Evaluation of Printed Health Education Materials Questions

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Question Description

PLEASE USE the ATTACHED TEMPLATE to appraise the ATTACHED ARTICLE.

Direct quoted material from the article may be used to help explain answers and identify components (must include article page number).

Please address all questionsBRIEFLY with simple items, phrases, or (if required) a sentence or two.

If a yes/no question – please answer as appropriate – if not applicable, please state – not applicable.

List references ONLY IF other than the article being reviewed

Helpful strategy - first view the critique template - to have an idea of what items to keep in mind when reading the article.

Unformatted Attachment Preview

Quantitative Study Critique- 75 points possible The purpose of this assignment is to develop skills in reviewing and appraising research articles. Specific details are considered to determine quality, utility, and evidence. Review Chapter 4 in: Polit, D. F., & Beck, C. T. (2018). Essentials of nursing research: Appraising evidence for nursing practice (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. PLEASE USE THIS TEMPLATE for the assignment – save with your last name and submit in Canvas. Direct quoted material from the article may be used to help explain answers and identify components (must include article page number). Please address all questions – briefly with simple items, phrases, or (if required) a sentence or two. If a yes/no question – please answer as appropriate – if not applicable, please state – not applicable. List references ONLY IF other than the article being reviewed or the course text. Helpful strategy - first view the critique template - to have an idea of what items to keep in mind when reading the article. 1. APA citation (2 points possible) 1.1. Provide the reference (authors, year, title, volume, issue, pages, doi) in correct APA format: (use italics where appropriate, etc.) -- (2 pt.) 2. Introduction: Problem and Purpose (3 points possible) 2.1 Is the problem clear, precise and well defined? Briefly identify. literature review/ (1 pt.) 2.2 Is a good argument made for the importance of the problem to clinical practice, research, theory, or knowledge and policy development? Briefly explain. (2 pts) 3.Introduction: Background/ Literature Review (5 pts possible) 3.1 How many articles in the background /literature review are within and after five years of the article’s publication date? (Often in published studies, the literature review is not a separate section titled Literature Review, but a literature review is included in the Introduction or Background section.)(1 pt) 3.2 What is the publication date range of the background/literature review articles? (1 pt.) 3.3 From what type of sources (studies, relevant organizations, media)? (1 pt.) 3.4 Are the current gaps in knowledge clearly presented? Briefly explain? (note: typically related to the purpose for the study) (2 pt.) 4. Introduction: Conceptual/theoretical framework Research Questions or Hypotheses (5 points possible) 4.1 Is a Research Question or PICO Question presented? If yes, please include here: (1 pt.) 1 Quantitative 19SU 4.2 Is a Hypothesis presented? If yes, please include here: (1 pt.) 4.3 Is a Theoretical or Conceptual Framework presented? If yes, please include here: (1 pt.) 4.4 What is the Main overall topic (in a broad sense) – i.e. childhood obesity, surgical site infections, medical error? (2 pt.) 5. Method: Protection of Human Rights (8 pts possible l) 5.1 Was the study approved by an IRB? (1 pt.) 5.2 5.3 What appropriate procedures were used to safeguard the rights of all study participants? Explain. (3 pts) Were any vulnerable populations used in the study? If yes, who? (2 pt.) 5.4 What risks may subjects be exposed to while participating in the study? (2 pt.) 6. Method: Research Design (11 pts possible) 6.1 What was the type of quantitative research design used? (i.e. RCT, cross sectional, retrospective analysis, cohort study?) (3 pts) 6.2 Is there an Independent Variable(s) (Intervention)? If yes, Identify here: (3 pt.) 6.3 Is there a Dependent Variable(s) (outcome)? If yes, Identify here: (3 pt.) 6.4 Is there a control group (experimental design)? If yes, Identify here: (1 pt.) 6.5 Is there a comparison group (non-experimental design)? If yes, Identify here: (1 pt.) 7. Method: Population and Sample (11 pts possible) 7.1 Who or what (if the sample includes material items) is identified as the target population/item? (2 pts) 7.2 How were the samples chosen (sampling method: i.e. randomly, convenience sampling, etc..)? (3 pts) 7.3 How large was the sample? (1 pt.) 7.4 What were the sample inclusion criteria and exclusion criteria? (2 pt.) 7.5 Did any of the participants drop out (attrition)? If yes, was it explained why (please share)? (1 pt.) 8. Method: Data collection and Measure (11 pts possible) 2 Quantitative 19SU 8.1 How were data collected? (3 pts) 8.2 What instruments or tools were used to collect data? (Did the researchers use already designed tools/instruments/questionnaires/ lab or x-ray results OR design and build their own?) Identify instruments by full title (not abbreviations). (3 pts) 8.3 Were the instruments reliable and valid? (Review your text for how instrument reliability and validity are established.) Provide evidence for your response. (2 pts) 8.4 Were the data collected in a way that decreased bias? Explain. For example, was the staff collecting data appropriately trained, or inter-rater reliability addressed? Explain. (3 pts) 