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  • SAGE Publications  (14)
  • Schillinger, Dean  (14)
  • 1
    Online Resource
    Online Resource
    Interventions to Improve Patient Comprehension in Informed Consent for Medical and Surgical Procedures: An Updated Systematic Review
    SAGE Publications ; 2020
    In:  Medical Decision Making Vol. 40, No. 2 ( 2020-02), p. 119-143
    Details
    In: Medical Decision Making, SAGE Publications, Vol. 40, No. 2 ( 2020-02), p. 119-143
    Abstract: Background. Patient comprehension is fundamental to valid informed consent. Current practices often result in inadequate patient comprehension. Purpose. An updated review to evaluate the characteristics and outcomes of interventions to improve patient comprehension in clinical informed consent. Data Sources. Systematic searches of MEDLINE and EMBASE (2008–2018). Study Selection. We included randomized and nonrandomized controlled trials evaluating interventions to improve patient comprehension in clinical informed consent. Data Extraction. Reviewers independently abstracted data using a standardized form, comparing all results and resolving disagreements by consensus. Data Synthesis. Fifty-two studies of 60 interventions met inclusion criteria. Compared with standard informed consent, a statistically significant improvement in patient comprehension was seen with 43% (6/14) of written interventions, 56% (15/27) of audiovisual interventions, 67% (2/3) of multicomponent interventions, 85% (11/13) of interactive digital interventions, and 100% (3/3) of verbal discussion with test/feedback or teach-back interventions. Eighty-five percent of studies (44/52) evaluated patients’ understanding of risks, 69% (41/52) general knowledge about the procedure, 35% (18/52) understanding of benefits, and 31% (16/52) understanding of alternatives. Participants’ education level was reported heterogeneously, and only 8% (4/52) of studies examined effects according to health literacy. Most studies (79%, 41/52) did not specify participants’ race/ethnicity. Limitations. Variation in interventions and outcome measures precluded conduct of a meta-analysis or calculation of mean effect size. Control group processes were variable and inconsistently characterized. Nearly half of studies (44%, 23/52) had a high risk of bias for the patient comprehension outcome. Conclusions. Interventions to improve patient comprehension in informed consent are heterogeneous. Interactive interventions, particularly with test/feedback or teach-back components, appear superior. Future research should emphasize all key elements of informed consent and explore effects among vulnerable populations.
    Type of Medium: Online Resource
    ISSN: 0272-989X , 1552-681X
    URL: Article
    DOI: 10.1177/0272989X19896348
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2040405-0
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  • 2
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    Online Resource
    Seeing in 3-D: Examining the Reach of Diabetes Self-Management Support Strategies in a Public Health Care System
    SAGE Publications ; 2008
    In:  Health Education & Behavior Vol. 35, No. 5 ( 2008-10), p. 664-682
    Details
    In: Health Education & Behavior, SAGE Publications, Vol. 35, No. 5 ( 2008-10), p. 664-682
    Abstract: The authors examined whether tailored self-management support (SMS) strategies reach patients in a safety net system and explored variation by language, literacy, and insurance. English-, Spanish-, and Cantonese-speaking diabetes patients were randomized to weekly automated telephone disease management (ATDM) or monthly group medical visits. The SMS programs employ distinct communication methods but share common objectives, including behavioral “action plans.” Reach was measured using three complementary dimensions: (a) participation among clinics, clinicians, and patients; (b) patient representativeness; and (c) patient engagement with SMS. Participation rates were high across all levels and preferentially attracted Spanish-language speakers, uninsured, and Medicaid recipients. Although both programs engaged a significant proportion in action planning, ATDM yielded higher engagement, especially among those with limited English proficiency and limited literacy. These results provide important insights for health communication and translational research with respect to realizing the public health benefits of SMS and can inform system-level planning to reduce health disparities.
