Showing papers in "Journal of Health Communication in 2011"

Interventions for Individuals with Low Health Literacy: A Systematic Review

Abstract: The US Department of Health and Human Services recently called for action on health literacy An important first step is defining the current state of the literature about interventions designed to mitigate the effects of low health literacy We performed an updated systematic review examining the effects of interventions that authors reported were specifically designed to mitigate the effects of low health literacy We searched MEDLINE®, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Educational Resources Information Center (ERIC), and the Cochrane Library databases (2003 forward for health literacy; 1966 forward for numeracy) Two reviewers independently reviewed titles, abstracts, and full-text articles for inclusion and included studies that examined outcomes by health literacy level and met other pre-specified criteria One reviewer abstracted article information into evidence tables; a second checked accuracy Two reviewers independently rated study quality using predefined criteria Among 38 included studies, we found multiple discrete design features that improved comprehension in one or a few studies (eg, presenting essential information by itself or first, presenting information so that the higher number is better, adding icon arrays to numerical information, adding video to verbal narratives) In a few studies, we also found consistent, direct, fair or good-quality evidence that intensive self-management interventions reduced emergency department visits and hospitalizations; and intensive self- and disease-management interventions reduced disease severity Evidence for the effects of interventions on other outcomes was either limited or mixed Multiple interventions show promise for mitigating the effects of low health literacy and could be considered for use in clinical practice

Obesity Stigma in Online News: A Visual Content Analysis

Abstract: This study conducted a content analysis to examine the types of images that accompany online news stories about obesity and to determine how obese people are portrayed in news photographs. Images were selected from news articles about obesity obtained from 5 major news Web sites, during a 2-week period in September of 2009. Images accompanying news stories about obesity (N = 549) were systematically coded. Of 441 individuals identified in news photographs, 65% were overweight/obese and 27% were nonoverweight. Overall, 72% of images that depicted an overweight or obese person were portrayed in a negative, stigmatizing manner. Overweight/obese individuals were significantly more likely to have their heads cut out of the photos, to be portrayed showing only their abdomens or lower bodies, and to be shown eating or drinking than were nonoverweight individuals. Overweight/obese individuals were significantly less likely to be shown fully clothed, wearing professional clothing, or exercising than were nonoverweight individuals. Obese individuals are frequently stigmatized in online news photographs; this phenomenon has important implications for public perceptions of obese persons and may reinforce pervasive prejudice and discrimination.

Health Literacy Explains Racial Disparities in Diabetes Medication Adherence

Abstract: Although low health literacy and suboptimal medication adherence are more prevalent in racial/ethnic minority groups than Whites, little is known about the relationship between these factors in adults with diabetes, and whether health literacy or numeracy might explain racial/ethnic disparities in diabetes medication adherence. Previous work in HIV suggests health literacy mediates racial differences in adherence to antiretroviral treatment, but no study to date has explored numeracy as a mediator of the relationship between race/ethnicity and medication adherence. This study tested whether health literacy and/or numeracy were related to diabetes medication adherence, and whether either factor explained racial differences in adherence. Using path analytic models, we explored the predicted pathways between racial status, health literacy, diabetes-related numeracy, general numeracy, and adherence to diabetes medications. After adjustment for covariates, African American race was associated with poor medication adherence (r = -0.10, p < .05). Health literacy was associated with adherence (r = .12, p < .02), but diabetes-related numeracy and general numeracy were not related to adherence. Furthermore, health literacy reduced the effect of race on adherence to nonsignificance, such that African American race was no longer directly associated with lower medication adherence (r = -0.09, p = .14). Diabetes medication adherence promotion interventions should address patient health literacy limitations.

Applicability of internationally available health literacy measures in the Netherlands.

Abstract: Health literacy measures for use in clinical-epidemiological research have all been developed outside Europe. In the absence of validated Dutch measures, we evaluated the cross-cultural applicability of the Rapid Estimate of Adult Literacy in Medicine (REALM), the Newest Vital Sign (NVS), the Set of Brief Screening Questions (SBSQ), and the measure of Functional Communicative and Critical Health Literacy (FCCHL). Each measure was translated into Dutch following standardized procedures. We assessed feasibility, internal consistency, and construct validity among patients with coronary artery disease (n = 201) and patients with diabetes type 2 (n = 88). Patients expressed most problems in responding to the NVS-D. They were not familiar with the type of food label and had difficulties calculating in portions instead of grams. The FCCHL-D items seemed too theoretical for many patients. Cronbach's alpha was acceptable for all measures. Correlation patterns between the measures were moderately coherent with a priori hypotheses. All translated measures were able to distinguish between high- and low-educated groups of patients, with the NVS-D performing best. Despite reasonable psychometric properties as demonstrated so far, these measures need to be further developed in order to increase applicability for assessing health literacy in clinical-epidemiological research in the Netherlands.