9. Results: Data Analysis (4 pts possible) 9.1 Was a statistician or statistical software program (SPSS, SAS?) used for data analysis? (1 pt.) 9.2 Were these methods used appropriate for the study? Briefly explain how? (consider the aim of the study: to describe, compare/difference, or explore relationship/correlation) (3 pts) 10. Discussion: Interpretation of the Findings (6 pts possible) 10.1 What were the major findings presented? Briefly Discuss. (3 pts) 10.2 Were tables and figures used? (1 pts) 10.3 Were all research questions/hypotheses discussed? (2 pts) 11. Discussion: Limitations (4 pts possible) 11.1 Did the researchers discuss the limitations and strengths of the study? Briefly What were they? (3 pts) 11.2 Were there other limitations that you recognized? (1 pts) 12. Discussion: Implications/Recommendations (5 pts possible) 12.1 Do the conclusions accurately reflect the data? Briefly explain. (2 pts/) 12.2 Are the implications for practice clearly presented? Briefly Explain (1 pts) 12.3 Are suggestions for future research clearly presented? Briefly Explain (1 pts) 12.4 How do you see this research useful in HC? (1 pts) List references ONLY IF other than the article being reviewed or the course text. 3 Quantitative 19SU CLINICAL SCHOLARSHIP Evaluation of Printed Health Education Materials for Use by Low-Education Families Lesa Ryan, BS1 , M. Cynthia Logsdon, PhD, WHNP-BC, FAAN2 , Sarah McGill, BS3 , Reetta Stikes, MSN, RNC-NIC, CLC4 , Barbara Senior, BSN, MBA, RN5 , Bridget Helinger, MSN, ARNP, ACNP-BC, CCRN6 , Beth Small, BSN, RN, OCN7 , & Deborah Winders Davis, PhD8 1 Medical Student, University of Louisville, School of Medicine, Department of Pediatrics, Louisville, KY 2 Professor, University of Louisville, School of Nursing, and Associate Chief of Nursing for Research, University of Louisville Hospital/James Graham Brown Cancer Center, Louisville, KY 3 Medical Student, University of Louisville, School of Medicine, Louisville, KY 4 Advanced Practice Educator, Center for Women and Infants, University of Louisville Hospital/James Graham Brown Cancer Center, Louisville, KY 5 Clinical Nurse Manager, Stroke ICU, University of Louisville Hospital/James Graham Brown Cancer Center, Louisville, KY 6 Advanced Practice RN, Stroke Services, University of Louisville Hospital/James Graham Brown Cancer Center, Louisville, KY 7 Registered Nurse Clinician, University of Louisville Hospital/James Graham Brown Cancer Center, Louisville, KY 8 Professor, University of Louisville, School of Medicine, Department of Pediatrics, Louisville, KY Key words Health literacy, patient education, health communication, suitability of materials, reading level Correspondence Dr. Deborah Winders Davis, 571 S. Floyd Street, Suite 412, University of Louisville, Department of Pediatrics, Child Development Unit, Louisville, KY 40202. E-mail: deborah.davis@louisville.edu Accepted: January 22, 2014 doi: 10.1111/jnu.12076 Abstract Purpose: Millions of adults lack adequate reading skills and many written patient education materials do not reflect national guidelines for readability and suitability of materials, resulting in barriers to patients being partners in their own health care. The purpose of this study was to evaluate commonly used printed health materials for readability and suitability for patients with limited general or health literacy skills, while providing easy recommendations to health care providers for how to improve the materials. Methods: Materials (N = 97) from three clinical areas that represented excellence in nursing care in our organization (stroke, cancer, and maternal-child) were reviewed for a composite reading grade level and a Suitability Assessment of Materials (SAM) score. Results: Twenty-eight percent of the materials were at a 9th grade or higher reading level, and only 23% were 5th grade or below. The SAM ratings for not suitable, adequate, and superior were 11%, 58%, and 31%, respectively. Few materials were superior on both scales. The SAM scale was easy to use and required little training of reviewers to achieve interrater reliability. Conclusions: Improving outcomes and reducing health disparities are increasingly important, and patients must be partners in their care for this to occur. One step to increasing patient understanding of written instructions is improving the quality of the materials in the instruction for all patients and their families, especially those with limited literacy skills. Clinical Relevance: Using materials that are written in a manner that facilitates the uptake and use of patient education content has great potential to improve the ability of patients and families to be partners in care and to improve outcomes, especially for those patients and families with limited general literacy or health literacy skills. According to the National Adult Literacy Study, over 40 million adults are functionally illiterate and another 50 million have insufficient reading skills (Kirsch, Jungeblut, Jenkins, & Kolstad, 2002). In addition to poor gen218 eral literacy skills, others have shown that 22% of adults have only basic health literacy skills and 14% are below basic levels of health literacy (Kutner, Greenberg, Jin, & Paulsen, 2006). Poor health literacy skills have Journal of Nursing Scholarship, 2014; 46:4, 218–228.  