Informing Men about Prostate Cancer Screening: A Randomized Controlled Trial of Patient Education Materials Informed consent document improvement does not increase patients' comprehension in biomedical research. Functional health literacy mediates the relationship between socio-economic status, perceptions and lifestyle behaviors related to cancer risk in an Australian population. Informed consent for cataract surgery: Patient understanding of verbal, written, and videotaped information Association between low functional health literacy and mortality in older adults: longitudinal cohort study Communicating global cardiovascular risk: are icon arrays better than numerical estimates in improving understanding, recall and perception of risk? The use of illustration to improve older adults' comprehension of health-related information: is it helpful? An advance directive redesigned to meet the literacy level of most adults: a randomized trial. Patient education in rheumatoid arthritis: the effectiveness of the ARC booklet and the mind map. Evaluation of Language Concordant, Patient-Centered Drug Label Instructions The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. A multimedia patient education program on colorectal cancer screening increases knowledge and willingness to consider screening among Hispanic/Latino patients. Interpretation of Medication Pictograms by Adults in the UK Comparing narrative and informational videos to increase mammography in low-income African American women. Alternate Methods of Framing Information About Medication Side Effects: Incremental Risk Versus Total Risk of Occurrence The effects of two health information texts on patient recognition memory: a randomized controlled trial. Patient education about anticoagulant medication: is narrative evidence or statistical evidence more effective? Entertainment education for prostate cancer screening: a randomized trial among primary care patients with low health literacy. A randomised study of three different informational AIDS prior to coronary angiography, measuring patient recall, satisfaction and anxiety. A community-based randomised controlled trial of three different educational resources for men about prostate cancer screening. Lower Health Literacy is Associated with Poorer Health Status and Outcomes in Chronic Obstructive Pulmonary Disease Comparison of two enhanced consent procedures for patients with mild Alzheimer disease or mild cognitive impairment.
Background Patient education material s can assist patient decision making on prostate cancer screening . Objective To explore the effectiveness of presenting health information on prostate cancer screening using video , internet , and written interventions on patient decision making , attitudes , knowledge , and screening interest . Design R and omized controlled trial . Participants A total of 161 men aged over 45 , who had never been screened for prostate cancer , were r and omized to receive information on prostate cancer screening . Measurements Participants were assessed at baseline and 1-week postintervention for decisional conflict , screening interest , knowledge , anxiety , and decision-making preference . Results A total of 156 men were followed-up at 1-week postintervention . There was no statistical , or clinical , difference in mean change in decisional conflict scores between the 3 intervention groups ( video vs internet −0.06 [ 95 % CI −0.24 to 0.12 ] ; video vs pamphlet 0.04 [ 95%CI −0.15 to 0.22 ] ; internet vs pamphlet 0.10 [ 95%CI −0.09 to 0.28 ] ) . There was also no statistically significant difference in mean knowledge , anxiety , decision-making preference , and screening interest between the 3 intervention groups . Conclusion Results from this study indicate that there are no clinical ly significant differences in decisional conflict when men are presented health information on prostate cancer screening via video , written material s , or the internet . Given the equivalence of the 3 methods , other factors need to be considered in deciding which method to use . Health professionals should provide patient health education material s via a method that is most convenient to the patient and their preferred learning style AIMS International guidelines on ethics in biomedical research require that the informed consent of all enrolled participants is obtained . A written document describing the research , the informed consent ( IC ) document , must be given to all participants by the investigator . Most IC documents are long , containing much information . The aim of the present study was to determine whether the modification of the IC document by a working group or systematic improvement in its lexicosyntactic readability can improve comprehension of the written information given to patients participating in biomedical research . METHODS One hundred and fifty-nine patients were r and omized to read one of the three versions of the IC document : unchanged document , document modified using systematic improvement of lexicosyntactic readability and document modified by a working group . RESULTS Neither the improvement in the lexicosyntactic readability , nor the intervention of the working group significantly improved the score of objective comprehension for the subjects