with family/friends (55.3%) or with a health professional (52.7%). CONCLUSIONS: Specific gaps were identified in the provision of information and education for cancer patients about fatigue. A low-cost intervention asking to read a brief information booklet was associated with improved knowledge. This could be considered as a first step offered as part of a bundle of further efforts to improve knowledge and care of fatigue.

Practical Advice Regarding the Reliability of the Patient Educational Materials Assessment Tool for Health Educators.

The quality of patient education materials is an important issue for health educators, clinicians, and community health workers. We describe a challenge achieving reliable scores between coders when using the Patient Educational Materials Assessment Tool (PEMAT) to evaluate farmworker health materials in spring 2020. Four coders were unable to achieve reliability after three attempts at coding calibration. Further investigation identified improvements to the PEMAT codebook and evidence of the difficulty of achieving traditional interrater reliability in the form of Krippendorff's alpha. Our solution was to use multiple raters and average ratings to achieve an acceptable score with an intraclass correlation coefficient. Practitioners using the PEMAT to evaluate materials should consider averaging the scores of multiple raters as PEMAT results otherwise may be highly sensitive to who is doing the rating. Not doing so may inadvertently result in the use of suboptimal patient education materials.

Educação em saúde para pacientes submetidos à revascularização miocárdica: validação de história em quadrinhos / Educación en salud para pacientes sometidos a revascularización miocárdica: validación de historieta / Health education for patients undergoing myocardial revascularization: comic book validation

Resumo Objetivo Desenvolver e analisar as evidências de validade de conteúdo de uma tecnologia educacional do tipo história em quadrinhos (HQ) para pacientes submetidos à Cirurgia de Revascularização do Miocárdio (CRM). Métodos Estudo de validação realizado em três etapas. A primeira consistiu na avaliação das necessidades de informações dos pacientes submetidos à CRM; a segunda foi o desenvolvimento de um roteiro para a tecnologia educacional do tipo HQ; e a terceira, a análise das evidências de validade de conteúdo desse roteiro, realizada por seis especialistas, sendo considerado válido quando obtido um Índice de Validade de Conteúdo superior a 80%, sendo, posteriormente, elaborada a HQ por um ilustrador. Resultados Na primeira etapa, 10 pacientes relataram terem necessidades de informações sobre alimentação, consumo de bebidas alcoólicas, controle da ansiedade e do estresse, controle da dor, cuidados com a ferida operatória, tabagismo, atividade física, relação sexual, retorno ao trabalho, liberação para viagens e direção de automóveis. Com base nesses dados, elaborou-se, a partir de revisão de literatura, a história fictícia de um paciente submetido à cirurgia de revascularização do miocárdio, com as respectivas orientações realizadas pela enfermeira. Esse roteiro da HQ foi avaliado pelos especialistas alcançando adequada concordância após a segunda rodada. Após validação, a HQ foi elaborada pelo ilustrador e analisada pelos especialistas. Conclusão A tecnologia educacional do tipo HQ atingiu adequadas evidências de validade de conteúdo pelos especialistas, podendo ser utilizada como uma das estratégias na orientação da alta hospitalar.

Resumen Objetivo Desarrollar y analizar las evidencias de validez de contenido de una tecnología educativa del tipo historieta para pacientes sometidos a cirugía de revascularización del miocardio (CRM). Métodos Estudio de validación realizado en tres etapas. La primera consistió en la evaluación de las necesidades de información de los pacientes sometidos a CRM; la segunda fue el desarrollo de un guion para la tecnología educativa del tipo historieta, y la tercera fue el análisis de las evidencias de validez de contenido de ese guion, realizada por seis especialistas, donde fue considerado válido un Índice de Validez de Contenido superior al 80 %, y luego un ilustrador elaboró la historieta. Resultados En la primera etapa, 10 pacientes mencionaron la necesidad de obtener información sobre alimentación, consumo de bebidas alcohólicas, control de la ansiedad y del estrés, control del dolor, cuidados de la herida quirúrgica, tabaquismo, actividad física, relación sexual, vuelta al trabajo, autorización para viajar y para conducir vehículos. Con base en estos datos y a partir de la revisión de literatura, se elaboró la historia ficticia de un paciente sometido a una cirugía de revascularización del miocardio, con las respectivas orientaciones realizadas por una enfermera. El guion de la historieta fue evaluado por los especialistas y obtuvo una concordancia adecuada luego de la segunda ronda. Después de la validación, el ilustrador elaboró la historieta y los especialistas la analizaron. Conclusión La tecnología educativa de tipo historieta alcanzó evidencias de validez de contenido adecuadas por los especialistas y puede ser utilizada como una de las estrategias para la orientación en el alta hospitalaria.

