The core competencies of a health education teacher.

Teachers play a crucial role in students' learning and in the development of health literacy. Hence, the aim of this study was to identify the core competencies needed for teachers of health education in supporting student learning. A three-round Delphi study was carried out over an 8-week period, through consultation with 25 Finnish experts in health education. An open-ended question was used to identify the core competencies for school health educators. The data were analysed using inductive content analysis. In subsequent rounds, experts were asked to assess the importance of the identified competencies on a 7-point Likert scale, and finally to rank the most important competencies. In total, 52 competencies were identified and categorized into eight core competence domains. Thereafter, 40 competencies were assessed and selected for the third round, in which the experts ranked the 15 most important competencies, encompassing four core domains, i.e. pedagogic and subject-specific didactic, social and emotional, content knowledge and continuous professional development. Other domains of competence identified in the present study were ethical competence, competence in school health promotion, contextual competence and professional well-being competence. The study defines health education teacher core competencies and domains, and the information can be used in teacher education programmes, for developing teaching and for teachers' self-evaluation.

Evaluation of a Brief, Tailored Skin Cancer Risk Assessment and Referral Intervention for Community-Based Health Educators: Brief Report.

Skin cancer rates are rising and earlier detection through screening leads to better outcomes. Health educators in community centers are well-situated to assess skin cancer risk, deliver tailored health information, and refer high-risk patients to a dermatologist for a screening. This study describes the evaluation of a brief, tailored skin cancer risk assessment, and referral intervention training. The training was developed as part of a pilot feasibility study and seven health educators were trained in an interactive session. Knowledge, attitudes, and efficacy were assessed before and after training. Health educators showed overall improvements of 22% in skin cancer risk knowledge, 50% improvement in positive attitudes toward assessment and referral, and a 40% increase in efficacy to intervene with patients. Community-based health educators that completed the training were able to successfully assess their patients for skin cancer risk and refer high-risk patients for a screening with a healthcare provider.

Health Educators in State/Local Public Health Departments: Training Needs and Awareness of Emerging Areas of Public Health Practice.

Although great progress has been made to define the field of health education and provide a voluntary certification system for professionals, research about the governmental health educator and health education specialist workforce is limited. The 2017 PH WINS (Public Health Workforce Interests and Needs Survey) provides valuable data on understanding the workforce demographics, attitudes, and training needs of governmental public health workers, including health educators, and informs future investments in workforce development efforts nationally. The purpose of this article is to examine demographics, job engagement and satisfaction, training needs, certification, and other characteristics of health educators and certified health education specialists (CHES) from PH WINS. We analyzed the data to describe the health educator workforce and compared it with the national governmental workforce across a range of variables. Compared with the national 2017 PH WINS sample, health educators were relatively younger, more ethnically diverse, more likely to be educated with an advanced degree, and were predominately employed in local versus state public health agencies. Health educators sampled were significantly more knowledgeable of all public health concepts compared with the national 2017 PH WINS respondent workforce. Comparison of CHES versus non-CHES professionals is also provided, along with practice and policy implications based on the data. This is the first detailed analyses of health educators in state and local health departments, with important findings and implications related to workforce composition, satisfaction, retention, and training. Further cross-sectional workforce research is needed to understand the current strengths and gaps in the health education workforce.

Health educators' professional agency in negotiating their problem-based learning (PBL) facilitator roles: Q study.

