Participant satisfaction with appearance-based versus health-based educational videos promoting sunscreen use: a randomized controlled trial.

BACKGROUND: Increasing participant satisfaction with health interventions can improve compliance with recommended health behaviors and lead to better health outcomes. However, factors that influence participant satisfaction have not been well studied in dermatology-specific behavioral health interventions. We sought to assess participant satisfaction of either an appearance-based educational video or a health-based educational video promoting sunscreen use along dimensions of usefulness of educational content, message appeal, and presentation quality. METHODS: In a randomized controlled trial, participants were randomized 1:1 to view an appearance-based video or a health-based video. After six weeks, participant satisfaction with the educational videos was assessed. RESULTS: Fifty high school students were enrolled and completed the study. Participant satisfaction ratings were assessed using a pre-tested 10-point assessment scale. The participants rated the usefulness of the appearance-based video (8.1 ± 1.2) significantly higher than the health-based video (6.4 ± 1.4, p<0.001). The message appeal of the appearance-based video (8.3 ± 1.0) was also significantly higher than the health-based video (6.6 ± 1.6, p<0.001). The presentation quality rating was similar between the appearance-based video (7.8 ± 1.3) and the health-based video (8.1 ± 1.3), p=0.676. CONCLUSIONS: Adolescents rated the appearance-based video higher than the health-based video in terms of usefulness of educational content and message appeal.

Effect of appearance-based education compared with health-based education on sunscreen use and knowledge: a randomized controlled trial.

BACKGROUND: Appearance-based education shows promise in promoting sunscreen use although resource-intensive methods used in prior studies preclude wide dissemination. Appearance-based video education can be made easily accessible. OBJECTIVE: We sought to compare the effectiveness of appearance-based video education with that of health-based video education in improving sunscreen use and knowledge. DESIGN: In a randomized controlled trial, participants viewed either an appearance-based video on ultraviolet-induced premature aging or a health-based video emphasizing ultraviolet exposure and skin cancer risk. RESULTS: Fifty high-school students participated in the study, conducted from February through March 2012. The health-based group had a nonstatistically significant increase in sunscreen use (0.9 ± 1.9 d/wk, P = .096), whereas the appearance-based group demonstrated a statistically significant increase in sunscreen use (2.8 ± 2.2, P < .001). Between-group comparisons revealed that the appearance-based group applied sunscreen at significantly greater frequencies compared with the health-based group (2.2 ± 1.4 vs 0.2 ± 0.6, P < .001). Knowledge scores significantly improved in both study groups. The difference in knowledge scores between the study groups was not significant. LIMITATIONS: The study population may not reflect the general population. CONCLUSION: Appearance-based video education appears to be effective in promoting sunscreen use and knowledge in adolescents.

Videos to influence: a systematic review of effectiveness of video-based education in modifying health behaviors.

This systematic review examines the effectiveness of videos in modifying health behaviors. We searched PubMed (1975-2012), PsycINFO (1975-2012), EMBASE (1975-2012), and CINAHL (1983-2012) for controlled clinical trials that examined the effectiveness of video interventions in changing health behaviors. Twenty-eight studies comprised of 12,703 subjects were included in the systematic review. Video interventions were variably effective for modifying health behaviors depending on the target behaviors to be influenced. Video interventions appear to be effective in breast self-examination, prostate cancer screening, sunscreen adherence, self-care in patients with heart failure, HIV testing, treatment adherence, and female condom use. However, videos have not shown to be effective in influencing addiction behaviors when they are not tailored. Compared to loss-framing, gain-framed messages may be more effective in promoting certain types of health behavior change. Also, video modeling may facilitate learning of new behaviors and can be an important consideration in future video interventions.

Behavioral and psychosocial responses to genomic testing for colorectal cancer risk.