Abstract Objective To develop and analyze the evidence of content validity of a comic book-type educational technology for patients undergoing Coronary Artery Bypass Graft surgery (CABG). Methods Validation study conducted in three steps. The first consisted of assessing the information needs of patients undergoing CABG; the second was the development of a comic book-type educational technology script; and the third, was the analysis of the evidence of content validity of this script performed by six experts. It was considered valid when a Content Validity Index above 80% was obtained. Subsequently, the comic book was designed by an illustrator. Results In the first step, ten patients reported needing information about food, alcohol consumption, anxiety and stress control, pain control, surgical wound care, smoking, physical activity, sexual intercourse, returning to work and clearance to travel and drive. Based on these data, a fictitious history of a patient undergoing coronary artery bypass graft surgery was developed from a literature review, with the respective instructions given by the nurse. This comic book script was evaluated by the experts, reaching adequate agreement after the second round. After validation, the comic book was designed by the illustrator and analyzed by the experts. Conclusion The educational technology of the comic book-type reached adequate evidence of content validity by the experts, and can be used as one of the strategies in guidance of hospital discharge.

Changing Hearts and Plates: The Effect of Animal-Advocacy Pamphlets on Meat Consumption.

Social movements have driven large shifts in public attitudes and values, from anti-slavery to marriage equality. A central component of these movements is moral persuasion. We conduct a randomized-controlled trial of pro-vegan animal-welfare pamphlets at a college campus. We observe the effect on meat consumption using an individual-level panel data set of approximately 200,000 meals. Our baseline regression results, spanning two academic years, indicate that the pamphlet had no statistically significant long-term aggregate effects. However, as we disaggregate by gender and time, we find small statistically significant effects within the semester of the intervention: a 2.4 percentage-point reduction in poultry and fish for men and a 1.6 percentage-point reduction in beef for women. The effects disappear after 2 months. We merge food purchase data with survey responses to examine mechanisms. Those participants who (i) self-identified as vegetarian, (ii) reported thinking more about the treatment of animals or (iii) expressed a willingness to make big lifestyle changes reduced meat consumption during the semester of the intervention. Though we find significant effects on some subsamples in the short term, we can reject all but small treatment effects in the aggregate.

Decision aid for women with newly diagnosed breast cancer seeking breast reconstruction surgery: A prospective, randomized, controlled, single-blinded, pilot study.

BACKGROUND: Women undergoing immediate breast reconstruction for breast cancer often experience anxiety when faced with reconstruction and the type of reconstruction to choose. The purpose of this study is to analyze the impact of a decision aid on decisional conflict in women with newly diagnosed breast cancer seeking breast reconstruction. METHODS: Newly diagnosed breast cancer patients seeking breast reconstruction at a single center were prospectively randomized into two groups. Comparisons were made between two groups using the decisional conflict scale (DCS): women who reviewed the standard educational materials prior to initial consultation (control) and women who reviewed standard materials prior to initial consultation and then reviewed a decision aid brochure at initial consultation and two-week post-consultation (intervention). Pre-to-post-consultation DCS scores were compared within and between the control groups and intervention groups to assess which group had lower DCS scores. RESULTS: A total of 20 patients, mean age 53±9 years were included. Median differences between pre-to-post-consultation DCS total scores in the control and intervention groups lowered from 32 to 22 and 28 to 16, respectively. Significant differences in subscores were control group: uncertainty: 54-21 (p = 0.030), and intervention group: uncertainty: 46-29 (p = 0.036) and values clarity: 29-25(p = 0.042). Pre-to-post-consultation differences between DCS scores and subscores did not demonstrate any statistical significance. CONCLUSION: Decision aids did not significantly reduce pre-operative DCS total scores compared to current educational materials. More educational materials may not always be helpful for patients.

