bims-paceca Biomed News
on Patient-centred care
Issue of 2022‒09‒11
fifteen papers selected by
Rob Penfold
Queensland Health
  1. "You have to have a level of trust": consumer-described health literacy barriers and enablers to engaging with healthcare professionals.
  2. The Importance of Health Literacy in Addressing Eye Health and Eye Care Disparities.
  3. Self-report instruments for measuring patient dignity: A psychometric systematic review.
  4. Communication between parents and neonatal healthcare professionals using pictorial support when language barriers exist - parents' experiences.
  5. Patient-identified priorities for successful partnerships in patient-oriented research.
  6. Surgeon Perceptions of the Integration of Patient-Reported Outcome Measures into Clinical Practice.
  7. What constitutes a quality community aged care service-client perspectives: An international scoping study.
  8. Patients' Preference for Participation in Medical Decision-Making: Secondary Analysis of the BEDSIDE-OUTSIDE Trial.
  9. Designing Hospitals Through the Lens of Universal Design. An Evaluation Tool to Enhance Inclusive Healthcare Facilities.
  10. The impact of implementing patient-reported measures in routine maternity care: a systematic review.
  11. Older adults can use technology: why healthcare professionals must overcome ageism in digital health.
  12. Patient and Family Representation in Randomized Clinical Trials Published in 3 Medical and Surgical Journals: A Systematic Review.
  13. Deprescribing practices in Canada: A scoping review.
  14. Considering health literacy in cardiovascular disease management: a qualitative study on healthcare professionals' and patients' perspectives.
  15. Missing the Bigger Picture: The Need for More Research on Visual Health Misinformation.
  1. Health Promot J Austr. 2022 Sep 07.
    "You have to have a level of trust": consumer-described health literacy barriers and enablers to engaging with healthcare professionals.
    H Wood, D Benino, G Brand, R Clifford, K Lee, L Seubert.
      ISSUE ADDRESSED: Health literacy - the degree to which people can access, understand and use health information - is essential for shared decision-making and improved health outcomes. Health consumers' ability to engage with healthcare professionals (HCPs) is influenced by their health literacy capabilities. This research sought to understand health literacy-related barriers and enablers to engaging with non-physician HCPs as experienced by consumers.METHODS: A qualitative descriptive approach was undertaken. A semi-structured interview guide was used, incorporating five health literacy domains described in the Health Literacy Questionnaire that related to consumers' engagement with health professionals. Audio- or digitally-recorded interviews were conducted with Australian health consumers, and transcribed and themed using the Patient-centred Access to Care framework as a template.
    RESULTS: Interviewing 30 consumers revealed that HCPs' clinical skills often enabled consumers to seek engagement; however during active engagement their interpersonal skills became a key enabler. Conversely, a lack of developed interpersonal skills in HCPs was frequently seen as a barrier to consumer engagement. Barriers to engagement were also created when HCPs' information did not match what consumers discovered from other sources. However, consumers self-reported that they were unable to appraise health information at least some of the time.
    CONCLUSION: Barriers and enablers to consumers' engagement with HCPs were identified across each of the five relevant health literacy domains.
    Keywords:  Health literacy; capacity building; competencies; health behaviours
    DOI:  https://doi.org/10.1002/hpja.659
  2. Ophthalmology. 2022 Aug 18. pii: S0161-6420(22)00495-X. [Epub ahead of print]
    The Importance of Health Literacy in Addressing Eye Health and Eye Care Disparities.
    Hilda Capó, Jane C Edmond, Chrisfouad R Alabiad, Ahmara G Ross, Basil K Williams, César A Briceño.
      Disparities in eye health and eye care frequently result from a lack of understanding of ocular diseases and limited use of ophthalmic health services by various populations. The purpose of this article is to describe the principle of health literacy and its central role in enhancing health, and how its absence can result in poorer health outcomes. The article evaluates the current status of health literacy in visual health and disparities that exist among populations. It also explores ways to improve health literacy as a means of reducing disparities in visual health and eye care. Advancing dissemination of health information and enhancing health literacy may help not only to reduce healthcare barriers in the underserved populations but also to lessen visual health disparities.