C 2014 Sigma Theta Tau International Suitability and Readability of Materials Ryan et al. been associated with less positive health decision making (James, Boyle, Bennett, & Bennett, 2012; Weiss, 1999), adverse health outcomes (DeWalt, Berkman, Sheridan, Lohr, & Pignone, 2004; Edwards, Wood, Davies, & Edwards, 2012), increased emergency care utilization (Omachi, Sarkar, Yelin, Blanc, & Katz, 2013), greater risk for hospitalization (Baker, Parker, Williams, & Clark, 1998), higher annual healthcare costs (Baker et al., 1998; Weiss, 1999, 2007), and lack of adherence to instructions (Smith, Brice, & Lee, 2012). Individuals with chronic health conditions who have limited health literacy have greater severity in symptoms, have poorer health-related quality of life, and feel more helpless than their more literate counterparts, even after controlling for income and education (Omachi et al., 2013). Additionally, patients with inadequate literacy and/or health literacy skills have difficulty comprehending medical forms, insurance information, and prescription labels (Williams, Baker, Honig, Lee, & Nowlan, 1998). The adverse outcomes, in part, may be the result of patients misunderstanding or rejecting health instructions due to their lack of literacy skills (Doak, Doak, & Root, 1996). To compound the primary problem of low health literacy skills, individuals who lack literacy skills feel shame and embarrassment, which has been shown to be an additional barrier in accessing health information because they are not willing to admit that they have a problem or are fearful in seeking help for their healthcare needs (Parikh, Parker, Nurss, Baker, & Williams, 1996). Patients who admitted to experiencing shame and having difficulty reading have often not told their spouses, children, and/or healthcare providers for fear of being negatively judged (Parikh et al., 1996). Research has also shown that self-reported education level may not accurately reflect the reading level of the patient (Davis et al., 1994; Mayeaux et al., 1995). In one study, participants had, on average, an 11th grade education, but were reading at the 7th to 8th grade reading level (Davis et al., 1994). Care must be taken not to assume reading level is the same as educational attainment because educational standards may differ from state to state and country to country. In addition to the impact of health literacy on one’s own health and healthcare utilization, there is evidence to suggest that parent health literacy is associated with child outcomes as well. For example, it has been shown that children with asthma who have parents with low literacy were more likely to visit the emergency room, be hospitalized, and miss school more frequently than children whose parents had higher levels of literacy (DeWalt, Dilling, Rosenthal, & Pignone, 2007), and parents with higher health literacy have healthier children and are more likely to breastfeed (Kaufman, Skipper, Small, Terry, & McGrew, 2001). Journal of Nursing Scholarship, 2014; 46:4, 218–228.  C 2014 Sigma Theta Tau International Although there is a growing body of literature suggesting that health literacy is an important factor in the provision of healthcare services, healthcare professionals and organizations have been slow to adapt materials to ensure greater readability for all users. The average reading level for most Americans is at the 8th or 9th grade level, with one out of five adults reading at or below the 5th grade level. Additionally, two out of five adults 65 or older and inner-city minorities read at or below the 5th grade level (Doak et al., 1996). Previous studies have reported that as many as 53% to 90% of patient education materials are written at a 9th grade reading level or higher (Freda, 2005; Hoffmann & McKenna, 2006; Shieh & Hosei, 2008; Weintraub, Maliski, Fink, Choe, & Litwin, 2004). Other factors, in addition to reading level, contribute to the suitability of materials for those with limited education or literacy skills, including health literacy (Doak et al., 1996). Before interventions can be developed to improve health outcomes for both children and adults and before patients and families can be partners in their health care, commonly distributed patient education materials must be evaluated for appropriateness for low-education families. While there is a growing body of literature on health literacy and reading level of materials, there is much variability in the findings. Contributing to the variability is the way the materials are evaluated. Some researchers present a single readability score, and others have used both the Suitability of Materials (SAM) score and a readability score. The purpose of this study was to evaluate commonly used printed health materials for readability and suitability for patients with limited general or health literacy skills, while providing easy recommendations to healthcare providers for how to improve the materials. Both the SAM score (Doak et al., 1996) and a reading score that is a composite of seven commonly used tests for readability were used as more comprehensive ways to evaluate the materials. Having a more comprehensive evaluation of the materials will provide needed information to support specific revisions of the materials for improved comprehension by a wider range of patient ability levels and allows healthcare providers to develop materials that more specifically match the needs of their population. Methods Printed materials were evaluated from an academic health sciences center in the southern United States. The hospital is a tertiary center for the southwestern half of the state. As a referral center, three areas that are considered to be areas of excellence include cancer, 219 Suitability and Readability of Materials stroke, and maternal-infant care. The medical center serves a high percentage of minorities