Obesity in the News: Do Photographic Images of Obese Persons Influence Antifat Attitudes?

Abstract: News coverage of obesity has increased dramatically in recent years, and research shows that media content may contribute to negative public attitudes toward obese people. However, no work has assessed whether photographic portrayals of obese people that accompany news stories affect attitudes. In the present study, the authors used a randomized experimental design to test whether viewing photographic portrayals of an obese person in a stereotypical or unflattering way (versus a nonstereotypical or flattering portrayal) could increase negative attitudes about obesity, even when the content of an accompanying news story is neutral. The authors randomly assigned 188 adult participants to read a neutral news story about the prevalence of obesity that was paired with 1 of 4 photographic portrayals of an obese adult (or no photograph). The authors subsequently assessed attitudes toward obese people using the Fat Phobia Scale. Participants in all conditions expressed a moderate level of fat phobia (M = 3.83, SD = 0.58). Results indicated that participants who viewed the negative photographs expressed more negative attitudes toward obese people than did those who viewed the positive photographs. Implications of these findings for the media are discussed, with emphasis on increasing awareness of weight bias in health communication and journalistic news reporting.

Health Literacy Measurement: A Proposed Research Agenda

Abstract: Although the field of health literacy is experiencing tremendous growth in terms of producing peer-reviewed journal articles and attracting practitioners, the foundation of that growth is potentially unstable. Despite a steady increase in their number, existing measures and screeners of health literacy are not based on an accepted conceptual framework and fail to align with the growing body of theoretical and applied work. Existing measures are mainly focused on assessing what individuals can read and understand in clinical contexts. This leaves important factors untested, such as how individuals use information, and how health professionals and systems communicate with patients. This article outlines key elements of a proposed research agenda focusing on development of a new, comprehensive approach to measuring health literacy.

Interpersonal Communication as an Indirect Pathway for the Effect of Antismoking Media Content on Smoking Cessation

Abstract: In the context of health campaigns, interpersonal communication can serve at least 2 functions: (a) to stimulate change through social interaction and (b) in a secondary diffusion process, to further disseminate message content. In a 3-wave prospective study of 1,079 smokers, the authors demonstrate that mass media messages (antismoking campaigns and news coverage relevant to smoking cessation) have an indirect effect on smoking cessation intention and behavior via interpersonal communication. Exposure to campaigns and news coverage prompts discussion about the campaigns, and, in turn, about smoking cessation. Interpersonal communication regarding smoking cessation then influences intention to quit smoking and attempts to quit smoking. The study finds evidence not only for the social interaction function of interpersonal communication, but also for the secondary diffusion function. A substantial number of smokers who are not directly exposed to the antismoking campaigns are nevertheless indirectly exposed via communication with people who have seen these campaigns. These results imply that encouragement of interpersonal communication can be an important campaign objective.

Is the internet filling the sexual health information gap for teens? An exploratory study.

Abstract: At the same time that there was a decline in comprehensive school-based sex education, adolescents' use of the Internet became nearly universal. This study explores adolescents' use and evaluation of the Internet for sexual health information, with a focus on the issues of contraception and abstinence. The authors conducted 58 in-depth interviews with juniors and seniors in 3 public high schools in New York City and Indiana. Most of the adolescents used the Internet on a daily basis, but few considered it a main source of information about contraception or abstinence. Students were more likely to rely on and had greater trust in traditional sexuality education sources such as school, family members, and friends. Most of the adolescents the authors interviewed were wary of sexual health information on the Internet, and the authors describe strategies adolescents used to sort through the abundance of sex-related material. Formal and informal efforts to provide sexuality education to adolescents should include specific age- and content-appropriate Web sites because many teens are not actively searching on their own, and they express reservations about relying on the Internet as a source of sexual health information.

Exploring the potential of Web 2.0 to address health disparities.