    Keywords:  Organizational health literacy; Personal health literacy; Visual health disparities
    DOI:  https://doi.org/10.1016/j.ophtha.2022.06.034
  3. J Adv Nurs. 2022 Sep 07.
    Self-report instruments for measuring patient dignity: A psychometric systematic review.
    Le Trinh Lam, Hsin-Yi Chang, Dhea Natashia, Wei-Shu Lai, Miaofen Yen.
      AIMS: To synthesize and evaluate the psychometric properties of self-report instruments that measure patient dignity.DESIGN: A psychometric systematic review.
    DATA SOURCES: A comprehensive search of studies published from inception until February 17, 2022, was performed using PubMed, Embase, CINAHL, Web of Science, and Scopus.
    REVIEW METHODS: The methodological quality of the psychometric studies was evaluated following the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines.
    RESULTS: Eleven self-report instruments that evaluate dignity were identified. For most instruments, psychometric properties, including reliability, cross-cultural validity, responsiveness, and measurement error, had not been adequately examined. The Patient Dignity Inventory (PDI), the Jacelon's Attributed Dignity Scale (JADS), and the Inpatient Dignity Scale (IPDS) had acceptable content validity, structure validity, and internal consistency to measure dignity among adult patients under palliative care, community-dwelling older adults, and inpatients receiving daily care.
    CONCLUSION: The PDI, the JADS, and the IPDS are recommended for future clinical practice and research to measure dignity among adult patients under palliative care, community-dwelling older adults, and inpatients receiving daily care. Early identification of patients' dignity-related problems in nursing care can prevent negative health outcomes and help develop a timely intervention to promote patients' health and recovery.
    IMPACT: Given that the psychometric properties of the existing self-report dignity instruments have not been systematically assessed, the present review utilized comprehensive methods according to COSMIN to evaluate and determine the most appropriate measure for research and practice. The PDI, the JADS, and the IPDS demonstrated satisfactory psychometric properties and are, thus, recommended for clinical and research applications. Nursing professionals can employ these instruments to assess and promptly identify dignity issues among both young and older adults in hospitals and communities.
    Keywords:  COSMIN; human dignity; nursing; psychometrics; respect; systematic review
    DOI:  https://doi.org/10.1111/jan.15436
  4. Int J Qual Stud Health Well-being. 2022 Dec;17(1): 2122151
    Communication between parents and neonatal healthcare professionals using pictorial support when language barriers exist - parents' experiences.
    Eva-Karin Gotting, Ulrika Ferm, Helena Wigert.
      PURPOSE: Families arriving in Sweden after being forced to flee their home need health care. Communication is a key component to establishing good care relations and becomes difficult when there are language barriers between families and healthcare professionals. In the context of neonatal care, communication is carried out with parents. The aim of the study was to describe parents' experiences of communication with neonatal healthcare professionals and using pictorial support when language barriers exist.METHOD: The study takes a qualitative approach based on seventeen interviews with parents who had experienced neonatal ward. Qualitative content analysis was used.
    RESULTS: The parents needed to communicate through supports, which caused distress and misunderstanding. The relationship between parents and the healthcare professionals affected the communication. Pictorial support was used to different degrees. Four categories were identified from the data analysis: Communicating through supports, Facing barriers in communication, Facing external influences and The need for a good healthcare relationship.
    CONCLUSION: The present study is the first to describe parents' experience with using the pictorial support developed in the project KomHIT Refugee and therefore fulfils the function of being a first evaluation of the pictures from parents' perspective.
    Keywords:  Communication; interpreters; interviews; language barriers; pictorial support
    DOI:  https://doi.org/10.1080/17482631.2022.2122151
  5. Res Involv Engagem. 2022 Sep 07. 8(1): 49
    Patient-identified priorities for successful partnerships in patient-oriented research.