We conducted a translational genomic pilot study to evaluate the impact of genomic information related to colorectal cancer (CRC) risk on psychosocial, behavioral and communication outcomes. In 47 primary care participants, 96% opted for testing of three single nucleotide polymorphisms (SNPs) related to CRC risk. Participants averaged 2.5 of 6 possible SNP risk alleles (10% lifetime risk). At 3-months, participants did not report significant increases in cancer worry/distress; over half reported physical activity and dietary changes. SNP risk scores were unrelated to behavior change at 3-months. Many participants (64%) shared their SNP results, including 28% who shared results with a physician. In this pilot, genomic risk education, including discussion of other risk factors, appeared to impact patients' health behaviors, regardless of the level of SNP risk. Future work can compare risk education with and without SNP results to evaluate if SNP information adds value to existing approaches.

"Is it really worth it to get tested?": primary care patients' impressions of predictive SNP testing for colon cancer.

Despite significant progress in genomics research over the past decade, we remain years away from the integration of genomics into routine clinical care. As an initial step toward the implementation of genomic-based medicine, we explored primary care patients' ideas about genomic testing for common complex diseases to help develop future patient education materials and interventions to communicate genomic risk information. We conducted a mixed-methods study with participants from a large primary care clinic. Within four focus groups, we used a semi-structured discussion guide and administered brief pre- and post- discussion quantitative surveys to assess participants' interest, attitudes, and preferences related to testing and receipt of test results. Prior to the discussion, moderators presented a plain-language explanation of DNA and genetics, defined "SNP", and highlighted what is known and unknown about the risks associated with testing for SNPs related to colorectal cancer risk. We used the NVIVO 8 software package to analyze the transcripts from the focus group discussions. The majority of participants (75 %) were "very" or "somewhat interested" in receiving information from a colon cancer SNP test, even after learning about and discussing the small and still clinically uncertain change in risk conferred by SNPs. Reported interest in testing was related to degree of risk conferred, personal risk factors, family history, possible implications for managing health /disease prevention and curiosity about genetic results. Most people (85 %) preferred that genetic information be delivered in person by a healthcare or genetics professional rather than through print materials or a computer. These findings suggest that patients may look to genetic counselors, physicians or other healthcare professionals as gatekeepers of predictive genomic risk information.

The development of a web- and a print-based decision aid for prostate cancer screening.

BACKGROUND: Whether early detection and treatment of prostate cancer (PCa) will reduce disease-related mortality remains uncertain. As a result, tools are needed to facilitate informed decision making. While there have been several decision aids (DAs) developed and tested, very few have included an exercise to help men clarify their values and preferences about PCa screening. Further, only one DA has utilized an interactive web-based format, which allows for an expansion and customization of the material. We describe the development of two DAs, a booklet and an interactive website, each with a values clarification component and designed for use in diverse settings. METHODS: We conducted two feasibility studies to assess men's (45-70 years) Internet access and their willingness to use a web- vs. a print-based tool. The booklet was adapted from two previous versions evaluated in randomized controlled trials (RCTs) and the website was created to closely match the content of the revised booklet. Usability testing was conducted to obtain feedback regarding draft versions of the materials. The tools were also reviewed by a plain language expert and the interdisciplinary research team. Feedback on the content and presentation led to iterative modifications of the tools. RESULTS: The feasibility studies confirmed that the Internet was a viable medium, as the majority of men used a computer, had access to the Internet, and Internet use increased over time. Feedback from the usability testing on the length, presentation, and content of the materials was incorporated into the final versions of the booklet and website. Both the feasibility studies and the usability testing highlighted the need to address men's informed decision making regarding screening. CONCLUSIONS: Informed decision making for PCa screening is crucial at present and may be important for some time, particularly if a definitive recommendation either for or against screening does not emerge from ongoing prostate cancer screening trials. We have detailed our efforts at developing print- and web-based DAs to assist men in determining how to best meet their PCa screening preferences. Following completion of our ongoing RCT designed to test these materials, our goal will be to develop a dissemination project for the more effective tool. TRIAL REGISTRATION: NCT00623090.

Group for Research and Assessment of Psoriasis and Psoriatic Arthritis 2015 Treatment Recommendations for Psoriatic Arthritis.