Abstract: This article addresses use of the Internet and Web 2.0 technologies by racial and ethnic minorities and explores the potential opportunities and challenges in leveraging Web 2.0 approaches to impact health disparities. These opportunities and challenges include developing approaches and methods to (a) identify strategies for integrating social media into health promotion interventions focused on major health-related issues that affect members of medically underserved groups; (b) amalgamate techniques to leverage and connect social-media technologies to other evidence-informed online resources; (c) integrate health communication best practices, including addressing health literacy issues; (d) capitalize on social networking to enhance access and communication with health care providers; and (e) advance current efforts and ongoing expansion of research participation by individuals from underserved communities.

Knowledge and Perceptions of Health Literacy Among Nursing Professionals

Abstract: Low health literacy affects nearly half of the U.S. population. Health care professionals may not recognize low health literacy in their patients nor understand its impact on health outcomes. The purpose of this pilot study was to describe nurses' knowledge and perceptions of low health literacy on patients, their practice, and the health system. This cross-sectional, descriptive study used a web-based survey to assess the knowledge and perceptions of health literacy among nursing professionals. Registered nurses licensed by the State of California were randomly selected and invited to participate in the study. Data analysis included descriptive statistics to describe nursing professionals' general knowledge and perceptions. Qualitative textual analysis was done on participant responses to a survey question that asks participants to define health literacy using their own words. Results of this study revealed that nursing professionals' knowledge of health literacy and their understanding on the role health literacy plays on patient health outcomes is limited. Health literacy was also reported to be a low priority among providers and organizations. Nursing plays an important role in direct patient care and in the delivery of health services. Educating nurses on health literacy and improving patient communication and understanding can improve health outcomes.

Testing the effect of framing and sourcing in health news stories.

Abstract: This study examines whether changing the way news stories report on health can induce shifts in readers' perceptions of problems of obesity, diabetes, immigrant health, and smoking. The authors manipulated two variables in a controlled experiment: the quality of sourcing-the number of sources and their expertise-and the framing-changing from an episodic, traditional frame to a thematic frame that incorporated information on context, risk factors, prevention strategies, and social attributions of responsibility. The authors found that a thematic frame made readers more supportive of public policy changes and encouraged them to improve their own health behaviors. However, it did not alter their attributions of responsibility for health problems from one of blaming individuals to seeing the larger social factors. Adding richer sourcing to the thematic frame did not increase these effects, nor did readers find the thematic stories to be more interesting, relevant, believable, important, and informative. In addition, there were differential results because of story topics that represent uncontrolled effects. The implications for improving health reporting to encourage positive change in society are discussed.

The influence of sexually explicit Internet material on sexual risk behavior: a comparison of adolescents and adults.

Abstract: This study had three goals: first, to investigate whether sexually explicit Internet material (SEIM) affects sexual risk behavior; second, to study whether these effects differ between adolescents and adults; and third, to analyze, separately for adolescents and adults, whether gender and age moderate an influence of SEIM on sexual risk behavior. The authors conducted a 2-wave panel survey among nationally representative random samples of 1,445 Dutch adolescents and 833 Dutch adults. SEIM use increased sexual risk behavior among adults, but not among adolescents. More specifically, moderator analyses showed that SEIM use increased sexual risk behavior only among male adults, but not among female adults. In the adolescent sample, no moderating gender effect occurred. Neither among adolescents nor among adults did age moderate the effects. Our study shows that SEIM may influence outcomes related to people's sexual health. It also suggests that male adults may present a potential risk group for adverse effects of SEIM.

Using Web 2.0 Technologies to Enhance Evidence-Based Medical Information

Abstract: This article invokes research on information seeking and evaluation to address how providers of evidence-based medical information can use Web 2.0 technologies to increase access to, enliven users’ experiences with, and enrich the quality of the information available. In an ideal scenario, evidence-based medical information can take appropriate advantage of community intelligence spawned by Web 2.0 technologies, resulting in the ideal combination of scientifically sound, high-quality information that is imbued with experiential insights from a multitude of individuals. To achieve this goal, the authors argue that people will engage with information that they can access easily, and that they perceive as (a) relevant to their information-seeking goals and (b) credible. The authors suggest the utility of Web 2.0 technologies for engaging stakeholders with evidence-based medical information through these mechanisms, and the degree to which the information provided can and should be trusted. Last, the authors ...