Post-Arthroscopic Rotator Cuff Repair Rehabilitation Booklet: A Patient-Based Evaluation.

BACKGROUND: Lack of physical therapists has led to increment of self-managed rehabilitations in post-arthroscopic rotator cuff repair (ARCR) in the forms of booklets or leaflets. PURPOSE: The aim of study is to investigate 1) the acceptance of post-ARCR patients towards an education booklet, and 2) whether it could be a timesaving and laborsaving tool to physical therapists. METHODS: An education booklet was established through a systematic review. Patients who underwent ARCR in our hospital were included and randomly assigned to the intervention or control group (27 women, 21 men, mean age=57.06 years old). Patients in the intervention group received educational booklets, and an evaluation was also obtained after they finished reading. Patients' understanding of the booklet was determined by asking patients to re-enact training presented in the booklet. Then, a therapist blinded to allocations would personally demonstrate training to patients until patients fully understood the protocol. For the control group, the same therapist coached patients until the whole protocol was clearly understood. The coaching time for patients in both groups was recorded. RESULTS: Out of 48 patients, 24 (50%) were randomly assigned to the intervention group, and 21 (87.50%) completed their questionnaire. Out of these 21 patients, 20 (95.24%) rated the booklet as "excellent and easy to read", and 17 (80.95%) felt that the booklet was helpful. The re-enaction accuracy was for strengthening training and specific training (71.43% and 61.90%, respectively). As compared to the control group, the time of coaching for the patients to fully master the protocol in the intervention group was significantly less (P<0.01). CONCLUSION: Patients highly applauded this booklet, and they cherished the information and support it contained. Nevertheless, the re-enaction accuracy was not high, suggesting that the high level of acceptance does not guarantee full understanding of information sent to patients.

Guessability of U.S. pharmaceutical pictograms in Iranian prospective users.

OBJECTIVE: This study examined the gueassability of US pharmaceutical pictograms as well as associated demographic factors and cognitive design features among Iranian adults. METHODS: A total of 400 participants requested to guess the meaning of 53 US pharmaceutical pictograms using the open-ended method. Moreover, the participants were asked to rate the cognitive design features of each pictorial in terms of familiarity, concreteness, simplicity, meaningfulness and semantic closeness on a scale of 0-100. RESULTS: The average guessability score (standard deviation) was 66.30 (SD=24.59). Fifty-five percent of pharmaceutical pictograms understudy met the correctness criteria of 67% specified by ISO3864, while only 30% reached the criterion level of 85% set by ANSIz535.3. Low literate participants with only primary school education had substantial difficulty in the interpretation of pharmaceutical pictograms compared to those completed higher education levels. Younger adults of <30 years significantly performed better in the interpretation of pharmaceutical pictograms as compared to >31 years old participants. 'Home patient care' and 'daily medication use' had no effect on guessability performance. Concerning cognitive design features, meaningfulness better predict geussability score compared to the others. CONCLUSIONS: Several USP pictograms fail to be correctly interpreted by Iranian users and need to be redesigned respecting cognitive design features. Interface designers are recommended to incorporate more familiar and concrete elements into their graphics in order to create more meaningful pictorial symbols and to avoid any misinterpretation by the user. Much effective medication use is expected to be achieved by means of this approach, through the improvement of the communication property of pharmaceutical pictograms.

Evaluation of a prompt card for community pharmacists performing consultations with patients on anticoagulation - lessons learned.