    Maria J Santana, D'Arcy Duquette, Paul Fairie, Ingrid Nielssen, Sumedh Bele, Sadia Ahmed, Tiffany Barbosa, Sandra Zelinsky.
      Albertans4HealthResearch, supported by the Alberta Strategy for Patient-Oriented Research Patient Engagement Team, hosted a virtual round table discussion to develop a list of considerations for successful partnerships in patient-oriented research. The group, which consists of active patient partners across the Canadian province of Alberta and some research staff engaged in patient-oriented research, considered advice for academic researchers on how to best partner with patients and community members on health research projects. The group identified four main themes, aligned with the national strategy for patient-oriented research (SPOR) patient engagement framework, highlighting important considerations for researchers from the patient perspective, providing practical ways to implement SPOR's key principles: inclusiveness, support, mutual respect, and co-building. This commentary considers the process behind this engagement exercise and offers advice directly from active patient research partners on how to fulfill the operational patient engagement mandate. Academic research teams can use this guidance when considering how to work together with patient partners and community members.
    Keywords:  Co-production; Patient and public involvement; Patient priorities
    DOI:  https://doi.org/10.1186/s40900-022-00384-4
  6. J Surg Res. 2022 Sep 03. pii: S0022-4804(22)00486-3. [Epub ahead of print]280 486-494
    Surgeon Perceptions of the Integration of Patient-Reported Outcome Measures into Clinical Practice.
    Brittni Driscoll, Laura D Leonard, Alexandra Kovar, Joshua Billings, Sarah E Tevis, Simon P Kim, Ethan Cumbler.
      INTRODUCTION: Patient-reported outcome measures (PROMs/PROM) are standardized, validated instruments used to measure the patient's perception of their own health status including their symptoms, functional wellbeing, and mental health. Although PROMs were initially developed as research tools, their use in clinical practice for shared decision-making and to assess the impact of disease and treatment on quality of life of individual patients has been increasing. There is a paucity of research exploring providers' perspectives on the clinical integration of PROMs. We sought to use a qualitative methodology to understand surgeons' perceptions of integrating PROMs into their clinical practices.METHODS: Semistructured interviews were performed from November 2019 until August 2020. All interviews were recorded and transcribed verbatim. Thematic saturation was achieved after interviewing nine surgeons representing eight surgical specialties. Qualitative interview data were thematically analyzed using an inductive approach facilitated by Atlas.ti qualitative software.
    RESULTS: Forty seven unique codes were identified that fit into 21 themes that revealed five novel insights. Key insights included: (1) PROM data can modify surgical practice on an individual and institutional level, (2) Surgeon's view PROM clinical integration as a potential method of advancing patient-centered care, (3) There are various institutional processes that must be in place, including strong leadership and an integrative platform, to enable successful clinical PROM integration, (4) Surgeons appreciate challenges of integrating PROMs into surgical practice including risks of incorrect use or interpretation, and (5) A PROM platform must be adaptable to the diversity within surgery and to unique physician workflows.
    CONCLUSIONS: Surgeons perceived value from integrating PROMs into routine care to better inform patients during preoperative discussions and to help identify at-risk patients in the postoperative period. However, they also identified numerous barriers to the implementation of an integrated system for the routine use of PROMs in clinical practice and expressed concern about using PROMs to compare operative outcomes between surgeons. Based on this work, institutions that want to incorporate PROMs into surgical practice need a leadership team capable of supporting the change management necessary for effective integration and use a PROM platform that gives individual surgeons and surgical teams the ability to customize platforms for their unique practices.
    Keywords:  Clinical practice; Patient-reported outcome measures; Qualitative methodology; Surgeons' perceptions; Surgery
    DOI:  https://doi.org/10.1016/j.jss.2022.07.038
  7. Health Soc Care Community. 2022 Sep 09.
    What constitutes a quality community aged care service-client perspectives: An international scoping study.
    Sandra Smith, Melinda Martin-Khan, Catherine Travers.