Promoting Exercise Self-Efficacy With an Exergame

Abstract: A new generation of exercise video games (exergames) shows promise as a tool to motivate and engage users in physical activity. However, little research has been conducted to examine whether exergames work equally well across diverse populations and contexts. Therefore, in the present study, the authors investigated the effects of an individual psychological difference factor and a specific contextual factor on the exercise experience using an exergame. They used the objective self-awareness theory as the theoretical underpinning. In a 2 (seeing the image of self on screen: seeing oneself vs. not seeing oneself) × 2 (body image dissatisfaction: low vs. high) between-subjects design experiment, the authors found significant interaction effects showing that the feature of seeing the image of self on screen provided by the exergame works positively for individuals with low body image dissatisfaction, yet works negatively for individuals with high body image dissatisfaction. The finding of the present study has significant implications for health professionals and individuals who use the new generation of exergames for physical activities.

“Teach to Goal”: Theory and Design Principles of an Intervention to Improve Heart Failure Self-Management Skills of Patients with Low Health Literacy

Abstract: Self-management is vital for achieving optimal health outcomes for patients with heart failure (HF). We sought to develop an intervention to improve self-management skills and behaviors for patients with HF, especially those with low health literacy. Individuals with low health literacy have difficulty reading and understanding written information and comprehending numerical information and performing calculations, and they tend to have worse baseline knowledge, short-term memory, and working memory compared with individuals with higher health literacy. This paper describes theoretical models that suggest methods to improve the design of educational curricula and programs for low literate audiences, including cognitive load theory and learning mastery theory. We also outline the practical guiding principles for designing our intervention, which includes a multisession educational strategy that teaches patients self-care skills until they reach behavioral goals ("Teach to Goal"). Our intervention strategy is being tested in a randomized controlled trial to determine if it is superior to a single-session brief educational intervention for reducing hospitalization and death. If this trial shows that the "Teach to Goal" approach is superior, it would support the value of incorporating these design principles into educational interventions for other diseases.

Understanding the Internal and External Validity of Health Literacy Interventions: A Systematic Literature Review Using the RE-AIM Framework

Abstract: We conducted a systematic literature review, using the RE-AIM framework, with the goal of determining what information is available to inform research to practice translation of health promotion interventions developed to address health literacy. Thirty-one articles reflecting 25 trials published between 2000 and 2010 met inclusion criteria. Two researchers coded each article, using a validated RE-AIM (reach, effectiveness/efficacy, adoption, implementation, maintenance) data extraction tool, and group meetings were used to gain consensus on discrepancies. Across all studies (14 randomized controlled trials, 11 quasi-experimental; 24 clinic-based, 1 community-based), the mean level of reporting RE-AIM indicators varied by dimension (reach = 69%; efficacy/ effectiveness = 58%; adoption = 36%; implementation = 35%; maintenance = 11%). Among participants enrolled in the 25 interventions, approximately 38% were identified as low health literate. Only eight of the studies examined health literacy status as a moderator of intervention effectiveness. This review suggests that the current research on health promotion for participants with low health literacy provides insufficient information to conclude whether interventions for health literacy can attract the target population, achieve an effect that is sustainable, or be generalized outside of clinical settings. Recommendations for enhancing the design and reporting of these trials are provided.

Physical inactivity: the "Cinderella" risk factor for noncommunicable disease prevention.

Abstract: There is strong evidence demonstrating the direct and indirect pathways by which physical activity prevents many of the major noncommunicable diseases (NCD) responsible for premature death and disability Physical inactivity was identified as the 4th leading risk factor for the prevention of NCD, preceded only by tobacco use, hypertension, and high blood glucose levels, and accounting for more than 3 million preventable deaths globally in 2010 Physical inactivity is a global public health priority but, in most countries, this has not yet resulted in widespread recognition nor specific physical activity–related policy action at the necessary scale Instead, physical inactivity could be described as the Cinderella of NCD risk factors, defined as “poverty of policy attention and resourcing proportionate to its importance” The pressing question is “Why is this so?” The authors identify and discuss 8 possible explanations and the need for more effective communication on the importance of physical activity in

Narrative and framing: a test of an integrated message strategy in the exercise context.