OBJECTIVES: To evaluate a prompt card (i.e., a post-card sized tool that lists counselling prompt information) with 5 key elements and 3 open key questions to ask patients in community pharmacies. METHODS: Community pharmacists practicing in England and accredited to perform consultations used the prompt card during a formal consultation with emphasis on patients receiving oral anticoagulation. Main outcome measure was the number of performed consultations with pharmacists' thoughts and feedbacks in writing. RESULTS: During 8 weeks, 19 pharmacists (mean age: 36.6 (SD=9) years; 7 women; accredited an average of 12.9 (SD=9.8) years) performed 1,034 consultations and used the prompt card 104 times during anticoagulation consultations. Overall the prompt card was judged practical and relevant by the 16 pharmacists who used it (100%), especially because it outlines what a good consultation should comprise. The key elements offered a logical framework to guide the overall approach when undertaking a consultation. The two questions, "Why do you want to use this medicine?" and "Why would you not want to use this medicine?" generated negative responses from the patient and pharmacists, respectively. CONCLUSIONS: Our prompt card with key questions summarizing all the points that should be addressed in a consultation supported effective communication during patient-pharmacist interaction. Two questions need rephrasing and a further question is needed to determine how patients are using their medicines.

Developing and validating an educational brochure to promote breastfeeding and the infant's complementary food / Construção e validação de folheto educativo para promoção do aleitamento materno e alimentação complementar do lactente

Abstract Objectives: to describe the stages of developing and validating two educational brochures to promote breastfeeding and the infant's complementary food. Methods: an observational descriptive study was performed with eight health professionals and 60 caregiver of children under two years old divided into two groups of 30 (one for each brochure) in a Pediatric Outpatient Clinic at a Maternal and Child Reference Hospital. The research was developed in four stages: bibliographical survey, development of the brochures, validation by specialists and target audience and adequacy of the materials. The validation method used was the Índice de Validade de Conteúdo (Content Validity Index) calculation. Results: two nutritional orientation brochures for infants were developed. Experts validated the breastfeeding brochure on its relevance and the brochure on complementary food regarding its relevance and goal. The other items were validated after suggested modifications. In relation to the target audience, the concordance index found in brochures 1 and 2 was higher than 75%. The Índice de Validade de Conteúdo Global (Global Content Validity Index) of the materials was greater than 0.78. Conclusions: regarding its appearance and content after the adjustments, the brochures were considered valid by the experts and the representatives of the target audience.

Resumo Objetivos: descrever as etapas de construção e validação de dois folhetos educativos para promoção do aleitamento materno e alimentação complementar do lactente. Métodos: foi realizado um estudo observacional descritivo com oito profissionais de saúde e 60 cuidadores de crianças menores de dois anos divididos em dois grupos de 30 (um para cada folheto) em um Ambulatório de Pediatria de um Hospital de Referência Materno-Infantil. A pesquisa foi desenvolvida em quatro etapas: levantamento bibliográfico, construção dos folhetos, validação pelos especialistas e público-alvo e adequação dos materiais. O método de validação utilizado foi o cálculo do Índice de Validade de Conteúdo. Resultados: foram elaborados dois folhetos de orientação nutricional para lactentes. O Índice de Validade de Conteúdo obtido pelos especialistas validou o folheto sobre aleitamento materno quanto à relevância e o folheto sobre alimentação complementar quanto à relevância e objetivo. Os outros itens receberam validação, após modificações sugeridas. Em relação ao público-alvo, o índice de concordância encontrado do folheto 1 e 2 foi superior a 75%. O Índice de Validade de Conteúdo Global dos materiais foi superior a 0,78. Conclusões: os folhetos foram considerados validados quanto à aparência e conteúdo pelos especialistas e representantes do público-alvo, após a adequação dos materiais.

Preferences for the Provision of Smoking Cessation Education Among Cancer Patients.

Many individuals who use tobacco will continue to smoke after a cancer diagnosis and throughout treatment. This study aims to better understand cancer patient preferences to learn about smoking cessation. All new patients seen at Princess Margaret Cancer Centre between 1 January 2014 and 30 June 2015 were asked to complete the Combined Tobacco History Survey as part of standard new patient assessments. Smoking status, second hand smoke exposure, years smoked, family support, cessation preferences, demographic and tumour details were collected. Multivariable regression assessed factors associated with smoking cessation educational preferences. Nine thousand and one hundred ten patients completed the survey. One thousand and six hundred ninety-one were current smokers (17 %) of which 43 % were female and median age was 57 years (range 18-95). One thousand and two hundred thirty-eight (73 %) were willing to consider quitting and 953 (56 %) reported a readiness to quit next month. Patients were most interested in pamphlets (45 %) followed by telephone support (39 %), speaking with a healthcare professional (29 %), website (15 %), support group (11 %) and speaking with successful former smokers (9 %). Younger patients (≤45 years) preferred receiving smoking cessation education over the telephone (50 %; p < 0.001), while older patients (46-65 years and >65 years) preferred smoking education to be provided in pamphlets (43 and 51 %, respectively; p = 0.07). In multivariable analyses, older patients were more likely to prefer pamphlets than younger patients OR 1.11 (95 % CI 1.01-1.23; p = 0.03). Older cancer patients preferred to receive smoking cessation education through pamphlets and younger patients preferred the telephone. Tailored provision of cessation education resources for cancer patients is warranted.

