Proceedings 14th IEEE Symposium on Computer-Based Medical Systems. CBMS 2001
Abstract A needs assessment was performed to determine user information requirements for hand-hel... more Abstract A needs assessment was performed to determine user information requirements for hand-held and mobile personal digital assistants within the clinical oncology community. Quantitative and qualitative data were collected through semi-structured interviews, a ...
In more and more medical settings, physicians have less and less time to be effective communicato... more In more and more medical settings, physicians have less and less time to be effective communicators. To be effective, they need accurate, current information about their patients. Tailored health communications can facilitate positive patient-provider communications and foster behavioral changes conducive to health. Tailored communications (TCs) are produced for an individual based on information about that person. The focus of this report is on tailored print communications (TPCs). TPCs also enhance the process of evaluation, because they require a database and the collection of patient-specific information. We present a Tailoring Model for Primary Care that describes the steps involved in creating TPCs. We also provide examples from three ongoing studies in which TPCs are being used in order to illustrate the kinds of variables used for tailoring the products that are developed and how evaluation is conducted. TPCs offer opportunities to expand the reach of health professionals an...
Cancer now attacks one in three Americans, resulting in one in six deaths. Yet, until recently, f... more Cancer now attacks one in three Americans, resulting in one in six deaths. Yet, until recently, few patient education programs were directed toward cancer patients. This review examines the status of cancer patient education and suggests future directions. We focus on several aspects of cancer patient education, including needs assessments and programs in treatment, rehabilitation, and continuing care and evaluation. The most comprehensive patient education programs are those directed toward patients in active treatment; one of its tasks is to help patients manage treatment side effects. A major component of rehabilitation programs is counseling patients to help them cope with the effects of cancer. Many patient education programs have performed evaluations; most reflect difficulties in one or more areas, such as selecting appropriate measures or accruing adequate sample sizes. We recommend several directions for the future, including the use of appropriate measurement tools, adequate sample sizes, multimodality programs with incorporation of psychological techniques such as relaxation training and guided imagery, and assessment of the impact of patient education programs on costs.
We conducted a 4-year randomized study in a community health center that serves primarily low inc... more We conducted a 4-year randomized study in a community health center that serves primarily low income Blacks in Durham, North Carolina. Patients (1318 at baseline) were assigned randomly to one of three study groups: provider prompting intervention alone, provider prompting and tailored print materials or the previous group and tailored telephone counseling. The purpose of the study was to determine whether increasingly intensive, tailored print and telephone interventions also were increasingly effective in promoting adherence to mammograms, Pap tests and overall cancer screening compliance. Thus, the combination of tailored print interventions (print and telephone) should have been more effective than the provider prompting intervention alone, or the print intervention and prompting combination. This is one of the few studies to examine a measure of overall cancer screening compliance and to assess the benefit of combinations of tailored interventions in promoting adherence to cancer screening. Patients gave extremely high ratings to the interventions. At the bivariate level, we found a significant effect of the most intensive group (provider prompting intervention, tailored print communications and tailored telephone counseling) on Pap test compliance (P = 0.05) and borderline significance at the multivariate level (P = 0.06) as well on overall screening compliance (P = 0.06). There was not a significant effect on mammography, probably because a majority of the patients were receiving regular mammograms. We also found some important subgroup differences. For example, a larger proportion of women reported Pap tests in the tailored print and counseling group when they believed the materials were 'meant for me.' These results show that a combination of tailored interventions may have potential for reaching the women who have too often been labeled the 'hard to reach.'
Although some &am... more Although some "how-to" guides have been written on tailored messaging, we found no reports on lessons learned from the process of developing a tailored intervention. Such lessons may be useful for practitioners and researchers who are new to tailored intervention development. The authors describe lessons gleaned from the process of developing a repeat mammography tailored print intervention. Lessons learned include the following: Selection of determinants appropriate for tailoring should be based on a theoretic framework and refined through assessment of the target population; researchers should anticipate threats to fidelity of intervention delivery because of incomplete or illogical survey data; fingerprinting enables assessment of intervention dose and how it relates to effectiveness of the tailored intervention; and a systematic process for conducting a systems test is needed to check for inconsistencies and errors before final tailored letter production. These lessons are discussed in the context of challenges and possible solutions for tailored health communication.
The authors tested an empirical definition of comprehension and investigated the relationship bet... more The authors tested an empirical definition of comprehension and investigated the relationship between comprehension, retention, attitudes, beliefs, and behavioral change in response to a persuasive health message. The study used a randomized post-tests only design with one experimental and one control group. A booklet about exercise was given to experimental group participants in their homes. They were interviewed immediately after reading the booklet and one month later. Control group participants were interviewed at both times without exposure to the booklet. The authors found that participants who were able to operationalize key concepts related to the exercise message were the most likely group to have performed the recommended behavior according to self-reports. Measures of recognition and recall were not significantly related to behavior, but measures of psychological-operational meaning (defined as the learner's ability to use the information and relate it to his/her own life) were related significantly to self-reported behavior. The authors also examined the relationship of comprehension to other variables, such as attitudes, beliefs, and behavior. The study's results support the hypothesis that comprehension is a necessary but not sufficient precursor of behavior. Implications for both program design and measurement are discussed.