Abstract: Health communication interventions encouraging exercise may aid in mitigating the obesity crisis in the United States. Although much research has investigated behavioral predictors of exercise, little work has explored message characteristics most persuasive in the exercise context. The purpose of this study, therefore, was to test a message strategy drawing on previous work in health behavior theory combined with persuasion theories (exemplification theory and prospect theory) to encourage positive exercise attitudes, control beliefs, and intentions. The authors report the results of a controlled experiment testing messages using gain or loss frames and narrative or statistical evidence. Results indicate that gain-framed messages are significantly more successful in promoting positive exercise variables and are perceived as more effective than are loss-framed or control messages. The authors discuss the implications of the results for future research.

Framing medical tourism: an examination of appeal, risk, convalescence, accreditation, and interactivity in medical tourism web sites.

Abstract: This exploratory study analyzed the content of medical tourism Web sites in an attempt to examine how they convey information about benefits and risks of medical procedures, how they frame credibility, and the degree to which these Web sites include interactive features for consumers. Drawing upon framing theory, the researchers content analyzed a sample of 66 medical tourism Web sites throughout the world. The results indicated that medical tourism Web sites largely promote the benefits of medical procedures while downplaying the risks, and relatively little information regarding the credibility of these services appears. In addition, the presentation of benefits/risks, credibility, and Web site interactivity were found to differ by region and type of facility. The authors discuss the implications of these findings concerning the framing of medical tourism Web site content, future directions for research, and limitations.

Realizing the Promise of Web 2.0: Engaging Community Intelligence

Abstract: Discussions of Health 2.0, a term first coined in 2005, were guided by three main tenets: (a) health was to involve more participation, because an evolution in the web encouraged more direct consumer engagement in their own health care; (b) data was to become the new “Intel Inside” for systems supporting the vital decisions in health; and (c) a sense of collective intelligence from the network would supplement traditional sources of knowledge in health decision making. Interests in understanding the implications of a new paradigm for patient engagement in health and health care were kindled by findings from surveys such as the National Cancer Institute's Health Information National Trends Survey, showing that patients were quick to look online for information to help them cope with disease. This article considers how these 3 facets of Health 2.0—participation, data, and collective intelligence—can be harnessed to improve the health of the nation according to Healthy People 2020 goals. The authors begin wi...

The process-knowledge model of health literacy: Evidence from a componential analysis of two commonly used measures

Abstract: We investigated the effects of domain-general processing capacity (fluid ability such as working memory), domain-general knowledge (crystallized ability such as vocabulary), and domain-specific health knowledge for two of the most commonly used measures of health literacy (S-TOFHLA and REALM). One hundred forty six community-dwelling older adults participated; 103 had been diagnosed with hypertension. The results showed that older adults who had higher levels of processing capacity or knowledge (domain-general or health) performed better on both of the health literacy measures. Processing capacity interacted with knowledge: Processing capacity had a lower level of association with health literacy for participants with more knowledge than for those with lower levels of knowledge, suggesting that knowledge may offset the effects of processing capacity limitations on health literacy. Furthermore, performance on the two health literacy measures appeared to reflect a different weighting for the three types of abilities. S-TOFHLA performance reflected processing capacity as well as general knowledge, whereas performance on the REALM depended more on general and health knowledge than on processing capacity. The findings support a process-knowledge model of health literacy among older adults, and have implications for selecting health literacy measures in various health care contexts.

A Close Examination of Trait Reactance and Issue Involvement as Moderators of Psychological Reactance Theory

Abstract: This study used psychological reactance theory (PRT) to investigate (a) the effectiveness of 2 message features (freedom-threatening language and character frame) and (b) the role of trait reactance and issue involvement as moderators of a perceived freedom threat. Within the context of organ donation, the results indicated no differences for character frame among the donor, recipient, or waiting list narratives. However, freedom-threatening language was positively associated with a perceived freedom threat. In turn, a perceived freedom threat was positively associated with state reactance, which was inversely, albeit nonsignificantly, associated with organ donation attitudes. Attitudes predicted intentions to be an organ donor. Results also revealed that trait reactance was positively associated with a perceived freedom threat. Although not associated with a freedom threat, issue involvement was positively associated with organ donation attitudes and intent to be a donor. Additionally, a trait reactance ...

Low health literacy and poor health status in Asian Americans and Pacific Islanders in Hawai'i.

