1. Home
  2. comprehension

comprehension

Development and Assessment of a Pictographic Pediatric Constipation Action Plan

Author/s: 
Reeves, Patrick T., Kolasinski, Nathan T., Shonna YIn, H., Alqurashi, Waleed, Echelmeyer, Sofia, Chumpitazi, Bruno P., Rogers, Philip L., Burklow, Carolyn S., Nylund, Cade M.

Objective: To assess the Uniformed Services Constipation Action Plan (USCAP) as an evidence-based, personalized, clinical action tool with pictograms to aid clinicians and families in the management of functional constipation.

Study design: The USCAP facilitates the management functional constipation by using a health literacy-informed approach to provide instructions for pharmacotherapies and lifestyle modifications. This study included part 1 (pictogram validation) and part 2 (assessment). For part 1, pictogram transparency, translucency, and recall were assessed by parent survey (transparency ≥85%, mean translucency score ≥5, recall ≥85% required for validation). For part 2, the USCAP was assessed by parents, clinical librarians, and clinicians. Parental perceptions (n = 65) were assessed using the Consumer Information Rating Form (17 questions) to gauge comprehensibility, design quality and usefulness. Readability was assessed by 5 formulas and a Readability Composite Score was calculated. Clinical librarians (n = 3) used the Patient Education Materials Assessment Tool to measure understandability (19 questions) and actionability (7 questions) (>80% rating was acceptable). Suitability was assessed by clinicians (n = 34) using Doak's Suitability Assessment of Materials (superior ≥70% rating).

Results: All 12 pictograms demonstrated appropriate transparency, translucency, and recall. Parental perceptions reflected appropriate comprehensibility, design quality, and usefulness. The Readability Composite Score was consistent with a fifth-grade level. Clinical librarians reported acceptable understandability and actionability. Clinicians reported superior suitability.

Conclusions: The USCAP met all criteria for clinical implementation and future study of USCAP implementation for treating children with chronic functional constipation.

Keywords 
Discharge Planning Functional Gastroenterology patient education Pictogram Validation

Randomized Controlled Trial of Iron-Fortified versus Low-Iron Infant Formula: Developmental Outcomes at 16 Years

Author/s: 
Gahagan, S., Delker, E., Blanco, E., Burrows, R., Lozoff, B.

OBJECTIVES:

To test differences in cognitive outcomes among adolescents randomly assigned previously as infants to iron-fortified formulaor low-iron formula as part of an iron deficiency anemia prevention trial.

STUDY DESIGN:

Infants were recruited from community clinics in low- to middle-income neighborhoods in Santiago, Chile. Entrance criteria included term, singleton infants; birth weight of ≥3.0 kg; and no major congenital anomalies, perinatal complications, phototherapy, hospitalization >5 days, chronic illness, or iron deficiency anemia at 6 months. Six-month-old infants were randomized to iron-fortified(12 mg/L) or low-iron (2.3 mg/L) formula for 6 months. At 16 years of age, cognitive ability, visual perceptual ability, visual memory, and achievement in math, vocabulary, and comprehension were assessed, using standardized measures. We compared differences in developmental test scores according to randomization group.

RESULTS:

At the follow-up assessment, the 405 participants averaged 16.2 years of age and 46% were male. Those randomized to iron-fortified formula had lower scores than those randomized to low-iron formula for visual memory, arithmetic achievement, and reading comprehension achievement. For visual motor integration, there was an interaction with baseline infancy hemoglobin, such that the iron-fortified group outperformed the low-iron group when 6-month hemoglobin was low and underperformed when 6-month hemoglobin was high.

CONCLUSIONS:

Adolescents who received iron-fortified formula as infants from 6 to 12 months of age at levels recommended in the US had poorer cognitive outcomes compared with those who received a low-iron formula. The prevention of iron deficiency anemia in infancy is important for brain development. However, the optimal level of iron supplementation in infancy is unclear.

TRIAL REGISTRATION:

Clinicaltrials.gov: NCT01166451.

Keywords 
infants formula Iron

AHRQ Health Literacy Universal Precautions Toolkit

Author/s: 
Brega, Angela G., Barnard, Juliana, Mabachi, Natabhona M., Weiss, Barry D., DeWalt, Darren A., Brach, Cindy, Cifuentes, Maribel, Albright, Karen, West, David R., Callahan, Leigh F., Hawk, Victoria H., Broucksou, Kimberly A., Hink, Ashley, Rudd, Rima

Introduction

To successfully manage their health, people must be able “to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Known as health literacy, this ability involves using reading, writing, verbal, and numerical skills in the context of health. Being health literate, however, also depends on the complexity of the health information given to patients and the tasks they are asked to perform. A national survey showed that 88% of U.S. adults do not have the health literacy skills needed to manage all the demands of the current health care system and 36% have limited health literacy. 

Research shows that clinicians have trouble identifying patients with limited health literacy. Although some groups have higher rates of health literacy limitations, such as some racial/ethnic minority and older populations, limited health literacy is seen in all sociodemographic groups. Moreover, managing one’s health can be more challenging in times of stress. When patients or caregivers are anxious or overwhelmed with too much information, their ability to absorb, recall, and use health information can decline, compromising their ability to manage their health.

What Are Health Literacy Universal Precautions?

Because limited health literacy is common and is hard to recognize, experts recommend using health literacy universal precautions. Practices should assume that all patients and caregivers may have difficulty comprehending health information and should communicate in ways that anyone can understand. Health literacy universal precautions are aimed at—

■ simplifying communication with and confirming comprehension for all patients, so that the risk of miscommunication is minimized 

■ making the office environment and health care system easier to navigate

■ supporting patients’ efforts to improve their health

Everyone gains from health literacy universal precautions. Research shows that interventions designed for people with limited health literacy also benefit those with stronger health literacy skills. Communicating clearly helps people feel more involved in their health care and increases the chances of following through on their treatment plans. All patients appreciate receiving information that is clear and easy to act on.

Keywords 
health literacy universal precautions toolkit
Subscribe to comprehension