      Overwhelmingly, older Australians (people aged 65 years and older or 50 years and older for Aboriginal and Torres Strait Islander people) prefer to remain living in their own home rather than moving into residential care. To enable older Australians who require assistance to remain living at home, the Federal Government provides a wide range of community care services, the provision of which has increased substantially over the last 15 years. The importance of client preferences, prefaced by the introduction of consumer directed care across community aged care services, has gathered momentum in Australia following legislation in 2015. Older peoples' preferences differ in comparison to younger people with disability and those with mental health concerns. Older people focus more on the provision of services rather than the notion of independent living itself. This scoping review aimed to explore what aspects people aged 65 years and older consider to be important qualities of aged care services delivered in the community. A computerised search in MEDLINE, CINAHL, PubMed and PsychINFO and hand searches of the Cochrane database and Google Scholar were completed in May 2022. Sixty-two articles met the selection criteria and were included in the review. Data were extracted using a fit-for-purpose protocol and analysed using the Miles and Huberman Model for thematic analysis. Results identified five themes representing quality domains that describe features that are important to clients: staff knowledge, respect for clients, a person-centred approach, a collaborative partnership with clients and clear communication. When providers of community aged care services are planning to assess the quality of their services, these findings could be used to guide their evaluation. This will ensure that future services delivered accommodate the needs and preferences of clients who receive them.
    Keywords:  community services for the elderly; community-based research; home care; older people's services; patient preferences; patient satisfaction
    DOI:  https://doi.org/10.1111/hsc.13998
  8. J Gen Intern Med. 2022 Sep 09.
    Patients' Preference for Participation in Medical Decision-Making: Secondary Analysis of the BEDSIDE-OUTSIDE Trial.
    Christoph Becker, Sebastian Gross, Martina Gamp, Katharina Beck, Simon A Amacher, Jonas Mueller, Chantal Bohren, René Blatter, Rainer Schaefert, Philipp Schuetz, Joerg Leuppi, Stefano Bassetti, Sabina Hunziker.
      BACKGROUND: Patients may prefer different levels of involvement in decision-making regarding their medical care which may influence their medical knowledge.OBJECTIVE: We investigated associations of patients' decisional control preference (DCP) with their medical knowledge, ward round performance measures (e.g., duration, occurrence of sensitive topics), and perceived quality of care measures (e.g., trust in the healthcare team, satisfaction with hospital stay).
    DESIGN: This is a secondary analysis of a randomized controlled multicenter trial conducted between 2017 and 2019 at 3 Swiss teaching hospitals.
    PARTICIPANTS: Adult patients that were hospitalized for inpatient care.
    MAIN MEASURES: The primary outcome was patients' subjective average knowledge of their medical care (rated on a visual analog scale from 0 to 100). We classified patients as active, collaborative, and passive according to the Control Preference Scale. Data collection was performed before, during, and after the ward round.
    KEY RESULTS: Among the 761 included patients, those with a passive DCP had a similar subjective average (mean ± SD) knowledge (81.3 ± 19.4 points) compared to patients with a collaborative DCP (78.7 ± 20.3 points) and active DCP (81.3 ± 21.5 points), p = 0.25. Regarding patients' trust in physicians and nurses, we found that patients with an active vs. passive DCP reported significantly less trust in physicians (adjusted difference, - 5.08 [95% CI, - 8.69 to - 1.48 points], p = 0.006) and in nurses (adjusted difference, - 3.41 [95% CI, - 6.51 to - 0.31 points], p = 0.031). Also, patients with an active vs. passive DCP were significantly less satisfied with their hospital stay (adjusted difference, - 7.17 [95% CI, - 11.01 to - 3.34 points], p < 0.001).
    CONCLUSION: Patients with active DCP have lower trust in the healthcare team and lower overall satisfaction despite similar perceived medical knowledge. The knowledge of a patient's DCP may help to individualize patient-centered care. A personalized approach may improve the patient-physician relationship and increase patients' satisfaction with medical care.
    TRIAL REGISTRATION: ClinicalTrials.gov (NCT03210987).