included in this study : it was 66.6 ( 95 % confidence interval 64.0 , 69.2 ) for the control group , 68.8 ( 66.2 , 71.4 ) for the group with the document improved for lexicosyntactic readability and 69.2 ( 66.0 , 72.4 ) for the group who read the document improved by the working group ( P= 0.38 ) . CONCLUSIONS We failed to show that improving IC document comprehension through a lexicosyntactic approach or by a working group leads to better comprehension OBJECTIVE To determine if functional health literacy ( FHL ) mediates the relationship between socio-economic status , and perception of the risk of lifestyle behaviors for cancer . METHODS Cross-sectional , r and om population survey , 2824 people aged ≥15 years , September-October 2008 , included newest vital sign measure of FHL . RESULTS Less than adequate FHL occurred in 45.1 % . People who perceived behavioral factors ( smoking , diet , obesity , alcohol , physical activity ) to be not important , or did not know if they were important cancer risks , were more likely to have inadequate FHL . In a logistic regression model adjusted for age , gender , education , income , occupation , country of birth and area of residence , inadequate FHL was associated with 2 - 3 ( OR=1.9 ; 95 % CI : 1.2 - 3.0 ) and 4 or more self-reported lifestyle risk factors ( OR=2.8 ; 95 % CI : 1.6 - 5.0 ) . In a structural equation model of the relationship of socio-economic status , perceptions of risk and behaviors there was significant mediation effect of FHL on the path from SES to health perceptions , estimated 29.4 % of the total effect . CONCLUSION A specific focus on the literacy dem and s made on individuals from health promotion and material s with a view to improving health communication is indicated . PRACTICE IMPLICATION S Health literacy is important for health promotion PURPOSE : To determine the effectiveness of verbal , written , and videotaped descriptions of cataract surgery on patients ’ underst and ing of the risks , benefits , and treatment alternatives . SETTING : Veterans Affairs Boston Healthcare System , Boston , Massachusetts , USA . DESIGN : R and omized prospect i ve study . METHODS : Patients eligible for cataract surgery were r and omized into 1 of 4 arms of the informed consent process as follows : Group 1 , conventional verbal information ; Group 2 , conventional verbal information plus second‐ grade reading level brochure ; Group 3 , conventional verbal information plus eighth‐ grade reading level brochure ; Group 4 , conventional verbal information plus American Academy of Ophthalmology DVD Underst and ing Cataract Surgery : Patient Education DVD Featuring an Aid to Informed Consent . After the informed consent process , patients in each group completed a 12‐ question question naire discussing the surgical procedure , its benefits , its foreseeable and unforeseeable risks , and the alternatives to cataract surgery . Scores in each group were calculated as the number of correct responses out of 12 questions . RESULTS : Patients in Group 2 ( mean score 10.8 ± 1.29 [ SD ] ) and Group 4 ( mean score 10.56 ± 1.44 ) scored significantly higher than patients in Group 1 ( mean score 7.68 ± 2.80 ) or Group 3 ( mean score 9.08 ± 1.60 ) . Previous cataract surgery and education level had no significant influence on recall of the informed‐consent process . CONCLUSIONS : Concise informed consent information sheets at lower reading grade levels and videotape presentation optimized patient underst and ing of the risks , benefits , and treatment alternatives to cataract surgery . The cost – benefit of these results is important because better patient underst and ing has the potential to decrease the risk for indemnity payments awarded because of inadequate informed consent . Financial Disclosure : No author has a financial or proprietary interest in any material or method mentioned Objective To investigate the association between low functional health literacy ( ability to read and underst and basic health related information ) and mortality  in older adults . Design Population based longitudinal cohort study based on a stratified r and om sample of households . Setting Engl and . Participants 7857 adults aged 52 or more who participated in the second wave ( 2004 - 5 ) of the English Longitudinal Study of Ageing and survived more than 12 months after interview . Participants completed a brief four item test of functional health literacy  , which assessed underst and ing of written instructions for taking an aspirin tablet . Main outcome measure Time to death , based on all cause mortality through October 2009 . Results Health literacy was categorised as high ( maximum score , 67.2 % ) , medium ( one error , 20.3 % ) , or low ( more than one error , 12.5 % ) . During follow-up ( mean 5.3 years ) 621 deaths occurred : 321 ( 6.1 % ) in the high health literacy category , 143 ( 9.0 % ) in the medium category , and 157 ( 16.0 % ) in the low category . After adjusting for personal characteristics , socioeconomic position , baseline health , and health behaviours , the hazard ratio for all cause mortality for participants with low health literacy was 1.40 ( 95 % confidence interval 1.15 to 1.72 ) and with medium health literacy was 1.15 ( 0.94 to 1.41 ) compared with