DOES HANDING OUT LEAFLETS TO PATIENTS AT REGISTRATION INCREASE DIABETES

Background: Among Singaporeans with diabetes, 1 in 3have not been diagnosed. A large proportion ofSingaporean adults are not current for theirrecommended diabetic screening.Objective: To determine whether handing out diabetesscreening leaflets to patients at the point of registrationin a general practice (GP) clinic would influence theiruptake of diabetes screening.Design: A randomized controlled trial with a follow-upperiod of 3 months. Outcome measured was whetherpatients did the diabetes screening test (fasting plasmaglucose).Intervention: A leaflet on diabetes screening was givento patients when they registered in the GP clinic. Thecontrol group did not receive a leaflet.Setting: A GP clinic in Toa Payoh, a suburb in centralSingapore.Participants: 97 patients 40 years old and above whowere not known diabetics.Results: There was no significant difference in theuptake of diabetes screenings between the interventionand the control group (p=0.740).Conclusion: Handing out leaflets at registration in theGP clinic does not change uptake of diabetes screening.

Effects of Radiation Safety Management Education with the Use of a Booklet for Intensive Care Unit Nurses / 중환자간호학회지

PURPOSE: This study investigated the effects that the use of a booklet for intensive care unit nurses had on radiation safety management education (knowledge about and behaviors in radiation safety management, and awareness of anxiety caused by radiation hazards).METHODS: A randomized control group pretest-posttest design was used. A booklet about radiation safety management developed by the authors was used as educational material. Participants (N=42) were intensive care unit nurses of P hospital in B city. Training was provided to the experimental group (N=21). Knowledge about and behaviors in radiation safety management and awareness of anxiety caused by radiation hazards were measured by questionnaires before and after the intervention. Data was analyzed by an χ2-test, non-paired t-test, and paired t-test.RESULTS: There was a significant difference between groups in knowledge of (t=-14.932, p < .001) and behaviors in (t=-8.297, p < .001) radiation safety management and awareness of anxiety caused by radiation hazards (t=9.378, p < .001).CONCLUSION: The levels of knowledge about and behaviors in radiation safety management and awareness of anxiety generated by radiation hazards of intensive care unit nurses increased after receiving one session of radiation safety management education using the booklet. Therefore, providing radiation safety management training is suggested as an effective strategy for improving radiation safety management.

Development and Validation of Educational Leaflet for Caregivers of Preterm Infants.

INTRODUCTION: Facilitation of child development is usually emphasized in the form of early intervention classes and practical demonstrations. However, non-adherence to home program for such interventions has been reported due to various reasons. AIM: To develop and validate an educational leaflet as a supplement guide for caregivers to promote better development of their child during 4-6 months of age. MATERIALS AND METHODS: An in-depth literature review and focus group discussion with the experts was conducted to formulate the content of leaflet. Initial framework consisted of introduction, main text with pictorial representation and instructions about facilitation of various milestones, do's-don'ts and disclaimer. Validation was done through a questionnaire consisting of 9 questions pertaining to completeness, understandability, legibility, clarity and utility of educational material for caregivers and a section for comments. Leaflet with enclosed questionnaire was distributed to 14 validators (2 neonatologists, 4 paediatricians and 8 physiotherapists), along with a covering letter stating the purpose and relevance of this educational material, and the importance of their participation in validation process. Scoring was done on 5 point Likert scale for each item in the material. RESULTS: Responses from the 14 evaluators were collected and analysed. Item level content validity index (I-CVI) was calculated for individual items which ranged from 0.73 - 1. Scale level Content Validity Index (S-CVI) was calculated for complete nine items and it was found to be 0.91. Validators expressed their views to include a column on normal milestones across 4-6 months of age and also to highlight the significance of performing each activity mentioned in the leaflet. These suggestions were incorporated in consensus with the subject experts and the final draft was made. CONCLUSION: Educational leaflet for caregivers of 4-6 months preterm infants has been developed and validated. It can be provided as a supplement guide to the caregivers to facilitate better development of their child.

