High Altitude Illness: Knowledge, Practice, and Attitudes of Porters in Nepal.

INTRODUCTION: Porters working at high altitude face a number of preventable health risks ranging from frostbite to potentially fatal high-altitude pulmonary and cerebral edema. Porters are often recruited from impoverished low-altitude areas, poorly equipped in terms of protective clothing, and tasked with carrying loads that equal or exceed their body mass to high elevations. Despite a large population of porters working throughout mountainous parts of the world, there is little documentation regarding knowledge levels, attitudes, and practices related to the prevention of altitude illness in this population. Much of the literature focuses on biomechanics of load carrying for porters or altitude issues for trekkers. METHODS: A cross-sectional survey was developed using a modified Delphi technique. The survey was administered to a convenience sample of porters (n=146) from diverse cultural groups between Lukla (2774 m) and Everest Base Camp (5361 m). RESULTS: Many of the porters started at a young age, carried heavy loads, and had difficulty identifying symptoms of high altitude illness, and less than 20% correctly identified preventive measures for high-altitude illness. CONCLUSIONS: Porters in the Khumbu region continue to face hazards in their working environment. Future research and health education campaigns should address knowledge deficits and help with the design of tailored interventions.

Addressing low health literacy with "Talking Pill Bottles": A pilot study in a community pharmacy setting.

OBJECTIVES: To test the effect of "Talking Pill Bottles" on medication self-efficacy, knowledge, adherence, and blood pressure readings among hypertensive patients with low health literacy and to assess patients' acceptance of this innovation. DESIGN: Longitudinal nonblinded randomized trial with standard treatment and intervention arms. SETTING AND PARTICIPANTS: Two community pharmacies serving an ethnically diverse population in the Pacific Northwest. Participants were consented patients with antihypertension prescriptions who screened positive for low health literacy based on the Test of Functional Health Literacy Short Form. Participants in the intervention arm received antihypertensive medications and recordings of pharmacists' counseling in Talking Pill Bottles at baseline. Control arm participants received antihypertensive medications and usual care instructions. MAIN OUTCOME MEASURES: Comparison and score changes between baseline and day 90 for medication knowledge test, Self-Efficacy for Appropriate Medication Use Scale (SEAMS), Morisky Medication Adherence Scale (MMAS-8), blood pressure, and responses to semistructured exit interviews and Technology Acceptance Model surveys. RESULTS: Of 871 patients screened for health literacy, 134 eligible participants were enrolled in the trial. The sample was elderly, ethnically diverse, of low income, and experienced regarding hypertension and medication history. In both arms, we found high baseline scores in medication knowledge test, SEAMS, and MMAS-8 and minimal changes in these measures over the 90-day study period. Blood pressure decreased significantly in the intervention arm. Acceptability scores for the Talking Pill Bottle technology were high. CONCLUSION: Our results suggest that providing audio-assisted medication instructions in Talking Pill Bottles positively affected blood pressure control and was well accepted by patients with low health literacy. Further research involving newly diagnosed patients is needed to mitigate possible ceiling effects that we observed in an experienced population.

Information Needs of Men with Localized Prostate Cancer During Radiation Therapy.

The purpose of this study was to describe how patient information needs change over the course of receiving radiation therapy for prostate cancer. Convenience sampling was utilized to recruit men with stage I-III prostate cancer. A longitudinal repeated measures design was implemented for this pilot study. Patients were presented with 36 paired comparisons, each asking the participant to choose the most important information topic(s) for today. Following completion of the survey instruments, the clinic nurse delivered the four top-ranked information topic handouts to each patient with brief instruction on how to use the handouts. Over the course of 6 months, we were able to recruit 35 men. The four highest priority topics across all four sessions were prognosis, stage of disease, treatment options, and side effects. Our results suggest trends in the information priorities that men hold over the course of radiation treatment. The information priorities do appear to shift over time, notably prognosis concerns and risk for family members continued to rise over time, while side effect information declined. These findings will extend an already strong foundation of evidence for preparatory information in radiation therapy. Furthermore, these findings will strengthen current evidence that computerized assessment of patient self-report information is feasible and an important adjunct to clinical practice.

Actual use and perceived usefulness of a web-based, decision support program for men with prostate cancer.

The purpose of this pilot study was to develop and test the Personal Patient Profile-Prostate (P4), a customized, Internet-based decision support system for men with localized prostate cancer. In a sample of 30 men, the P4 program was successfully implemented in a clinical setting. Men reported the program useful and web-logs documented a high use rate of menu-driven components of the intervention.

Redesigning pictographs for patients with low health literacy and establishing preliminary steps for delivery via smart phones.

BACKGROUND: Pictographs (or pictograms) have been widely utilized to convey medication related messages and to address nonadherence among patients with low health literacy. Yet, patients do not always interpret the intended messages on commonly used pictographs correctly and there are questions how they may be delivered on mobile devices. OBJECTIVE: Our objectives are to refine a set of pictographs to use as medication reminders and to establish preliminary steps for delivery via smart phones. METHODS: Card sorting was used to identify existing pictographs that focus group members found "not easy" to understand. Participants then explored improvements to these pictographs while iterations were sketched in real-time by a graphic artist. Feedback was also solicited on how selected pictographs might be delivered via smart phones in a sequential reminder message. The study was conducted at a community learning center that provides literacy services to underserved populations in Seattle, WA. Participants aged 18 years and older who met the criteria for low health literacy using S-TOFHLA were recruited. RESULTS: Among the 45 participants screened for health literacy, 29 were eligible and consented to participate. Across four focus group sessions, participants examined 91 commonly used pictographs, 20 of these were ultimately refined to improve comprehensibility using participatory design approaches. All participants in the fifth focus group owned and used cell phones and provided feedback on preferred sequencing of pictographs to represent medication messages. CONCLUSION: Low literacy adults found a substantial number of common medication label pictographs difficult to understand. Participative design processes helped generate new pictographs, as well as feedback on the sequencing of messages on cell phones, that may be evaluated in future research.