participants with high health literacy . Further adjustment for cognitive ability reduced the hazard ratio for low health literacy to 1.26 ( 1.02 to 1.55 ) . Conclusions A third of older adults in Engl and have difficulties reading and underst and ing basic health related written information . Poorer underst and ing is associated with higher mortality . The limited health literacy capabilities within this population have implication s for the design and delivery of health related services for older adults in Engl and OBJECTIVE Experts recommend that adults have their global cardiovascular risk assessed . We investigated whether icon arrays increase underst and ing , recall , perception of CVR , and behavioral intent as compared with numerical information . METHODS Male outpatient veterans , at an intermediate to high cardiovascular risk participated in a r and omized controlled trial of a computer tutorial presenting individualized risk . Message format was presented in 3 formats : percentages , frequencies , and frequencies with icon arrays . We assessed underst and ing immediately ( T1 ) and recall at 20 min ( T2 ) and 2 weeks ( T3 ) after the intervention . We assessed perceptions of importance /seriousness , intent to adhere , and self-efficacy at T1 . Self-reported adherence was assessed at T3 . RESULTS One-hundred and twenty male veterans participated . Age , education , race , health literacy and numeracy were comparable at baseline . There were no differences in underst and ing at T1 [ p = .31 ] and recall at T3 [ p = .10 ] . Accuracy was inferior with frequencies with icon arrays than percentages or frequencies at T2 [ p ≤ .001 ] . There were no differences in perception of seriousness and importance for heart disease , behavioral intent , self-efficacy , actual adherence and satisfaction .  CONCLUSION Icon arrays may impair short-term recall of CVR . PRACTICE IMPLICATION S Icon arrays will not necessarily result in better underst and ing and recall of medical risk in all patients OBJECTIVE To examine whether explanatory illustrations can improve older adults '  comprehension of written health information . METHODS Six short health-related texts were selected from websites and pamphlets . Young and older adults were r and omly assigned to read health-related texts alone or texts accompanied by explanatory illustrations .  Eye movements were recorded while reading . Word recognition , text comprehension , and comprehension of the illustrations were assessed after reading . RESULTS Older adults performed as well as or better than young adults on the word recognition and text comprehension measures . However , older adults performed less well than young adults on the illustration comprehension measures . Analysis of readers ' eye movements showed that older adults spent more time reading illustration-related phrases and fixating on the illustrations than did young adults , yet had poorer comprehension of the illustrations . CONCLUSION Older adults might not benefit from text illustrations because illustrations can be difficult to integrate with the text . PRACTICE IMPLICATION S Health practitioners should not assume that illustrations will increase older adults ' comprehension of health information OBJECTIVE To determine whether an advance directive re design ed to meet most adults ' literacy needs ( fifth grade reading level with graphics ) was more useful for advance care planning than a st and ard form ( > 12th grade level ) . METHODS We enrolled 205 English and Spanish-speaking patients , aged > /=50 years from an urban , general medicine clinic . We r and omized participants to review either form . Main outcomes included acceptability and usefulness in advance care planning . Participants then review ed the alternate form ; we assessed form preference and six-month completion rates . RESULTS Forty percent of enrolled participants had limited literacy . Compared to the st and ard form , the re design ed form was rated higher for acceptability and usefulness in care planning , P</=0.03 , particularly for limited literacy participants ( P for interaction < /=0.07 ) . The re design ed form was preferred by 73 % of participants . More participants r and omized to the re design ed form completed an advance directive at six months ( 19 % vs. 8 % , P=0.03 ) ; of these , 95 % completed the re design ed form . CONCLUSIONS The re design ed advance directive was rated more acceptable and useful for advance care planning and was preferred over a st and ard form . It also result ed in higher six-month completion rates . PRACTICE IMPLICATION S An advance directive re design ed to meet most adults ' literacy needs may better enable patients to engage in advance care planning OBJECTIVE To determine the effectiveness of a pictorial ' mind map ' together with the Arthritis Research Campaign ( ARC ) booklet for imparting knowledge to participants with rheumatoid arthritis ( RA ) . Also , we wished to relate this to their reading ability . METHODS We studied 363 participants with RA . Reading ability was assessed using the REALM , and knowledge was assessed using the Knowledge Scale Question naire ( KSQ ) . Information on educational attainment , disease state and levels of anxiety and depression was also collected . Participants were r and omly assigned to receive either the ARC booklet alone or the booklet and the mind map together . RESULTS A significant minority ( 15 % ) of participants were functionally illiterate .  