    Keywords:  decision-making; decisional control preference; hospital medicine; quality of care; satisfaction
    DOI:  https://doi.org/10.1007/s11606-022-07775-z
  9. Stud Health Technol Inform. 2022 Sep 02. 297 331-339
    Designing Hospitals Through the Lens of Universal Design. An Evaluation Tool to Enhance Inclusive Healthcare Facilities.
    Erica Isa Mosca, Jonathan White, Edward Steinfeld, Stefano Capolongo.
      Various studies highlight a gap on reliable methods to measure the quality of projects and environments in terms of Universal Design (UD) and Design for All (DfA). In particular, healthcare facilities need decision support systems to improve the well-being of as many users as possible through a systematic approach. The present research proposes an evaluation tool to support designers and decision makers in the adoption of UD to develop healthcare facilities suitable for a wide range of users. Several methodologies have been adopted: an in-depth literature review on the current state of knowledge on UD evaluation, workshops and focus groups with both users and experts, and the analysis of four hospital case studies. The result was an evaluation framework built by using a Multi-criteria Analysis (MCA) methodology. The first version of the tool was applied to an American hospital and validated d in an Italian pilot case study. The research outlines a tool called Design for All A.U.D.I.T., able to evaluate Physical, Sensory-cognitive, and Social qualities based on a hierarchical framework with criteria and indicators based on UD and DfA. The framework evaluates the different areas of the hospital from outdoor to indoor spaces, allowing hospital administrators to act to improve the well-being of users according to the critical aspects of UD identified by the tool. The analysis provides a report of the facility status and design strategies to support designers for new projects or buildings renovations. The application shows that DfA A.U.D.I.T. can assess hospitals by examining both spatial qualities and DfA criteria. The tool could represent a decision support system in the national and international context, where many hospitals are not newly built. Further research will include application in different facilities and building typologies, aided by the flexible structure of the tool, which allows measurement of the environment's quality in terms of DfA and UD.
    Keywords:  Design for All; Evaluation; Hospital; Inclusive Design; building performance assessment
    DOI:  https://doi.org/10.3233/SHTI220857
  10. Acta Obstet Gynecol Scand. 2022 Sep 05.
    The impact of implementing patient-reported measures in routine maternity care: a systematic review.
    An Chen, Kirsi Väyrynen, Alexandra Schmidt, Riikka-Leena Leskelä, Paulus Torkki, Seppo Heinonen, Aydin Tekay, Ganesh Acharya.
      INTRODUCTION: While there is growing interest in applying patient-reported measures (PRMs) in clinical routine, limited collective evidence of the impact of PRMs hinder their widespread use in specific contexts, such as maternity care. Our objective was to synthesize existing empirical evidence on the impact of implementing PRMs in routine maternity care.MATERIAL AND METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (version 2020). We electronically searched six databases for the literature on the implementation of PRMs in maternity care. A multi-level (woman, clinical, organizational, national and societal) analytic framework for analyzing and synthesizing empirically proven impacts of PRMs was developed. Quality was assessed using the Mixed Method Appraisal Tool. The GRADE-CERQual approach was used to assess the confidence in the review findings and arguments. The protocol was registered in PROSPERO (CRD42021234501).
    RESULTS: Overall, 4971 articles were screened. The empirical evidence, collected from 11 relevant studies, showed that the use of PRMs in routine maternity care could produce positive effects on clinical process (assessment and detection of health problems, clinical visit preparation, resource use, woman-professional communication, decision-making, woman-professional relationship, and care quality), and health behavior and outcomes (women's health and wellbeing, quality of life, health behavior, experiences and satisfaction with healthcare services), awareness, engagement and self-management of own health, and disclosure of health issues. The confidence in the review findings was low to moderate due to a limited number of studies, inadequate data and methodological limitations of included studies.