Conhecimentos e práticas sobre saúde bucal da equipe de nefrologia, de crianças e adolescente / Oral health knowledge and practices of the nephrology team of children and adolescents

Os objetivos deste estudo foram: (1) avaliar a condição bucal de crianças e adolescentes com IRC e o conhecimento sobre saúde bucal desses pacientes, seus responsáveis e da equipe de nefrologia (Fase 1); elaborar e validar um folheto com instruções de saúde bucal para crianças e adolescentes com IRC (Fase 2); realizar um estudo piloto a fim de observar a influência do folheto no nível de conhecimento e nos índices de placa bacteriana e sangramento gengival desses pacientes (Fase 3). O trabalho foi realizado nos dois centros de referência de Nefrologia Pediátrica da cidade do Rio de Janeiro e na clínica de Odontopediatria da Universidade Federal do Rio de Janeiro (UFRJ). Para a Fase 1, o conhecimento de 30 pacientes pediátricos e dos seus responsáveis foi obtido através de entrevistas com roteiro pré-estruturado. Para 80 profissionais de saúde, um questionário com perguntas abertas e fechadas foi utilizado. Os resultados mostraram que os pacientes apresentam um baixo nível de conhecimento em relação à saúde bucal e elevados índices periodontais (biofilme, sangramento gengival e cálculo). Os profissionais de saúde apresentam um nível de conhecimento suficiente porém não repassam essas informações aos pacientes. Os responsáveis apresentam algum nível conhecimento, porém precisam ser melhores informados sobre saúde bucal. Na Fase 2, o folheto foi elaborado com base na literatura científica e nos resultados obtidos na Fase 1. A validação foi realizada em 4 etapas em que participaram especialistas, mestres e doutores em Odontopediatria, profissionais da área da educação, crianças e adolescentes sem IRC e pacientes pediátricos com IRC e seus responsáveis. As sugestões foram analisadas e aquelas consideradas pertinentes foram incorporadas. A validação foi importante para melhorar o conteúdo e a organização do material informativo. Na fase 3, para a verificar a eficácia do folheto, foram estabelecidos dois parâmetros de avaliação: dados clínicos (índice de biofilme e sangramento) e avaliação do conhecimento (entrevista com questionários pré estruturados). Após a coleta inicial dos dados, 30 pacientes foram convidados a comparecer na UFRJ para realização da raspagem de cálculo e leitura do folheto. Depois de um mês, todos os parâmetros foram reavaliados em 10 pacientes. Os resultados finais mostraram que os índices de biofilme e sangramento diminuíram significativamente (p˂0.05) e o nível de conhecimento sobre saúde bucal aumentou. Conclui-se que crianças e adolescentes com IRC e seus responsáveis precisam ser mais informados sobre os cuidados com a saúde bucal, e que a equipe de nefrologia precisa atuar mais nesse processo de orientação. O folheto pode ser uma opção para informar essa população e estimular o autocuidado em favor da saúde bucal. (AU)