There was a statistically significant increase in knowledge across both groups from baseline to re assessment after they were given the literature , but there was no difference in attainment between the groups . The more literate participants gained more knowledge regardless of the information they were given . They were also significantly less anxious and less depressed . CONCLUSIONS The ARC booklet with or without the mind map was associated with a significant increase in knowledge .  Poor readers had poor educational attainment and poor knowledge acquisition . The information on the mind map was not more accessible to them . Different educational strategies will be necessary to educate these patients ABSTRACT BACKGROUND Despite federal laws requiring language access in healthcare setting s , most US pharmacies are unable to provide prescription ( Rx ) medication instructions to limited English proficient ( LEP ) patients in their native language . OBJECTIVE To evaluate the efficacy of health literacy-informed , multilingual Rx instructions ( the ConcordantRx instructions ) to improve Rx underst and ing , regimen dosing and regimen consolidation in comparison to st and ard , language -concordant Rx instructions . DESIGN R and omized , experimental evaluation . PARTICIPANTS Two hundred and two LEP adults speaking five non-English language s ( Chinese , Korean , Russian , Spanish , Vietnamese ) , recruited from nine clinics and community organizations in San Francisco and Chicago . INTERVENTIONS ubjects were r and omized to review Rx bottles with either ConcordantRx or st and ard instructions . MAIN MEASURES Proper demonstration of common prescription label instructions for single and multi-drug medication regimens . Regimen consolidation was assessed by determining how many times per day subjects would take medicine for a multi-drug regimen . KEY RESULTS Subjects receiving the ConcordantRx instructions demonstrated significantly greater Rx underst and ing , regimen dosing and regimen consolidation in comparison to those receiving st and ard instructions ( incidence rate ratio [ IRR ] : 1.25 , 95 % confidence interval [ CI ] : 1.06 - 1.48 ; P = 0.007 for Rx underst and ing , IRR : 1.19 , 95 % CI : 1.03–1.39 ; P = 0.02 for regimen dosing and IRR : 0.76 , 95 % CI : 0.64–0.90 ; P = 0.001 for regimen consolidation ) . In most cases , instruction type was the sole , independent predictor of outcomes in multivariate models controlling for relevant covariates . CONCLUSIONS There is a need for st and ardized , multilingual Rx instructions that can be implemented in pharmacy practice s to promote safe medication use among LEP patients . The ConcordantRx instructions represent an important step towards achieving this goal OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity OBJECTIVE To test a multimedia patient education program on colorectal cancer ( CRC ) screening that was design ed specifically for the Hispanic/Latino community , and developed with input from community members . METHODS A total of 270 Hispanic/Latino adults , age 50 - 80 years , participated in Spanish for all phases of this pretest-posttest design . Patients were r and omly assigned to a version of the multimedia program that opened with either a positive or negative introductory appeal . Structured interviews assessed screening relevant knowledge ( anatomy and key terms , screening options , and risk information ) , past screening behavior , willingness to consider screening options , intention to discuss CRC screening with the doctor , and reactions to the multimedia patient education program .  RESULTS The multimedia program significantly increased knowledge of anatomy and key terms ( e.g. , polyp ) , primary screening options ( FOBT , flexible sigmoidoscopy , colonoscopy ) , and risk information as well as willingness to consider screening ( p<.001 for all ) . No significant differences emerged between positive and negative introductory appeals on these measures , intention to discuss CRC screening with their doctor , or rating the multimedia program . CONCLUSION Multimedia tools developed with community input that are design ed to present important health messages using graphics and audio can reach Hispanic/Latino adults across literacy levels and ethnic background s. Additional research is needed to determine effects on actual screening behavior . PRACTICE IMPLICATION S Despite promising results for engaging a difficult-to-reach audience , the multimedia program should not be considered a st and -alone intervention or a substitute for communication with physicians . Rather , it is a priming mechanism intended to prepare patients for productive discussion s of CRC screening BACKGROUND Patients ' ability to underst and information about medication is crucial for safety and effectiveness . Rates of illiteracy worldwide indicate that written information alone can not meet many patients ' needs . Medication pictograms are an alternative , but may be culturally sensitive . Previous testing has used large pictograms , which are impractical for conventional drug information formats . OBJECTIVE To compare 2 sets of pictograms for instructions or warnings ( from the US and South Africa ) for underst and ability by adults in the UK and examine the effects of pictogram size and repeat presentation on underst and ability among older adults . METHODS In the first part of the study , 160 adults ( aged 17–83 y ) review ed and interpreted 10 pictograms .  