Proceedings 14th IEEE Symposium on Computer-Based Medical Systems. CBMS 2001
Abstract A needs assessment was performed to determine user information requirements for hand-hel... more Abstract A needs assessment was performed to determine user information requirements for hand-held and mobile personal digital assistants within the clinical oncology community. Quantitative and qualitative data were collected through semi-structured interviews, a ...
In more and more medical settings, physicians have less and less time to be effective communicato... more In more and more medical settings, physicians have less and less time to be effective communicators. To be effective, they need accurate, current information about their patients. Tailored health communications can facilitate positive patient-provider communications and foster behavioral changes conducive to health. Tailored communications (TCs) are produced for an individual based on information about that person. The focus of this report is on tailored print communications (TPCs). TPCs also enhance the process of evaluation, because they require a database and the collection of patient-specific information. We present a Tailoring Model for Primary Care that describes the steps involved in creating TPCs. We also provide examples from three ongoing studies in which TPCs are being used in order to illustrate the kinds of variables used for tailoring the products that are developed and how evaluation is conducted. TPCs offer opportunities to expand the reach of health professionals an...
Cancer now attacks one in three Americans, resulting in one in six deaths. Yet, until recently, f... more Cancer now attacks one in three Americans, resulting in one in six deaths. Yet, until recently, few patient education programs were directed toward cancer patients. This review examines the status of cancer patient education and suggests future directions. We focus on several aspects of cancer patient education, including needs assessments and programs in treatment, rehabilitation, and continuing care and evaluation. The most comprehensive patient education programs are those directed toward patients in active treatment; one of its tasks is to help patients manage treatment side effects. A major component of rehabilitation programs is counseling patients to help them cope with the effects of cancer. Many patient education programs have performed evaluations; most reflect difficulties in one or more areas, such as selecting appropriate measures or accruing adequate sample sizes. We recommend several directions for the future, including the use of appropriate measurement tools, adequate sample sizes, multimodality programs with incorporation of psychological techniques such as relaxation training and guided imagery, and assessment of the impact of patient education programs on costs.
We conducted a 4-year randomized study in a community health center that serves primarily low inc... more We conducted a 4-year randomized study in a community health center that serves primarily low income Blacks in Durham, North Carolina. Patients (1318 at baseline) were assigned randomly to one of three study groups: provider prompting intervention alone, provider prompting and tailored print materials or the previous group and tailored telephone counseling. The purpose of the study was to determine whether increasingly intensive, tailored print and telephone interventions also were increasingly effective in promoting adherence to mammograms, Pap tests and overall cancer screening compliance. Thus, the combination of tailored print interventions (print and telephone) should have been more effective than the provider prompting intervention alone, or the print intervention and prompting combination. This is one of the few studies to examine a measure of overall cancer screening compliance and to assess the benefit of combinations of tailored interventions in promoting adherence to cancer screening. Patients gave extremely high ratings to the interventions. At the bivariate level, we found a significant effect of the most intensive group (provider prompting intervention, tailored print communications and tailored telephone counseling) on Pap test compliance (P = 0.05) and borderline significance at the multivariate level (P = 0.06) as well on overall screening compliance (P = 0.06). There was not a significant effect on mammography, probably because a majority of the patients were receiving regular mammograms. We also found some important subgroup differences. For example, a larger proportion of women reported Pap tests in the tailored print and counseling group when they believed the materials were 'meant for me.' These results show that a combination of tailored interventions may have potential for reaching the women who have too often been labeled the 'hard to reach.'
Although some &am... more Although some "how-to" guides have been written on tailored messaging, we found no reports on lessons learned from the process of developing a tailored intervention. Such lessons may be useful for practitioners and researchers who are new to tailored intervention development. The authors describe lessons gleaned from the process of developing a repeat mammography tailored print intervention. Lessons learned include the following: Selection of determinants appropriate for tailoring should be based on a theoretic framework and refined through assessment of the target population; researchers should anticipate threats to fidelity of intervention delivery because of incomplete or illogical survey data; fingerprinting enables assessment of intervention dose and how it relates to effectiveness of the tailored intervention; and a systematic process for conducting a systems test is needed to check for inconsistencies and errors before final tailored letter production. These lessons are discussed in the context of challenges and possible solutions for tailored health communication.
The authors tested an empirical definition of comprehension and investigated the relationship bet... more The authors tested an empirical definition of comprehension and investigated the relationship between comprehension, retention, attitudes, beliefs, and behavioral change in response to a persuasive health message. The study used a randomized post-tests only design with one experimental and one control group. A booklet about exercise was given to experimental group participants in their homes. They were interviewed immediately after reading the booklet and one month later. Control group participants were interviewed at both times without exposure to the booklet. The authors found that participants who were able to operationalize key concepts related to the exercise message were the most likely group to have performed the recommended behavior according to self-reports. Measures of recognition and recall were not significantly related to behavior, but measures of psychological-operational meaning (defined as the learner's ability to use the information and relate it to his/her own life) were related significantly to self-reported behavior. The authors also examined the relationship of comprehension to other variables, such as attitudes, beliefs, and behavior. The study's results support the hypothesis that comprehension is a necessary but not sufficient precursor of behavior. Implications for both program design and measurement are discussed.
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