BACKGROUND: University educators are expected to cope with emerging situations and complex issues in teaching and learning, and this requires them to be agentic and proactive. While professional agency of health educators has not been investigated adequately, this study explores health educators' perception of their enactment of professional agency in the PBL facilitation process in a postpandemic context. METHODS: Forty PBL facilitators from medical and dental programs in Qatar University participated in the study during the fall semester of 2021, after resuming in-person PBL sessions. To collect and analyse data both qualitatively and quantitatively, Q methodology was employed. A 33-statement Q-set was established based on a proposed theoretical framework of professional agency in PBL facilitation, which included three dimensions-intrapersonal, action, and environment. RESULTS: Q factor analysis identified five significantly different viewpoints regarding how PBL facilitators perceive their professional agency sources, namely, (1) institutional resources, (2) policy guideline, (3) making efforts to improve support for students, (4) beliefs on PBL effectiveness, and (5) agentic actions. While four of the viewpoints were positive, participants with the second viewpoint reported negative perceptions and described lack of interest in facilitation work. All three dimensions of the framework were addressed and indicated complexity and interrelatedness of agency enactment. Consensus was observed regarding the need for more professional learning activities for faculty involved in PBL facilitation as source of professional agency. DISCUSSION: The results revealed a high variation of participants' perceptions of professional agency enactment throughout the three dimensions, indicating the need for establishing a common understanding of PBL facilitation work in a given context. For practical implications, further institutional efforts are required to support professional learning for PBL facilitation in a postpandemic context. Alternate approaches highlighting enforcement of agentic actions in all dimensions of intrapersonal values, stance and action taking, and active interactions with students, colleagues, and institutional environments are crucial. Q methodology provides new conceptual and empirical insights to explore the subjectivity of actors in health education.

A mixed-methods study of the effectiveness and perceptions of a course design institute for health science educators.

BACKGROUND: Most health care professionals get their start in academics without formal teaching training. As such, institutions encourage participation in opportunities to address gaps in faculty's knowledge of pedagogy and learning theory in order to promote both successful student and patient outcomes. This study aimed to examine the reception of a faculty development program focused on teaching participants the basics of course design. METHODS: Applying a mixed-method approach, this retrospective study used pre/post-tests, assignment grades, self-assessment questionnaires, and focus groups to elucidate the impact of the faculty development intervention on course design. The participants (n = 12) were health educators from a private all-graduate level university with campus locations across the United States, including in the Southwest and Midwest. In the Course Design Institute (CDI), the participating faculty learned evidence-based instructional approaches and techniques to implement contemporary teaching practices. RESULTS: The data from the pre/post-tests and focus groups suggest that participants learned about topics including instructional alignment, learning goals and objectives, instructional strategies, assessment planning, feedback approaches, communicating expectations, and adult learning theories by participating in this course. The final deliverable scores indicate that the CDI graduates were able to apply a backward design process to plan their own instruction. Data from both the survey and the focus groups suggest that participants were satisfied with the experience and particularly appreciated that the course was relevant to them as educators in the health sciences. CONCLUSIONS: The results of this study indicate that the CDI was influential in developing the faculty's knowledge of the course design process, promoted the application of course design and pedagogy skills amongst CDI graduates, and positively impacted self-reported attitudes about their teaching abilities. In addition, feedback from participants indicates that they recognized the value of this program in their own development and they believed it should be a required course for all educators at the institution.

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.

COVID-19, Social Media, and the Role of the Public Physician.

The COVID-19 pandemic has resulted in an avalanche of information, much of it false or misleading. Social media posts with misleading or dangerous opinions and analyses are often amplified by celebrities and social media influencers; these posts have contributed substantially to this avalanche of information. An emerging force in this information infodemic is public physicians, doctors who view a public presence as a large segment of their mission. These physicians bring authority and real-world experience to the COVID-19 discussion. To investigate the role of public physicians, we interviewed a convenience cohort of physicians who have played a role in the infodemic. We asked the physicians about how their roles have changed, how their audience has changed, what role politics plays, and how they address misinformation. The physicians noted increased audience size with an increased focus on the pandemic. Most avoided confronting politics, but others found it unavoidable or that even if they tried to avoide it, it would be brought up by their audience. The physicians felt that confronting and correcting misinformation was a core part of their mission. Public physicians on social media are a new occurrence and are an important part of fighting online misinformation.

Contact lens education for the practitioners of the future.