    CONCLUSIONS: The limited empirical evidence available suggested that the use of PRMs may have positive effects at the individual health level and clinical process level. However, the evidence was not strong enough to provide policy recommendations on the use of PRMs in routine maternity care. This review revealed limitations of currently available research, such as lack of generalizability and narrow scopes in investigating impact. Efforts are needed to improve the quality of research on the use of PRMs in routine maternity care by widening the study population, including different types of PRMs, and considering the effects of PRMs at different levels and domains of healthcare.
    Keywords:  healthcare quality; impact; implementation; maternity care; patient reported measure; pregnancy and childbirth
    DOI:  https://doi.org/10.1111/aogs.14446
  11. Transl Behav Med. 2022 Sep 08. pii: ibac070. [Epub ahead of print]
    Older adults can use technology: why healthcare professionals must overcome ageism in digital health.
    Ryan A Mace, Meghan K Mattos, Ana-Maria Vranceanu.
      Older adults rapidly adopted technology for healthcare, known as digital health, during the COVID-19 pandemic. Older adults are increasingly using telehealth, smartphone apps, and other digital health technologies to reduce barriers to care, maintain patient-provider communication, and promote disease self-management. Yet, many healthcare professionals have maintained outdated beliefs rooted in societal ageism that digital health and older adults are incompatible. As a result, older adults have been disproportionally excluded from health services and clinical trials that use digital health relative to their younger counterparts. In this commentary, we urge all healthcare disciplines to challenge ageist beliefs and practices that have contributed to the "digital health divide" among older patients. We provide examples of evidence-based strategies and current scientific initiatives that can promote digital health inclusion in research, clinical practice, and training. By achieving digital health inclusion, we can increase access, provide preventative and comprehensive care, and decrease healthcare costs for older patients.
    Keywords:  Access to care; Digital health; Interdisciplinary; Public health; Technology
    DOI:  https://doi.org/10.1093/tbm/ibac070
  12. JAMA Netw Open. 2022 Sep 01. 5(9): e2230858
    Patient and Family Representation in Randomized Clinical Trials Published in 3 Medical and Surgical Journals: A Systematic Review.
    Nissim Benizri, Sophie Hallot, Karen Burns, Michael Goldfarb.
      Importance: Patient and family engagement in research may improve the design, conduct, and dissemination of clinical research, but little is known about whether these stakeholder groups are involved in the design and conduct of randomized clinical trials.Objective: To characterize the involvement and role of patient and family representatives in the design and conduct of randomized clinical trials by reviewing randomized clinical trials from 3 peer-reviewed medical and surgical journals with high impact factors.
    Evidence Review: In this systematic review, the first 50 consecutive randomized clinical trials published on or after January 1, 2021, until September 30, 2021, from each of 3 medical and surgical journals with high impact factors were reviewed for patient or family involvement in trial design and/or conduct. The manuscript, supplemental data, and trial registry records were searched for trial design and governance structures. Two independent, blinded reviewers screened citations and extracted data. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.
    Findings: Only 7 of 150 randomized clinical trials (5%) reported patient or family representation in their study design or conduct. Most studies with patient or family representation (n = 5) were from a single journal. Stakeholder involvement was mainly in the execution phase (n = 7), although in 2 studies stakeholders were also involved in the translation phase.
    Conclusions and Relevance: The findings of this systematic review suggest that patient or family involvement in the design and conduct of randomized clinical trials in the publications with high impact factors is lacking. We found that when patient or family groups are involved in research, the focus was mainly on the execution phase of research design. There is a need to increase stakeholder involvement in the research design, conduct, and translation of randomized clinical trials.
    DOI:  https://doi.org/10.1001/jamanetworkopen.2022.30858
  13. Can Pharm J (Ott). 2022 Sep-Oct;155(5):155(5): 249-257
    Deprescribing practices in Canada: A scoping review.
    Mansi Desai, Tanya Park.