In the second , 67 older adults ( aged 65–96 y ) were r and omly assigned to review 10 small or large pictograms . After giving their interpretation , they were informed of the correct meaning . One week later , they were shown the same pictograms and gave their interpretation . RESULTS The pictograms for the 10 different instructions and warnings showed great variation in interpretation rates ( 7.5–90 % ) , with few significant differences between the US and South African versions . Only 3 were understood by ≥85 % of the population . Pictograms performed significantly better if they were larger and at the second presentation . CONCLUSIONS Pictograms have the potential to help patients underst and information on drug therapy . This study shows that some existing pictograms are not easily interpreted and that testing is needed before their implementation . A reduction in their size to allow incorporation into conventional written formats may cause additional problems for patients OBJECTIVE Compare effects of narrative and informational videos on use of mammography , cancer-related beliefs , recall of core content and a range of reactions to the videos . METHOD African American women ( n=489 ) ages 40 and older were recruited from low-income neighborhoods in St. Louis , MO and r and omly assigned to watch a narrative video comprised of stories from African American breast cancer survivors ( Living Proof ) or a content-equivalent informational video using a more expository and didactic approach ( Facts for Life ) . Effects were measured immediately post-exposure and at 3- and 6-month follow-up . RESULTS The narrative video was better liked , enhanced recall , reduced counterarguing , increased breast cancer discussion s with family members and was perceived as more novel . Women who watched the narrative video also reported fewer barriers to mammography , more confidence that mammograms work , and were more likely to perceive cancer as an important problem affecting African Americans .  Use of mammography at 6-month follow-up did not differ for the narrative vs. informational groups overall ( 49 % vs. 40 % , p=.20 ) , but did among women with less than a high school education ( 65 % vs. 32 % , p<.01 ) , and trended in the same direction for those who had no close friends or family with breast cancer ( 49 % vs. 31 % , p=.06 ) and those who were less trusting of traditional cancer information sources ( 48 % vs. 30 % , p=.06 ) . CONCLUSIONS Narrative forms of communication may increase the effectiveness of interventions to reduce cancer health disparities . PRACTICE IMPLICATION S Narratives appear to have particular value in certain population sub-groups ; identifying these groups and matching them to specific communication approaches may increase effectiveness Communications of treatment risk , such as medication package inserts , commonly report total rates of adverse reactions ( e.g. , 4 % get heartburn with placebo , 9 % with medication ) . This approach , however , requires mental arithmetic to distinguish the incremental risk caused by medication ( here , 5 % ) from the total post-treatment risk . In two Internet-administered survey experiments ( N = 2,012 and 1,393 ) , we tested whether explicitly reporting the incremental risk and framing it as the “ additional risk ” of complications influenced people 's impressions of adverse event risks . Study 1 compared side-by-side displays of total risks against sequential presentations that highlighted the incremental risk , using both text and graphical formats . Results showed that incremental risk formats significantly lowered  participants ' worry about complications and reduced biases caused by varying the risk denominator . Study 2 unpacked this factor and showed that its effect on both perceived likelihood and worry derives primarily from the incremental risk framing rather than from sequential presentation . Explicitly reporting incremental risk statistics appears to facilitate recognition of how much risk already exists at baseline . Presenting adverse reaction risks in this manner may improve patient comprehension of the effects of treatment decisions and support effective risk communication OBJECTIVE To compare the effects of two health information texts on patient recognition memory , a key aspect of comprehension . METHODS R and omized controlled trial ( N=60 ) , comparing the effects of  experimental and control colorectal cancer ( CRC ) screening texts on recognition memory , measured using a statement recognition test , accounting for response bias ( score range -0.91 to 5.34 ) . The experimental text had a lower Flesch-Kincaid reading grade level ( 7.4 versus 9.6 ) , was more focused on addressing screening barriers , and employed more comparative tables than the control text . RESULTS Recognition memory was higher in the experimental group ( 2.54 versus 1.09 , t=-3.63 , P=0.001 ) , including after adjustment for age , education , and health literacy ( β=0.42 , 95 % CI : 0.17 , 0.68 , P=0.001 ) , and in analyses limited to persons with college degrees ( β=0.52 , 95 % CI : 0.18 , 0.86 , P=0.004 ) or no self-reported health literacy problems ( β=0.39 , 95 % CI : 0.07 , 0.71 , P=0.02 ) . CONCLUSION An experimental CRC screening text  improved recognition memory , including among patients with high education and self-assessed health literacy . PRACTICE IMPLICATION S CRC screening texts comparable to our experimental text may be warranted for all screening-eligible patients , if such texts improve screening uptake OBJECTIVE To determine the relative impact of incorporating narrative evidence , statistical evidence or both into patient education about warfarin , a widely used oral anticoagulant medication . METHODS 600 patients receiving anticoagulant therapy were r and omly assigned to view one of three versions of a video depicting a physician-patient encounter where anticoagulation treatment was discussed , or usual care ( no video ) . The videos differed in whether the physician used narrative evidence ( patient anecdotes ) , statistical evidence , or both to highlight key information . 317 patients completed both the baseline and post-test question naires . Questions assessed knowledge , beliefs and adherence to medication and laboratory monitoring regimens . RESULTS All three approaches positively effected patients ' warfarin-related knowledge , and beliefs in the importance of lab testing ; there was also some indication that viewing a video strengthened belief in the benefits of warfarin . There was some indication that narrative evidence had a greater impact than statistical evidence on beliefs about the importance of lab testing and on knowledge . No other evidence of the differential effectiveness of either approach was found . No statistically significant effect was found on intent to adhere , or documented adherence to lab monitoring . CONCLUSION Videos depicting a physician-patient dialogue about warfarin were effective in educating patients about anticoagulant medication , and had a positive impact on their beliefs . The use of narrative evidence in the form of patient anecdotes may be more effective than statistical evidence for some patient outcomes . PRACTICE IMPLICATION S Patients on oral anticoagulant therapy may benefit from periodic educational efforts reinforcing key medication safety information , even after initial education and ongoing monitoring . Incorporating patient anecdotes into physician-patient dialogues or educational material s may increase the effectiveness of the message OBJECTIVE To evaluate an entertainment-based patient decision aid for prostate cancer screening among patients with low or high health literacy . METHODS Male primary care patients from two clinical sites , one characterized as serving patients with low health literacy ( n=149 ) and the second as serving patients with high health literacy ( n=301 ) , were r and omized to receive an entertainment-based decision aid for prostate cancer screening or an audiobooklet-control aid with the same learner content but without the entertainment features . Postintervention and 2-week follow-up assessment s were conducted . RESULTS Patients at the low-literacy site were more engaged with the entertainment-based aid than patients at the high-literacy site . Overall , knowledge improved for all patients . Among patients at the low-literacy site , the entertainment-based aid was associated with lower decisional conflict and greater self-advocacy ( i.e. , mastering and obtaining information about screening ) when compared to patients given the audiobooklet . No differences between the aids were observed for patients at the high-literacy site . CONCLUSION Entertainment education may be an effective strategy for promoting informed decision making about prostate cancer screening among patients with lower health literacy . PRACTICE IMPLICATION S As barriers to implementing computer-based patient decision support programs decrease , alternative models for delivering these programs should be explored BACKGROUND Informed consent is a basic st and ard of care for all patients undergoing medical procedures , but recall of information has been shown to be poor . We sought to compare verbal , written and animated audiovisual information delivery , during consent for coronary angiography , by measuring improvement in recall . METHOD A sample population of 99 cardiac patients at Flinders Medical Centre was r and omised ( 1:1:1 ) to receive one of three information delivery methods . The information content was st and ardised by a risk proforma , which explained the procedure and defined 12 specific risks . Recall , satisfaction and anxiety were assessed by a question naire administered at three different time points : post-consent , post-procedure and at 30 days . Effect of delivery method on satisfaction and anxiety was rated on a self-reported scale from 1 - 5 , with 5 representing very satisfied or very anxious . Groups were compared by non-parametric testing and a p-value of < 0.05 was considered statistically significant . RESULTS Patients were a median age of 64 ( i.q.r . 