OBJECTIVE: To update the 2009 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations for the spectrum of manifestations affecting patients with psoriatic arthritis (PsA). METHODS: GRAPPA rheumatologists, dermatologists, and PsA patients drafted overarching principles for the management of PsA, based on consensus achieved at face-to-face meetings and via online surveys. We conducted literature reviews regarding treatment for the key domains of PsA (arthritis, spondylitis, enthesitis, dactylitis, skin disease, and nail disease) and convened a new group to identify pertinent comorbidities and their effect on treatment. Finally, we drafted treatment recommendations for each of the clinical manifestations and assessed the level of agreement for the overarching principles and treatment recommendations among GRAPPA members, using an online questionnaire. RESULTS: Six overarching principles had ≥80% agreement among both health care professionals (n = 135) and patient research partners (n = 10). We developed treatment recommendations and a schema incorporating these principles for arthritis, spondylitis, enthesitis, dactylitis, skin disease, nail disease, and comorbidities in the setting of PsA, using the Grading of Recommendations, Assessment, Development and Evaluation process. Agreement of >80% was reached for approval of the individual recommendations and the overall schema. CONCLUSION: We present overarching principles and updated treatment recommendations for the key manifestations of PsA, including related comorbidities, based on a literature review and consensus of GRAPPA members (rheumatologists, dermatologists, other health care providers, and patient research partners). Further updates are anticipated as the therapeutic landscape in PsA evolves.

Comparing the effectiveness of automated online counseling to standard web-based education on improving acne knowledge: a randomized controlled trial.

BACKGROUND: Evidence regarding what comprises effective education for acne vulgaris patients is lacking. Internet-based education may improve patient knowledge of this condition. OBJECTIVES: Our objective was to compare the effectiveness of standard web-based education and an automated counseling website in improving acne knowledge. DESIGN: In a randomized trial, participants visited either a standard website or an automated counseling website to learn about acne. Multiple-choice questions were administered at baseline and after 12 weeks to assess change in acne knowledge. RESULTS: A total of 97 high school students were enrolled, and 95 completed the study. The standard website group had a significant increase in knowledge from baseline (3.61 ± 1.22) to 12-week follow-up (5.46 ± 1.31, p < 0.001). Similarly, the automated counseling website group had a significant increase in knowledge between both time points (3.53 ± 1.50 vs. 6.49 ± 1.06, p < 0.001). After 12 weeks, mean improvement in knowledge was higher in the automated counseling group (2.96 ± 1.85) than in the standard website group (1.85 ± 1.46, d = 0.67, p = 0.002). The number of website visits was positively correlated with improvement in knowledge in both groups. Finally, the automated counseling website group rated their educational material more useful (p = 0.004) and more enjoyable to view (p = 0.003) than did the standard website group. LIMITATIONS: This study is limited to adolescents with mild-to-moderate acne vulgaris. CONCLUSION: Internet-based patient education appears to be an effective method of improving acne knowledge among adolescents.

Polyphenols as novel treatment options for dermatological diseases: A systematic review of clinical trials.

BACKGROUND: Polyphenol phytochemicals demonstrate biological properties in vitro and in vivo that have led to the development of novel treatments for certain dermatological conditions. OBJECTIVE: We sought to provide clinicians with an overview of clinical trials evaluating the effectiveness of polyphenol-based therapies and highlight novel treatments and the evidence available supporting their use. METHODS: PubMed and Embase databases were systematically searched to 4 July 2014. Two independent reviewers reviewed published abstracts for inclusion. References were also manually searched for relevant studies. Data were extracted independently from eligible studies and discrepancies were adjudicated by consensus. RESULTS: Our search yielded 356 unique abstracts, of which 17 studies met inclusion and exclusion criteria. Polyphenols were used in topical and oral forms. High-quality evidence suggests that green tea polyphenols may be effective in treating anogenital warts. Limited available evidence indicates that polyphenols may also benefit patients with alopecia, acne vulgaris, fungal infections, hyperpigmentation or photoaged skin. CONCLUSIONS AND RELEVANCE: Evidence-based knowledge regarding the effectiveness, indications and side effects of polyphenol-based phytochemicals is needed as their clinical use increases within dermatology. We qualitatively conclude that polyphenols may be effective in treating certain dermatological conditions. Additional rigorously conducted clinical trials are needed to further evaluate efficacy.