The objectives of this study are: (1) assess the oral status of pediatric patients undergoing hemodialysis and their level of knowledge, of their caregivers and of the health care team about the relationship between oral health and Chronic Kidney Disease (CKD) (Stage 1); (2) develop and validate a pamphlet with oral health instruction for children and adolescents with CKD (Stage 2); (3) and perform a pilot study in order to observe the influence of the pamphlet at the level of knowledge and periodontal plaque and gingival bleeding of these patients (Stage 3). The study was conducted in reference centers of pediatric nephrology in the city of Rio de Janeiro, Brazil. On Stage 1, the knowledge of caregivers and pediatric patients was obtained using a pre-prepared interview, while for the health professionals, a self-administered questionnaire was used. The results showed that children and adolescents had a low level of knowledge and increased periodontal indexes. The health professionals had a sufficient level of knowledge in relation to oral health; however, they did not pass this information on to patients. The caregivers had a certain level of knowledge; however, they need to be better informed. At Stage 2, the elaboration of the pamphlet was based on specific scientific literature of the area and based on the results of Stage 1. Validation was carried out in 4 steps which involved professors and researchers in the field of Pediatric Dentistry and renal diseases, educational professionals, children/adolescents without CKD and children/adolescents with CKD and their caregivers. The suggestions were analyzed and those considered relevant to the study were incorporated. The validation process was considered important to enhance the content and organization of the pamphlet. At Stage 3, to verify the effectiveness of the pamphlet were established two evaluation parameters: clinical data (biofilm and gingival bleeding indexes) and level of oral health knowledge (interview with pre-structured questionnaires). After the initial data collection, 30 patients were invited to go to a dentist appointment in UFRJ to perform the dental calculus removal and read the pamphlet. After a month, all parameters were assessed in 10 patients. The final results show that the biofilm and gingival bleeding indexes rates decreased significantly (p˂0.05) and the level of knowledge about oral health has increased. We conclude that children and adolescents with CKD and their parents need to be more informed about the oral care, and the nephrology team needs to work more in this orientation process. The pamphlet can be an option to report this population and encourage their self-care in favor of oral health. (AU)

A literatura de cordel como instrumento didático-pedagógico na educação, motivação e promoção da saúde bucal / The cordel (folk literature) as pedagogical-didactic tool in education, motivation and promotion of the oral health

Introdução: A Literatura de Cordel configura-se, desde sua chegada de Portugal na era colonial, até os dias atuais no Brasil, em uma ferramenta comunicativa e interativa que tenta perpetuar a cultura folclórica. Objetivo: Analisar a efetividade do cordel como estratégia pedagógica na aprendizagem em saúde bucal. Metodologia: Utilizou-se um questionário autoaplicável para sondagem dos conhecimentos prévios de escolares de 8 a 13 anos socialmente desfavorecidos, matriculados numa instituição pública de ensino de Natal-RN sobre saúde bucal e uma entrevista aberta com duas perguntas geradoras. A partir dos conhecimentos emergentes, foram confeccionados cinco cordéis. Fez-se um recital durante cinco dias e após este, foi reaplicado o mesmo questionário para aferir se os conhecimentos prévios foram acrescidos ou modificados após a intervenção. Resultados: A diferença entre os acertos do antes e após a intervenção foi avaliada pelo Teste de Wilcoxon para um nível de confiança de 95%. A mediana do nível de acertos foi significativa passando de 5,00 (antes) para 8,50 (após) para um valor de p<0,001. Conclusão: O cordel mostrou-se efetivo enquanto estratégia pedagógica criativa e dinâmica, na divulgação de conhecimentos, motivação, educação e promoção da saúde bucal (AU).

Introduction: The "CORDEL (Folk Literature)" configures itself, since its arrived from Portugal in the colonial era, to the present day in Brazil in a communicative and interactive tool that tries to perpetuate the folk culture. Objective: To analyze the effectiveness of the string as a pedagogical strategy in oral health learning. Methods: We used a self-administered questionnaire survey of school of previous knowledge about 9 to 14 years socially disadvantaged, enrolled in a public institution of Natal-RN ducation on oral health and an open interview with two generating questions. From the emerging knowledge were made five twine. There was a recital for five days after it was re-applied the same questionnaire to assess whether the prior knowledge were added or modified after the intervention. Results: The difference between the correct answers before and after the intervention was evaluated by Wilcoxon test for a 95% confidence level. The median level was significant hit going from 5.00 (before) to 8.50 (after) to a value of p <0.001. Conclusion: The "Cordel" was effective as a creative and dynamic teaching strategy, dissemination of knowledge, motivation, education and promotion of oral health.in the colonial age, in an interactive and communicative tool that tries to perpetuate the folk culture (AU).

'Causes of causes': ethnicity and social position as determinants of health inequality in Irish Traveller men.