The World Health Organization has identified a shortage of trained human resources as one of the greatest challenges to increasing the availability of eye care services and reducing preventable visual impairment around the world. Increased prevalence of myopia and new strategies for myopia management have raised the prospect of various interventions, including contact lenses for therapeutic use as well as for refractive correction. More personnel skilled in contact lens fitting will be needed to address potential worldwide demand for these interventions. This review investigates the current status and future requirements of global contact lens education in light of these developments. The COVD-19 pandemic led educational institutions worldwide to move towards online delivery. An online survey among 546 educators, conducted in May 2020, investigated changes to contact lens education delivery before and after the onset of the pandemic. A total of 214 responses were received from 32 countries. Prior to COVID-19 restrictions, 23% of educators had conducted more than 50% of their total teaching online; however, 69% expected to conduct more than half of their teaching online by the end of 2020 and 12% anticipated 90% or more of their teaching would be online. Some 76% of educators expected to provide more online lectures after the pandemic and 63% anticipated new methods to deliver practical education. Around half were planning to introduce new teaching online platforms (54%) and more online assessment methods (53%). The global need for increasing numbers of skilled personnel points to a crucial role for educators in teaching the contact lens practitioners of the future. Contact lens education delivery was already evolving prior to COVID-19, and changes that are currently occurring may lead to permanent differences in the way contact lenses are taught in future. The International Association of Contact Lens Educators (IACLE) provides educators with a standardised global curriculum, online resources and teaching technology that could also serve as a model for wider ophthalmic education in future.

Health Educator Perspectives on Seeking Medicaid Reimbursement in Indiana.

Health education is a growing field. However, there is confusion about the role delineation of health education specialists (HES) and other health education (HE) providers. Additionally, recent reimbursement opportunities allow employers to bill for HE services but offer confusing language regarding eligible service-providing professionals. This study surveyed health educators in Indiana to assess knowledge, attitudes, and perceived abilities to bill Medicaid and other insurers for HE services. Using a cross-sectional research design, an original 22-item Web-based questionnaire was developed and distributed to all Certified Health Education Specialist/Master Certified Health Education Specialist (CHES/MCHES) practitioners residing in Indiana. Additional respondents were recruited using a snowball technique, as original respondents asked to share the survey with colleagues. A final data set of 61 respondents was analyzed. All respondents' organizations provided HE services, with the majority indicating they do not charge and do not bill for HE services. Additionally, 60% of the respondents agreed that HES should be reimbursed for services, and the vast majority believed reimbursement to be important for the field. With recent reimbursement opportunities for HE and preventative health services, it is important that HES advocate for the profession and for potential reimbursement opportunities, such as Medicaid, to enhance the field and support HES jobs.

Effects of COVID-19 Pandemic on the Professional Roles and Responsibilities of Health Educators.

Public health professionals are at the forefront of the COVID-19 pandemic response. However, the roles and responsibilities of health educators in pandemic response are unknown. Researchers examined multiple factors that described how health educators' work priorities and lives have been affected by COVID-19. An electronic questionnaire was administered nationally to health educators to assess the effect of the pandemic on their professional responsibilities, the challenges they are facing, and their fears about the future. Of the 913 respondents, 487 (43%) reported changing work priorities, with 80% of that group (389) sharing that their work priorities shifted focus to COVID-19. Most felt qualified to take on the new job responsibilities, but many feared the inability to get back to previous work roles or for their organizations to financially withstand the pandemic. Regardless of workplace setting or job priorities, health educators are prepared in the skills outlined in the Responsibilities and Competencies for Health Education Specialists, which may have led to their abilities in shifting roles so quickly and effectively. Findings from this study may prepare public health agencies to better use and train health educators for their roles in rapidly shifting public health priorities.

Interpretation and Understanding of the Dietary Guidelines for Americans Consumer Messages Among Low-Income Adults.

Objective: The objective of this study was to determine the interpretation, understanding, and implementation of the Dietary Guidelines for Americans (DGA) consumer messages among low-income adults and compare findings to perceptions of the messages for consumers by community nutrition educators.Methods: In this mixed methods, cross-sectional study, a convenience sample of low-income adults (n = 98) with a child between the ages of 3 and 10 years old and nutrition educators (n = 9) were interviewed individually about the DGA messages, food-related behaviors, and barriers related to consuming fruits, vegetables, and whole grains. Interviews were audio-taped, transcribed verbatim, and analyzed using the inductive approach. Interpretation and ranking of the clarity and ease of the DGA messages by low-income adults and nutrition educators and perceptions about the messages were assessed. Descriptive statistics were conducted for demographic data and Fisher's exact tests were used to examine differences regarding the clarity and ease of the messages among low-income adults and nutrition educators.Results: According to the interview results, messages that tended to be misinterpreted most frequently were on topics such as sodium, fruit and vegetables, portions, and whole grain intake. Low-income adults and nutrition educators also differed in perceptions for the message clarity addressing whole grain servings (p = .001), avoiding oversized portions (p = .002), and comparing sodium (p < .001).Conclusions: Improvements in the DGA consumer messages are warranted to improve clarity and feasibility for low-income adults through new communication tools or strategies that complement the DGA.