Abstract: Health literacy is understudied in Asian Americans/Pacific Islanders (AA/PI). We used a population-based sample in Hawai'i to consider if low health literacy is associated with poor health outcomes in Japanese, Filipino, Native Hawaiians, and other AA/PI groups compared with Whites. In data weighted and adjusted for population undercounts and complex survey design, low health literacy varied significantly by group, from 23.9% among Filipinos, 20.6% in Other AA/PI, 16.0% in Japanese, 15.9% in Native Hawaiians, and 13.2% in Whites (χ(2) (4) = 52.22; p < .001). In multivariate models, low health literacy was significantly associated with (a) poor self-reported health in Japanese, Filipinos, Other AA/PI, and Whites; (b) diabetes in Hawaiians and Japanese; and (c) depression for Hawaiians. Low health literacy did not significantly predict overweight/obesity in any ethnic grouping in multivariate models. The design and relevance of health literacy interventions, as well as the pathways that link health literacy to health status, may vary by race/ethnicity, culture, and health outcomes.

Including Limitations in News Coverage of Cancer Research: Effects of News Hedging on Fatalism, Medical Skepticism, Patient Trust, and Backlash

Abstract: Past research has demonstrated that news coverage of cancer research, and scientific research generally, rarely contains discourse-based hedging, including caveats, limitations, and uncertainties. In a multiple message experiment (k = 4 news stories, N = 1082), the authors examined whether hedging shaped the perceptions of news consumers. The results revealed that participants were significantly less fatalistic about cancer (p = .039) and marginally less prone to nutritional backlash (p = .056) after exposure to hedged articles. Participants exposed to articles mentioning a second researcher (unaffiliated with the present study) exhibited greater trust in medical professions (p = .001). The findings provide additional support for the inclusion of discourse-based hedging in cancer news coverage and suggest that news consumers will use scientific uncertainty in illness representations.

The Economic Effect of Noncommunicable Diseases on Households and Nations: A Review of Existing Evidence

Abstract: In developing countries, the noncommunicable disease (NCD) and risk factor burdens are shifting toward the poor. Treating chronic diseases can be expensive. In developing countries where generally much health care costs are borne by patients themselves, for those who live in poverty or recently escaped severe poverty, when faced with large, lifelong out-of-pocket expenses, impoverishment persists or can reoccur. These patterns have implications for national economic growth and poverty-reduction efforts. NCDs can change spending patterns dramatically and result in significantly reducing non-medical-related spending on food and education. In India, about 40% of household expenditures for treating NCDs are financed by households with distress patterns (borrowing and sales of assets). NCD short- and long-term disability can lead to a decrease in working-age population participation in the labor force and reduce productivity and, in turn, reduce per capita gross domestic product growth. To fully capitalize on the demographic dividend (i.e., aging of the population resulting in less dependent children, not yet more dependent elderly, and greater national productivity), healthy aging is necessary, which, in turn, requires effectively tackling NCDs. Last, from an equity standpoint, the economic effect of NCDs, evident at the household level and at the country level, will disproportionately affect the poor and vulnerable populations in the developing world.

Dissemination 2.0: closing the gap between knowledge and practice with new media and marketing.

Abstract: Despite substantial investments in public health and clinical research at the national level, and significant advancements in these areas of science, few evidence-based programs and services are rapidly implemented in health care or public health practice as a result of failures of dissemination. A significant gap in current processes to disseminate and implement effective programs relates to the lack of systems and infrastructure to facilitate distribution of scientific research products to potential end users, including clinicians and other practitioners. In this article, the authors assert that Web 2.0 technologies can be leveraged to enhance dissemination efforts and increase the implementation of evidence-based programs and services in everyday practice. The authors describe the research-to-practice delivery process and highlight gaps in the supply chain necessary to translate research findings into evidence-based practice. The authors critically evaluate the 4 most prominent strategies currently use...