Effect of Automated Online Counseling on Clinical Outcomes and Quality of Life Among Adolescents With Acne Vulgaris: A Randomized Clinical Trial.

IMPORTANCE: Effective patient education is necessary for treating patients with acne vulgaris. Automated online counseling simulates face-to-face encounters and may be a useful tool to deliver education. OBJECTIVE: To compare the effectiveness of a standard educational website with that of an automated-counseling website in improving clinical outcomes and quality of life among adolescents with acne. DESIGN, SETTING, AND PARTICIPANTS: Randomized clinical trial conducted between March 27, 2014, and June 27, 2014, including a 12-week follow-up in a local inner-city high school. Ninety-eight students aged at least 13 years with mild to moderate acne were eligible for participation. A per-protocol analysis of the evaluable population was conducted on clinical outcome data. INTERVENTIONS: Participants viewed either a standard educational website or an automated-counseling website. MAIN OUTCOMES AND MEASURES: The primary outcome was the total acne lesion count. Secondary measures included the Children's Dermatology Life Quality Index (CDLQI) scores and general skin care behavior. RESULTS: Forty-nine participants were randomized to each group. At baseline, the mean (SD) total acne lesion count was not significantly different between the standard-website group and the automated-counseling-website group (21.33 [10.81] vs 25.33 [12.45]; P = .10). Improvement in the mean (SD) acne lesion count was not significantly different between the standard-website group and the automated-counseling-website group (0.20 [9.26] vs 3.90 [12.19]; P = .10). The mean (SD) improvement in CDLQI score for the standard-website group was not significantly different from that of the automated-counseling-website group (0.17 [2.64] vs 0.39 [2.94]; P = .71). After 12 weeks, a greater proportion of participants in the automated-counseling-website group maintained or adopted a recommended anti-acne skin care routine compared with the standard-website group (43% vs 22%; P = .03). CONCLUSIONS AND RELEVANCE: Internet-based acne education using automated counseling was not superior to standard-website education in improving acne severity and quality of life. However, a greater proportion of participants who viewed the automated-counseling website reported having maintained or adopted a recommended anti-acne skin care regimen. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02031718.

Photoprotective effect of botanicals and vitamins: A systematic review of clinical trials.

BACKGROUND: Overexposure to solar radiation is a major contributor to skin cancer development and premature skin aging. Botanical extracts and vitamins may represent novel photoprotective agents. OBJECTIVE: We sought to systemically review clinical evidence for the use of botanically derived agents and vitamins as photoprotective agents. METHODS: We systematically searched Embase and PubMed databases. Two independent reviewers reviewed abstracts for inclusion. Additional relevant studies were identified by a manual review of reference lists. Data from eligible studies were extracted independently and discrepancies were resolved by consensus. RESULTS: A total of 51 studies met inclusion criteria. Limited available evidence indicates that several botanical agents and vitamins in topical or oral forms may have promising photoprotective effects. However, generalizability of results is limited by small sample sizes. CONCLUSION AND RELEVANCE: Botanical extracts and vitamins may add to the armamentarium of sun-protective agents. Additional high-quality trials are needed to strengthen support for their use.

Novel use of terpenoids for treatment of dermatologic diseases: a systematic review of clinical trials.