Optimizing internet-delivered cognitive behaviour therapy for alcohol misuse: a study protocol for a randomized factorial trial examining the effects of a pre-treatment assessment interview and health educator guidance.

BACKGROUND: Alcohol misuse is a common, disabling, and costly issue worldwide, but the vast majority of people with alcohol misuse never access treatment for varying reasons. Internet-delivered cognitive behaviour therapy (ICBT) may be an attractive treatment alternative for individuals with alcohol misuse who are reluctant to seek help due to stigma, or who live in rural communities with little access to face-to-face treatment. With the growing development of ICBT treatment clinics, investigating ways to optimize its delivery within routine clinic settings becomes a crucial avenue of research. Some studies in the alcohol treatment literature suggest that assessment interviews conducted pre-treatment may improve short- and long-term drinking outcomes but no experimental evaluation of this has been conducted. Further, research on internet interventions for alcohol misuse suggests that guidance from a therapist or coach improves outcomes, but more research on the benefits of guidance in ICBT is still needed. METHODS: This study is a 2X2 factorial randomized controlled trial where all of the expected 300 participants receive access to the Alcohol Change Course, an eight-week ICBT program. A comprehensive pre-treatment assessment interview represents factor 1, and guidance from a health educator represents factor 2. All participants will be asked to respond to measures at screening, pre-treatment, mid-treatment, post-treatment and 3, 6 and 12 months after treatment completion. DISCUSSION: This study will provide valuable information on optimization of ICBT for alcohol misuse within routine clinic settings. TRIAL REGISTRATION: ClinicalTrials.gov, registered June 13th 2019, NCT03984786.

Using Peer Health Educators to Conduct Community Level Surveillance of HPV Vaccination Status: Findings Among Women Who Live in Medically Underserved Areas of Chicago.

Young women are key stakeholders in efforts to increase human papillomavirus (HPV) vaccination uptake. Community health workers who engage with young women can provide valuable information to inform intervention strategies to increase vaccine uptake. We aimed to determine HPV vaccination and sexually transmitted infection (STI) rates among urban women and to identify barriers to vaccination. A trained health educator collaborated with community-based organizations to host health education and STI testing sessions for women in Chicago, Illinois. Forty-nine sessions took place at 15 sites over two years. Each attendee met with the educator about sexual health and HPV vaccination, and completed a health survey. We used contingency tables and logistic regression to determine factors associated with HPV vaccination using the cross-sectional survey data. Of the 292 women who answered questions about history of HPV vaccination, the average age was 17 (SD 2.3) years old, 63% (n = 184) were African American, and 33% (n = 98) Hispanic. Only 13.4% (n = 39) previously received the vaccine, and 6.2% (n = 18) received two to three doses. After adjustment, prior HIV testing was associated with 4.6 times higher odds (95% CI 1.71, 12.53, p = 0.002) of being vaccinated compared to women without prior testing. Our study provides evidence that young African American and Hispanic women living in Chicago may have low HPV vaccination rates. Women who received prior STI testing (i.e., sought healthcare) were more likely to be vaccinated relative to their peers who did not, indicating that racial/ethnic or socioeconomic disparities may inhibit utilization of preventative services.

Perceptions and practices of general practitioners on providing oral health care to people with diabetes - a qualitative study.