      Background: Excessive and inappropriate use of medications, defined as polypharmacy, can increase the risk of adverse drug reactions while affecting patient adherence and quality of life. Therefore, optimizing pharmacotherapies through deprescribing practices plays a crucial role in managing chronic conditions, avoiding adverse effects and improving patient outcomes. The purpose of this study was to explore research initiatives surrounding deprescribing in Canada.Methods: A scoping review was conducted that involved a search of 6 databases. Studies that highlighted deprescribing interventions, experiences and other effects on Canadian populations were included.
    Results: Searches yielded 2327 citations, of which 31 were included in this review. Five major themes and ideas were identified: deprescribing targeted medications, financial effects of deprescribing, deprescribing in special populations, insight from health care providers and deprescribing frameworks.
    Conclusion: Deprescribing practices in Canada have shown a wide range of beneficial results across various health care settings, populations and medication classes and have the potential to reduce medication-related harm in all Canadian health care settings.
    DOI:  https://doi.org/10.1177/17151635221114114
  14. BMC Health Serv Res. 2022 Sep 05. 22(1): 1121
    Considering health literacy in cardiovascular disease management: a qualitative study on healthcare professionals' and patients' perspectives.
    Adèle Perrin, Eléonore Damiolini, Anne-Marie Schott, Jéremy Zermati, Estelle Bravant, François Delahaye, Alexandra L Dima, Julie Haesebaert.
      BACKGROUND: Implementing practices adapted to patient health literacy (HL) is a promising avenue for improving their outcomes in the context of cardiovascular diseases (CVD). The health communication skills of healthcare professionals (HCPs) and the quality of information provided are essential for low-HL patients. We aimed to explore HCP knowledge about HL, patients' and HCPs' views on current practices regarding low-HL patients, and facilitators and barriers to adapting communication to patients' HL level, in order to prepare the implementation of a complex intervention dedicated to improve CVD management for low-HL patients.METHODS: We conducted face-to-face semi-structured interviews with HCPs practicing in cardiology units and patients hospitalized for CVD. The study design and analysis were based on the Theory of Planned Behavior for HCPs and on the framework of Health Literacy and Health Action for patients. Deductive and inductive thematic analysis were used. Barriers and facilitators were structured into an Ishikawa fishbone diagram and implementation strategies were selected to address resulting themes from the Expert Recommendations for Implementing Change (ERIC).
    RESULTS: Fifteen patients and 14 HCPs were interviewed. HCPs had partial knowledge of HL dimensions. Perceptions of HCPs and patients were not congruent regarding HCP-patient interactions and information provided by hospital and community HCPs. HCPs perceived they lacked validated tools and skills, and declared they adapted spontaneously their communication when interacting with low-HL patients. Patients expressed unmet needs regarding communication during hospital discharge and at return to home.
    CONCLUSION: To implement HL-tailored practices in this setting, our results suggest that several implementation strategies will be valuable at individual (engaging patients and their family), interactional (educating and training of HCPs about HL), and organizational levels (creating a multidisciplinary HCP interest group dedicated to HL).
    TRIAL REGISTRATION: ClinicalTrials.gov, (NCT number) NCT03949309, May 10, 2019.
    Keywords:  Communication; Health literacy; Implementation; Qualitative study; Tailored strategy
    DOI:  https://doi.org/10.1186/s12913-022-08455-8
  15. Sci Commun. 2022 Aug;44(4): 514-527
    Missing the Bigger Picture: The Need for More Research on Visual Health Misinformation.
    Kathryn Heley, Anna Gaysynsky, Andy J King.
      Research shows that health misinformation is widespread online and poses a potentially significant threat to public health. Visual misinformation has been largely overlooked, a notable gap given the unique features and ubiquity of visual content. In this essay, we (a) provide a working definition of visual misinformation, (b) summarize the main categories of visual misinformation, (c) offer examples of the functions visuals can serve within misinformation content, and (d) outline priorities for advancing research on visual misinformation. A systematic approach to studying visual misinformation can improve efforts to mitigate health misinformation and optimize science communication in the current information environment.
    Keywords:  health communication; images; misinformation; social media; visual communication
    DOI:  https://doi.org/10.1177/10755470221113833
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