This study sought to engage Traveller men in a discussion about their lives, their health and key determinants of their health, with a view to engaging Traveller men in health promotion initiatives. Irish Travellers are an indigenous ethnic minority, constituting 0.8% of the population. As a marginalized group, they experience significantly poorer health status than their counterparts in the settled community. Traveller men have 3.7 times the mortality of the males in the general population. Travellers are identified as a hard-to-reach group and Traveller men particularly so. Traveller men have rarely participated in the research studies on health and health service utilization, and the results of this study, in which Traveller men participated in three focus groups, are therefore of particular interest. The Traveller men, in discussing health, related it to the absence of specific illnesses and conditions, expressing a negative and a physical concept of health. The results of the study provide evidence for the role of social constructions of masculinity in determining the health and help-seeking behaviour of Traveller men, but also the influence of wider social determinants such as ethnicity and social status. The futility of approaches to health promotion that comprise simplistic health information/education interventions is outlined in this context. The study presents a challenge to both address hegemonic versions of masculinity and discrimination based on ethnic status, and rather than challenge the behaviour of men or of health services that they come into contact with, to changing the conditions of Traveller men's lives.

Health rights pamphlets: critical literacy and inclusive citizenship, South Africa.

The Ottawa Charter recognizes the importance of strengthening community action for health and developing personal skills. At the same time, a rights-based approach to health includes the right to information, participation and accountability. The Learning Network for Health and Human Rights is a research and learning collaboration between Civil Society Organisations (CSOs) and universities in the Western Cape, South Africa. For the purposes of this article, a CSO is understood to be any organization that is outside of the state and private market sector. As part of a wider programme of action research, the learning network developed six pamphlets aimed at enhancing individual and collective skills to support action related to the implementation of the right to health. The research reported here analyses how the pamphlets, coupled with directed training, strengthened skills, promoted critical literacy and supported inclusive citizenship. Eighteen semi-structured interviews and eight focus groups were conducted with 59 participants from eight CSOs, their members, beneficiaries and communities. The success of the pamphlets was found to be attributed to the role they played in a wider training programme, requested by the CSOs and developed jointly by CSOs and university-based researchers. Community action on the right to health is contingent on personal as well as collective skills development. Understanding of the right to health and skills for participation and accountability were extended in breadth and depth, which enabled inclusive citizenship.

Randomized controlled pilot study of customized pamphlets to promote physical activity and symptom self-management in women with multiple sclerosis.

OBJECTIVE: Investigate the feasibility and potential efficacy of a customized print-based intervention to promote physical activity and symptom self-management in women with multiple sclerosis. DESIGN: A randomly allocated two-group repeated measures design, with a delayed-treatment contact group serving as the control. Participants were randomized to receive the intervention immediately (n =14) or receive it at week 12 (n =16). Outcome measures were administered at weeks 1, 12, and 24. SETTING: Community-based in metropolitan area. SUBJECTS: Thirty women with multiple sclerosis. INTERVENTION: Prescribing a home-exercise program and following up with customized pamphlets, which are matched to participants' stage of readiness to change physical activity behavior and physical activity barriers (e.g. encouraging self-management of symptoms). MAIN MEASURES: Physical Activity and Disability Survey-revised, Godin Leisure-Time Exercise Questionnaire, SF-12, Symptoms of Multiple Sclerosis Scale, and 6-minute walk test. RESULTS: Intent-to-treat analyses using mixed multivariate analysis of variance (MANOVA) were conducted on (1) physical activity levels and (2) health and function outcomes. The mixed MANOVAs for physical activity levels and health and function outcomes indicated significant improvements in the immediate group compared with the delayed group (i.e. condition by time interaction was significant, Wilks' λ = 0.59, F(2, 27) = 9.31, P = 0.001 and Wilks' λ = 0.70, F(4, 25) = 2.72, P = 0.052, respectively). The intervention had moderate to large effect sizes in improving physical activity levels (d = 0.63 to 0.89), perceptions of physical function (d = 0.63), and 6-minute walk test (d=0.86). CONCLUSION: This pilot study indicates that a customized print-based intervention shows promise in improving physical activity levels and health and function in women with multiple sclerosis.