BACKGROUND: Poorly controlled diabetes leads to multiple complications including oral health problems. General practitioners (GPs) are at the forefront of management of chronic diseases in primary health care. Diabetes guidelines encourage a proactive role for GPs in oral health complications management in people with diabetes, yet little is known about this area of care. This study aimed to explore current practices, perceptions and barriers of GPs towards oral health care for people with diabetes. METHODS: We employed a qualitative research method utilising telephone interviews. Purposive and snowball sampling were used to recruit 12 GPs from Greater Sydney region. A thematic analysis involving an inductive approach was used to identify and analyse contextual patterns and themes. RESULTS: A majority of participants were males (n = 10), working in group practices (n = 11) with a mean ± SD age of 55 ± 11.4 years and 25 ± 13.6 years work experience. Three major themes emerged: oral health care practices in general practice settings; barriers and enablers to oral health care; and role of diabetes care providers in promoting oral health. Most GPs acknowledged the importance of oral health care for people with diabetes, identifying their compromised immune capacity and greater risks of infections as risk factors. GPs reported 20-30% of their patients having oral health problems, however their current oral health care practices relating to education, risk assessment and referrals were reported as very limited. GPs identified several barriers including time constraints, absence of referral pathways, and limited knowledge and training in promoting oral health care. They also reported patient barriers including oral health care costs and lower oral health awareness. GPs perceived that resources such as education/training, a standardised assessment tool and patient education materials could support them in promoting oral health care. GPs also perceived that other diabetes care providers such as diabetes educators could play an important role in promoting oral health. CONCLUSIONS: Despite current recommendations, GPs' current oral health care practices among people with diabetes are limited. Further strategies including capacity building GPs by developing appropriate oral health training programs and simple risk assessment tools along with accessible referral pathways are needed to address the current barriers.

Using a 'rich picture' to facilitate systems thinking in research coproduction.

BACKGROUND: In coproduction research, traditional 'end-users' are involved in the entire research process. The aim is to facilitate research translation by improving the timeliness and relevance of research. Because end-users often come from multiple sectors and hold diverse perspectives and priorities, involving them in coproduction can be challenging. Tools and approaches are needed to support coproduction teams to successfully navigate divergent viewpoints while producing rigorous but meaningful research outcomes. Rich pictures are a systems thinking tool to help make sense of complexity. In this paper, we describe how we developed and applied a 'rich picture' in a coproduction project with policy-level partners. METHODS: Guided by systems thinking principles, we conducted a systemic analysis of ethnographic fieldnotes collected as part of a broader study that examined the dynamics between an IT system and the implementation of the state-wide childhood obesity prevention programmes it was designed to monitor. Translating qualitative themes into metaphor and imagery, we created a visual depiction of the system to reflect the experience of the system's users (health promotion practitioners) and facilitated a workshop with policy-level programme administrators (i.e. participants, n = 7). Our aim was to increase the transparency of the system for our research partners and to spark new insights to improve the quality of programme implementation. RESULTS: Guided by provocative questions, participants discussed and challenged each other's thinking on the current functioning of the system. They identified future lines of inquiry to explore for quality improvement. Participants strongly agreed that the picture was a constructive way to engage with the ethnographic data but were challenged by the information and its implications. The opportunity for participants to co-learn from each other as well as from the picture was an added value. CONCLUSION: In the context of the facilitated workshop, the rich picture enabled research partners to engage with complex research findings and gain new insights. Its value was harnessed via the guided participatory process. This demonstrates the importance that, in the future, such tools should be accompanied by practices that enable participants to think with and apply systems thinking concepts and principles.

A qualitative study of health professions curricula and management of lateral ankle ligament sprain demonstrates inconsistency.