56 , 72 ) years . Information delivery method had no effect on recall of risks at any time-point ( p=0.2 , 0.7 , 0.5 , respectively ) and the average recall score across the population was 3 - 4 out of 12 . There was no significant effect on median satisfaction scores : verbal ; 5 ( i.q.r.4 , 5 ) versus written/audiovisual ; 4 ( i.q.r.4 , 5 ) ( p = ns ) , or on median anxiety scores : verbal ; 3 ( i.q.r.2 , 4 ) versus written/audiovisual ; 3 ( i.q.r.2 , 4 ) ( p = ns ) . CONCLUSION Despite careful design of an innovative audiovisual delivery technique aim ed at optimising comprehension and aiding memory , recall of information was poor and informational aids showed no improvement . Modes of information delivery are not the key to patient assimilation of complex medical information R and omised evaluations of re sources to facilitate informed decisions about prostate cancer screening are rarely conducted . In this study , 421 men recruited from the community were r and omly allocated to receive a leaflet ( n = 140 ) or one of two re sources meeting criteria for a decision-aid : a video ( n = 141 ) or an evidence -based booklet , developed by the authors ( n = 140 ) . Men in all three groups demonstrated significant increases in knowledge scores from pre to post-test . Scores were significantly higher at post-test amongst those who had received our evidence -based booklet compared with men who received the leaflet or video ( P < 0.001 ) . Scores were significantly modified by men 's preferences for decisional control ( P = 0.002 ) . Decisional conflict was significantly lower amongst men receiving the evidence -based booklet ( P = 0.038 ) . Men receiving the evidence -based booklet also were less likely to accept a recommendation by a GP to undergo prostate-specific-antigen ( PSA ) screening ( P = 0.003 ) . Men require detailed information about the pros and cons of PSA screening in order to make an informed decision . Re sources are not equivalent in achieving these outcomes ABSTRACT BACKGROUND Limited health literacy is associated with poor outcomes in many chronic diseases , but little is known about health literacy in chronic obstructive pulmonary disease ( COPD ) . OBJECTIVE To examine the associations between health literacy and both outcomes and health status in COPD . PARTICIPANTS , DESIGN AND MAIN MEASURES Structured interviews were administered to 277 subjects with self-report of physician-diagnosed COPD , recruited through US r and om-digit telephone dialing . Health literacy was measured with a vali date d three-item battery . Multivariable linear regression , controlling for sociodemographics including income and education , determined the cross-sectional associations between health literacy and COPD -related health status : COPD Severity Score , COPD Helplessness Index , and Airways Question naire-20R [ measuring respiratory-specific health-related quality of life ( HRQoL ) ] . Multivariable logistic regression estimated associations between health literacy and COPD -related hospitalizations and emergency department ( ED ) visits . KEY RESULTS Taking socioeconomic status into account , poorer health literacy ( lowest tertile compared to highest tertile ) was associated with : worse COPD severity ( + 2.3 points ; 95 % CI 0.3–4.4 ) ; greater COPD helplessness ( + 3.7 points ; 95 % CI 1.6–5.8 ) ; and worse respiratory-specific HRQoL ( + 3.5 points ; 95 % CI 1.8–4.9 ) . Poorer health literacy , also controlling for the same covariates , was associated with higher likelihood of COPD -related hospitalizations ( OR = 6.6 ; 95 % CI 1.3–33 ) and COPD -related ED visits ( OR = 4.7 ; 95 % CI 1.5–15 ) . Analyses for trend across health literacy tertiles were statistically significant ( p < 0.05 ) for all above outcomes . CONCLUSIONS Independent of socioeconomic status , poor health literacy is associated with greater COPD severity , greater COPD helplessness , worse respiratory-specific HRQoL , and higher odds of COPD -related emergency health-care utilization . These results underscore that COPD patients with poor health literacy may be at particular risk for poor health-related outcomes OBJECTIVE The objective of this study was to evaluate the feasibility , acceptability , and preliminary efficacy of two enhanced consent procedures provided to patients with Alzheimer disease or mild cognitive impairment that used either a PowerPoint presentation or an enhanced printed consent form . METHODS Patients r and omly assigned to an  enhanced written consent procedure or slideshow presentation were assessed with the MacArthur Competence Assessment Tool for Clinical Research . RESULTS Verbal reexplanation was associated with improved underst and ing in both conditions . Level of underst and ing did not significantly differ between the two consent groups , but administration time for slideshow presentation was less than that for an enhanced written consent procedure . CONCLUSION Enhanced consent procedures are feasible and useful for consent to research among patients with mild cognitive impairment or mild Alzheimer disease
A systematic review was conducted to assess the available evidence for the effectiveness of interventions aim ing to improve the comprehensibility of health-related documents in older adults ( ≥50 ) with different levels of health literacy .