Literacy and retention of information after a multimedia diabetes education program and teach-back

Abstract: Few studies have examined the effectiveness of teaching strategies to improve patients' recall and retention of information. As a next step in implementing a literacy-appropriate, multimedia diabetes education program (MDEP), the present study reports the results of two experiments designed to answer (a) how much knowledge is retained 2 weeks after viewing the MDEP, (b) does knowledge retention differ across literacy levels, and (c) does adding a teach-back protocol after the MDEP improve knowledge retention at 2-weeks' follow-up? In Experiment 1, adult primary care patients (n = 113) watched the MDEP and answered knowledge-based questions about diabetes before and after viewing the MDEP. Two weeks later, participants completed the knowledge assessment a third time. Methods and procedures for Experiment 2 (n = 58) were exactly the same, except that if participants answered a question incorrectly after watching the MDEP, they received teach-back, wherein the information was reviewed and the question was asked again, up to two times. Two weeks later, Experiment 2 participants completed the knowledge assessment again. Literacy was measured using the S-TOFHLA. After 2 weeks, all participants, regardless of their literacy levels, forgot approximately half the new information they had learned from the MDEP. In regression models, adding a teach-back protocol did not improve knowledge retention among participants and literacy was not associated with knowledge retention at 2 weeks. Health education interventions must incorporate strategies that can improve retention of health information and actively engage patients in long-term learning.

The art and science of patient storytelling-harnessing narrative communication for behavioral interventions: the ACCE project.

Abstract: Narrative communication is an emerging form of persuasive communication used in health education to solicit actual patient stories. Eliciting a narrative is an open-ended process and may or may not map to desired intervention objectives or underlying behavioral constructs. In addition, incorporating actual, unscripted narratives into multimedia interventions is challenging. The authors evaluated a protocol of editing narratives for a multimedia intervention to promote smoking cessation in the African American community that maintains fidelity to the original message and was related to behavioral constructs from social cognitive theory. The authors used four steps: (a) narrative collection (videotaping), (b) narrative review (rating of content), (c) narrative editing (documentary style), and (d) pilot testing (usability and assessment of transportation). The authors videotaped 50 personal smoking cessation narratives. After coding for presence of theoretical constructs, perceived risks of smoking (present in 53% of narratives) was the most common related behavioral construct. Four narratives were chosen for inclusion in the DVD. Pilot testing showed viewers reported high level of transportation into the narrative. The authors found that some behavioral constructs were rare and difficult to solicit in this population but that the final product was engaging to the viewers. Lessons learned may be useful for other video-based behavioral interventions that incorporate personal narratives.

Source Selection in Prescription Drug Information Seeking and Influencing Factors: Applying the Comprehensive Model of Information Seeking in an American Context

Abstract: This study investigates source selection in prescription drug information seeking and influencing factors on selection and seeking behaviors applying a modified Comprehensive Model of Information Seeking in an American context. Survey results suggest consumers engage in prescription drug information search before and after visiting a doctor, but search is not extensive. Consumers turn to the Internet, pharmacists, and doctors most frequently for prescription drug information. Information-seeking behaviors are rather universal across demographic and health-related characteristics; however, higher income consumers are more likely to search. Although our study shows some support for the modified Comprehensive Model of Information Seeking, the results indicate influencing factors vary by information source types examined, suggesting the model is more complex than predicted. The study advances research on health communication, information-seeking behaviors, and prescription drug decision making.

Reducing salt intake in the Americas: Pan American Health Organization actions

Abstract: This article outlines the rationale for reducing dietary salt and some of the Pan American Health Organization actions to facilitate reductions in dietary salt in the Americas Excessive dietary salt (sodium chloride and other sodium salts) is a major cause of increased blood pressure, which increases risk for stroke, heart disease, and kidney disease Reduction in salt intake is beneficial for people with hypertension and those with normal blood pressure The World Health Organization recommends a population salt intake of less than 5 grams/person/day with a Pan American Health Organization expert group recommendation that this be achieved by 2020 in the Americas In general, the consumption of salt is more than 6 grams/day by age 5 years, with consumption of salt averaging between 9 and 12 grams per day in many countries Recent salt intake estimates from Brazil (11 grams of salt/day), Argentina (12 grams of salt/day), Chile (9 grams of salt/day) and the United States (87 grams of salt/day) confirm that high salt intakes are prevalent in Americas Sources of dietary salt vary, from 75% of it coming from processed food in developed countries, to 70% coming from discretionary salt added in cooking or at the table in parts of Brazil The Pan American Health Organization has launched a regionwide initiative called the ?Cardiovascular Disease Prevention Through Dietary Salt Reduction,? led by an expert working group Working closely with countries, the expert group developed resources to aid policy development through five subgroups: (a) addressing industry engagement and product reformulation; (b) advocacy and communication; (c) surveillance of salt intake, sources of salt in the diet, and knowledge and opinions on salt and health; (d) salt fortification with iodine; and (e) national-level health economic studies on salt reduction