BACKGROUND: Health educators aim to graduate students who are safe, effective and practice evidence-based medicine (EBM). Clinical Practice Guidelines (CPGs) are tools for translating evidence into clinical practice for health professionals and educators who lack time to appraise the evidence. There have been CPGs published for lateral ankle ligament sprains (LALS) for physiotherapists, nurses, and doctors. Clinical decision rules have also been developed for LALS to increase the safety of practice. The Ottawa Ankle Rules (OAR) were developed to screen for the need for an x-ray following an ankle or foot injury. METHODS: Educators from the Australasian College of Sports and Exercise Physicians (ACSEP), St John Ambulance first aiders, pharmacy, nursing, and physiotherapy disciplines were participants in this study. Using purposeful sampling with semi-structured questions and a LALS case study, 19 Australian educators were interviewed. Curricula and textbooks were also collected and analysed. Two researchers independently analysed the data using a deductive method. RESULTS: Analysis found that no educator used a CPG to inform their teaching. There was no common LALS curriculum for the five groups studied. There were two approaches: a triage curriculum (St John Ambulance, pharmacy, nursing) and a reflective curriculum (ASCEP and physiotherapy). Textbooks influenced curriculum for physiotherapy, pharmacy and first aid educators. The triage curricula recommend rest, ice, compression and elevation (RICE) alone, while the reflective curricula uses OAR, RICE, immobilisation if the LALS is severe, functional support (brace), exercises and manual therapy. In addition, ACSEP and physiotherapy do not recommend electrotherapy. All five groups were cautious about the use of non-steroidal anti-inflammatory drugs (NSAIDs). CONCLUSIONS: Physiotherapy and ACSEP educators teach OAR. Despite not using the CPGs to inform curriculum, physiotherapy and ACSEP have unintentionally aligned their curriculum with current LALS CPG recommendations. However, nursing, pharmacy and first aid trainers are not teaching OAR or aligned with LALS CPGs. Educators in pharmacy, nursing and first aid should re-examine their curricula and consider possibly teaching OAR and using CPG. Clinical practice guideline developers should consider pharmacists and first aiders as users of their LALS CPGs.

Differences in Health Education Competencies Among Obesity Prevention and Nutrition Education Professionals.

The study purpose was to examine perceived health education competencies among those responsible for planning, implementing, and evaluating health education programs. A total of 172 obesity prevention and nutrition education professionals in the United States completed a survey measuring their perceived competency to plan, implement, and evaluate nutrition education/obesity prevention education programs based on the National Commission for Health Education Credentialing health education competencies and their endorsement of various health education approaches. Using a series of multiple hierarchical regression models, we found that those trained in health education had greater perceived competency in assessing needs (B = 1.19, t = 2.11, p = .03), planning health education programs (B = 1.63, t = 2.96, p = .004), implementing health education programs (B = 1.00, t = 2.22, p = .03), evaluating health education programs (B = 4.85, t = 3.54, p = .001), and managing health education programs (B = 1.70, t = 2.21, p = .03) than those trained in nutrition or dietetics. Additionally, those trained in health education were more likely to endorse the use of a skill-based approach to obesity prevention (B = 0.25, t = 2.53, p = .01) and less likely to endorse teaching facts and information (B = 0.24, t = 1.99, p = .05) than those trained in nutrition or dietetics. These results have implications for improving the effectiveness of health education and promotion programs and the professional preparation of health educators and dietitians alike.

Health and social care educators' ethical competence.

BACKGROUND AND PURPOSE: Educators' ethical competence is of crucial importance for developing students' ethical thinking. Previous studies describe educators' ethical codes and principles. This article aims to widen the understanding of health- and social care educators' ethical competence in relation to core values and ethos. THEORETICAL BACKGROUND AND KEY CONCEPTS: The study is based on the didactics of caring science and theoretically links the concepts ethos and competence. METHODS: Data material was collected from nine educational units for healthcare and social service in Finland. In total 16 semi-structured focus group interviews with 48 participants were conducted. The interviews were analysed with a thematic analysis according to Braun and Clarke. ETHICAL CONSIDERATIONS: The study is approved by the Declaration of Helsinki, the legislation regarding personal data and the General Data Protection Regulation. The study received ethical permission from the University of Jyväskylä. Informed consent was obtained from all the educational units and participants in the study. FINDINGS: The findings are presented based on three general patterns, an ethical basic motive, an ethical bearing and ethical actions. Subthemes are Humane view of students as unique individuals with individual learning, Bearing of tactfulness and firmness, Bearing of perceptiveness and accessibility, Bearing of satisfaction and joy over student learning, Valuing bearing towards each oneself and colleagues, Ability to interact and flexibility, Collegiality and a supportive work community and Educators as role models and inspirators. CONCLUSION: Educators' personal and professional ethos is crucial to student learning, personal growth and ethical reasoning. Therefore, it is important to further develop educators' training regarding ethical competence.