BACKGROUND/OBJECTIVE: Terpenoids demonstrate pharmacologic activities that address important mechanisms underlying the pathogenesis of several cutaneous diseases. This review evaluated clinical trials of dermatology-specific terpenoid-based treatments. METHODS: PubMed and EMBASE were reviewed on July 8, 2014. Two independent reviewers reviewed studies for inclusion and extracted data for studies meeting eligibility criteria. References were manually reviewed for potentially relevant studies. RESULTS: The search yielded 437 unique abstracts, of which 13 met inclusion and exclusion criteria. High-quality evidence suggests that ingenol mebutate may be effective in treating actinic keratosis. Limited available evidence indicates that terpenoids may benefit patients with nonmelanoma skin cancers, cutaneous candidiasis, hyperpigmentation, photoaging, and wounds. CONCLUSIONS: Terpenoids appear to be effective in treating specific dermatologic conditions. However, additional rigorously conducted clinical trials are needed to better ascertain efficacy.

Effectiveness of a novel interactive health care education tool on clinical outcomes and quality of life in acne patients: A randomized controlled pilot study.

BACKGROUND: We developed an Internet-based education tool (My Personalized Application for health Care Education, MyPACE) to promote patient comprehension about acne. OBJECTIVE: To determine if MyPACE improves clinical outcomes and quality of life in acne patients. METHODS: Modeling the spaced education approach, 50 participants received weekly multiple-choice questions for 12 weeks. Those randomized to the intervention group received acne-related questions, while those in the control group received non-dermatologic health-related questions. Acne lesion counts and Dermatology Life Quality Index (DLQI) scores were recorded at initial enrollment and at 12 weeks. RESULTS: Within-group analysis for the intervention group showed a significant mean change in inflammatory and non-inflammatory acne lesions per person (-3.2 ± 1.3, p = 0.0219; -4.4 ± 1.8, p = 0.0267, respectively). The control group only demonstrated a significant mean change in inflammatory lesions (-2.8 ± 0.80, p = 0.0040). Both groups had statistically significant improvement in DLQI score. Compared with participants in the control group, those receiving acne-related questions experienced greater improvement in clinical outcomes and quality of life. LIMITATIONS: The small sample size limited our ability to detect statistically significant differences. CONCLUSION: Internet-based, disease-specific, spaced education tools may be more effective than non-targeted tools for improving clinical outcomes and quality of life.

Treatments for nail psoriasis: a systematic review by the GRAPPA Nail Psoriasis Work Group.

Nail involvement in psoriatic diseases causes significant physical and functional disabilities. Evaluating, measuring, and treating nail involvement is important in improving the health outcomes and quality of life among patients with psoriasis and psoriatic arthritis (PsA). We performed a systematic analysis of the literature on nail psoriasis to help inform an update of treatment recommendations by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA).

Translational Genomic Research: Protocol Development and Initial Outcomes following SNP Testing for Colon Cancer Risk.

Although single nucleotide polymorphism (SNP) testing for disease susceptibility is commercially available, translational studies are necessary to understand how to communicate genomic information and potential implications for public health. We explored attitudes about and initial responses to genomic testing for colon cancer risk. Following development of the educational materials, we offered testing for three colon cancer SNPs in a pilot study with primary care patients. Participants completed pre- and post-test sessions and interviews. We analyzed interview transcripts with qualitative software using thematic analysis. All 20 participants opted for SNP testing. Qualitative analysis identified several themes: Motivations for SNP Testing, Before/After: Meaning of Results, Emotional Responses to SNP Results and Genomic Literacy/ Information Delivery. Results demonstrate that individuals will pursue SNP testing in the context of pre and post-test education. SNP results may influence health behaviors like healthy eating and exercise yet did not appear to impact colon cancer screening intentions.

Melanoma: epidemiology, diagnosis, treatment, and outcomes.

Melanoma is a skin cancer that arises from the malignant transformation of melanocytes. Although it is typically considered a pigmented lesion, the clinical presentation of melanoma can vary greatly. With increased efforts in screening and detection of early-stage melanoma, researchers and clinicians hope to improve clinical outcomes for patients with melanoma. Novel immunotherapies directed at specific molecular targets in the pathogenesis of melanoma usher in a new era of treatment of advanced melanoma.