and underserved clients. Approximately 19% of patients are indigent, 29% receive Medicaid, over 40% are of a minority population, and 19% do not speak English. All printed materials for each of these units (total = 97) were included in the evaluation as follows: 28 items from the Stroke Center, 27 items from the Cancer Center, and 42 items from the Mother-Baby Unit. The sources of the materials varied from those obtained from national organizations such as the American Heart Association, the American Cancer Society, the U.S. Department of Health and Human Services, or the World Health Organization to institutiondeveloped materials or those that failed to identify the source of the information. Suitability of Materials Each material was evaluated for suitability using the SAM scale(Doak et al., 1996). The SAM scale was developed as a rigorous and quantifiable measure of attributes of printed materials that go beyond the assessment of reading level, but that influence readability (Doak et al., 1996). Although originally developed for use with printed materials, it has been successfully used with other media (Doak et al., 1996). The authors developed the tool and validated it with input from healthcare professionals from several cultures and from faculty and students from two prestigious universities (one school of public health and one school of medicine; Doak et al., 1996). The tool has become the most cited method for assessing patient education materials beyond reading level (Kang, Fields, Cornett, & Beck, 2005; Shieh & Hosei, 2008; Wallace, Rogers, Turner, Keenum, & Weiss, 2006; Wallace, Turner, Ballard, Keenum, & Weiss, 2005; Weintraub et al., 2004), and it is suggested for use by the Food and Drug Administration, the National Institutes of Health, and the National Library of Medicine. Suitability is based on ratings on 22 items that comprise six factors, which include content, literacy demand, graphics, layout and type, learning stimulation and motivation, and cultural appropriateness (Table 1). Each item is scored 0 (not suitable), 1 (adequate), or 2 (superior), and a raw score is calculated by adding the score for each item, when appropriate, and dividing by the total number of items scored out of a possible of 44. If an item is not applicable, no score is assigned and the denominator is adjusted as needed. The resulting percentages are classified as follows: not suitable (0–39%); adequate (40%–69%); or superior (70%–100%). A total of 97 materials were reviewed. A random sample of 35 materials was scored simultaneously and independently by two reviewers, and then scores were 220 Ryan et al. compared to establish interrater reliability. The reviewers were a post-baccalaureate research assistant and a second-year medical student. Any inconsistencies in scoring were discussed for clarification of the rules, and then the materials were reevaluated. Reviewers had 100% agreement on SAM overall classifications, with occasional differences on individual item scores that did not impact overall classifications. Interrater reliability for itemby-item analysis for the two raters was K = .78 (p < .001; 95% confidence interval [0.74–0.82]). Two reviewers evaluated the materials. The SAM tool was easy to use, and interrater reliability was acceptable. Readability Readability was evaluated using the Text Readability Consensus Calculator, a readability software tool (available free at http://www.readabilityformulas.com/freereadability-formula-tests.php). The program calculates the number of sentences, words, syllables, and characters in the text provided (Table 2). From those data, the readability assessment tool calculated readability using seven different commonly used (Charbonneau, 2012; Colaco, Svider, Agarwal, Eloy, & ...
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Quantitative Study Critique- 75 points possible
The purpose of this assignment is to develop skills in reviewing and appraising research articles. Specific
details are considered to determine quality, utility, and evidence.
Review Chapter 4 in:
Polit, D. F., & Beck, C. T. (2018). Essentials of nursing research: Appraising evidence for nursing practice (9th ed.).
Philadelphia, PA: Lippincott Williams & Wilkins.
PLEASE USE THIS TEMPLATE for the assignment – save with your last name and submit in Canvas.
Direct quoted material from the article may be used to help explain answers and identify components (must
include article page number).
Please address all questions – briefly with simple items, phrases, or (if required) a sentence or two.
If a yes/no question – please answer as appropriate – if not applicable, please state – not applicable.
List references ONLY IF other than the article being reviewed or the course text.
Helpful strategy - first view the critique template - to have an idea of what items to keep in mind when reading
the article.
1. APA citation (2 points possible)
1.1. Ryan, L., Logsdon, M. C., McGill, S., Stikes, R., Senior, B., Helinger, B., ... & Davis, D. W. (2014).
Evaluation of printed health education materials for use by low‐education families. Journal of Nursing
Scholarship, 46(4), 218-228.
2. Introduction: Problem and Purpose (3 points possible)
2.1

Is the problem clear, precise and well defined? Briefly identify. literature review/ (1 pt.)
The problem in the research is clear enough, focusing on the challenges associated with readability
of material intended to provide healthcare information to an audience.

2.2

Is a good argument made for the importance of the p...

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