Effectiveness of a therapeutic patient education program in improving cancer pain management: EFFADOL, a stepped-wedge randomised controlled trial.

BACKGROUND: Despite numerous guidelines, nearly one of two patients with cancer pain remains undertreated, thereby affecting their quality of life. Active patient involvement through Therapeutic Patient Education (TPE) is considered as a relevant strategy to overcoming hurdles in pain management. The aim of the EFFADOL study is to assess the effectiveness of a TPE program in improving cancer pain management. METHODS/DESIGN: The EFFADOL study is a stepped-wedge randomised controlled trial. A total of 260 cancer patients with unbalanced background pain will be randomised over the institutional level, i.e. stepped-wedge cluster design. Six clusters will be formed, one at the regional level of "Basse-Normandie" for patients receiving the educational approach by health providers already trained to TPE. Then, five additional centers will be gradually included at the national level, making it possible to compare the "conventional" management of pain (before medical staff training to TPE) with the educational approach (after being trained). The main study parameter is pain interference on daily life assessed with the self-administrated and validated Brief Pain Inventory questionnaire. Secondary objectives comprised the evaluation of patients' adherence to pain education program, the description of pain intensity, pain relief, analgesic adherence and pain emotional impact. Educational dimension of the program will be evaluated through the patients' acquisition of knowledge and skills about their pain and treatment as well as their self-efficacy to participate actively in pain management. The patient's feeling of pain changes will be measured. Finally, the satisfaction of participants and educators will be reported. We hypothetise active involvement of patients in TPE will lead to an improved pain management compared to standard care. DISCUSSION: Analyzing the impact of a TPE program in cancer pain patients will improve their pain management and quality of life. We expect that the dissemination of our project educational approach through the French territory will be accompanied by long term change in clinical practices with mutual benefit to patients and caregiver-educators. TRIAL REGISTRATION: NCT03297723 , registered: 09/28/2017. Protocol version: Version n°1.1 dated from 2016/09/08.

Perspectives of health educators and interviewers in a randomized controlled trial of a postpartum diabetes prevention program for Latinas: a qualitative assessment.

BACKGROUND: Lifestyle interventions regularly rely on study staff to implement the intervention and collect outcomes data directly from study participants. This study describes the experiences of project staff in two randomized controlled trials of a postpartum lifestyle intervention to reduce risk factors for type 2 diabetes in Latinas. Latinas are the fastest growing minority group in the U.S. and have the highest rates of type 2 diabetes after a diagnosis of gestational diabetes mellitus. The challenges of implementing lifestyle interventions for postpartum women have been poorly documented. METHODS: A qualitative focus group was conducted with eight staff members (five health educators and three health interviewers) involved in Proyecto Mamá and Estudio Parto. The discussion was audio recorded, transcribed, and coded in NVivo. Focus group topics included: 1) participant recruitment, 2) participant retention, 3) implementation of the lifestyle intervention, 4) assessment of behavior change, 5) overall challenges and rewarding aspects of the trial, and 6) recommended changes for future trials. RESULTS: Key themes emerged regarding enabling factors and barriers to implementing a lifestyle intervention in postpartum Latinas. Enabling factors included: a) the staff's belief in the importance of the intervention, b) opportunities associated with the longitudinal nature of the trial, c) belief that the staff could empower participants to make behavior change, d) benefits of flexible intervention sessions, and e) connection with participants due to shared cultural backgrounds. Barriers included: a) participant stressors: home, food, and financial insecurity, b) low health literacy, c) issues related to recent immigration to the continental U.S., d) handling participant resistance to behavior change, e) involvement of family members in assessment visits, f) limitations of the assessment tools, and g) time limitations. CONCLUSIONS: Findings highlight the challenging contexts that many study participants face, and shed light on the potentially influential role of health educators and interviewers in intervention implementation and data collection. Specific recommendations are made for strategies to improve adherence to diabetes prevention programs in postpartum underserved and minority populations in this challenging, transitional period of life. TRIAL REGISTRATION: NCT01679210 . Registered 5 September 2012; NCT01868230 . Registered 4 June 2013.