    Type of Medium: Online Resource
    ISSN: 1090-1981 , 1552-6127
    URL: Article
    DOI: 10.1177/1090198106296772
    RVK:
    XA 10000
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2008
    detail.hit.zdb_id: 2082564-X
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  • 3
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    Online Resource
    Interventions to Improve Patient Comprehension in Informed Consent for Medical and Surgical Procedures : A Systematic Review
    SAGE Publications ; 2011
    In:  Medical Decision Making Vol. 31, No. 1 ( 2011-01), p. 151-173
    Details
    In: Medical Decision Making, SAGE Publications, Vol. 31, No. 1 ( 2011-01), p. 151-173
    Abstract: Background. Patient understanding in clinical informed consent is often poor. Little is known about the effectiveness of interventions to improve comprehension or the extent to which such interventions address different elements of understanding in informed consent. Purpose. To systematically review communication interventions to improve patient comprehension in informed consent for medical and surgical procedures. Data Sources. A systematic literature search of English-language articles in MEDLINE (1949–2008) and EMBASE (1974–2008) was performed. In addition, a published bibliography of empirical research on informed consent and the reference lists of all eligible studies were reviewed. Study Selection. Randomized controlled trials and controlled trials with nonrandom allocation were included if they compared comprehension in informed consent for a medical or surgical procedure. Only studies that used a quantitative, objective measure of understanding were included. All studies addressed informed consent for a needed or recommended procedure in actual patients. Data Extraction. Reviewers independently extracted data using a standardized form. All results were compared, and disagreements were resolved by consensus. Data Synthesis. Forty-four studies were eligible. Intervention categories included written information, audiovisual/multimedia, extended discussions, and test/feedback techniques. The majority of studies assessed patient understanding of procedural risks; other elements included benefits, alternatives, and general knowledge about the procedure. Only 6 of 44 studies assessed all 4 elements of understanding. Interventions were generally effective in improving patient comprehension, especially regarding risks and general knowledge. Limitations. Many studies failed to include adequate description of the study population, and outcome measures varied widely. Conclusions. A wide range of communication interventions improve comprehension in clinical informed consent. Decisions to enhance informed consent should consider the importance of different elements of understanding, beyond procedural risks, as well as feasibility and acceptability of the intervention to clinicians and patients. Conceptual clarity regarding the key elements of informed consent knowledge will help to focus improvements and standardize evaluations.
    Type of Medium: Online Resource
    ISSN: 0272-989X , 1552-681X
    URL: Article
    DOI: 10.1177/0272989X10364247
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2011
    detail.hit.zdb_id: 2040405-0
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  • 4
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    Online Resource
    Functional Health Literacy and Medication Use: The Pharmacist's Role
    SAGE Publications ; 2003
    In:  Annals of Pharmacotherapy Vol. 37, No. 11 ( 2003-11), p. 1726-1729
    Details
    In: Annals of Pharmacotherapy, SAGE Publications, Vol. 37, No. 11 ( 2003-11), p. 1726-1729
    Type of Medium: Online Resource
    ISSN: 1060-0280 , 1542-6270
    URL: Article
    DOI: 10.1345/aph.1D070
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2003
    detail.hit.zdb_id: 2053518-1
    SSG: 15,3
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  • 5
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    Online Resource
    Getting Under the Skin of Clinical Inertia in Insulin Initiation : The Translating Research Into Action for Diabetes (TRIAD) Insulin Starts Project
    SAGE Publications ; 2012
    In:  The Diabetes Educator Vol. 38, No. 1 ( 2012-01), p. 94-100
    Details
    In: The Diabetes Educator, SAGE Publications, Vol. 38, No. 1 ( 2012-01), p. 94-100
    Abstract: Purpose The purpose of this cross-sectional study is to explore primary care providers’ (PCPs) perceptions about barriers to initiating insulin among patients. Studies suggest that many patients with poorly controlled type 2 diabetes do not receive insulin initiation by PCPs. Methods As part of the Translating Research Into Action for Diabetes study, the authors conducted structured interviews in health systems in Indiana, New Jersey, and California, asking PCPs about the importance of insulin initiation and factors affecting this decision. The authors calculated proportions choosing each multiple-choice response option and listed the most frequently offered open-ended response categories. Results Among 83 PCPs, 45% were women; 60% were white; and they averaged 13.4 years in practice. Four-fifths of PCPs endorsed guideline-concordant glycemic targets, but 54% individualized targets based on patient age, life expectancy, medical comorbidities, self-management capacity, and willingness. Most (64%) reported that many patients were resistant to new oral or insulin therapies due to fears about the therapy and what it meant about their disease progression. Two-thirds (64%) cited patient resistance as a barrier to insulin initiation, and 43% cited problems with patient self-management, including cognitive or mental health issues, dexterity, or ability to adhere. Eighty percent felt that patient nonadherence would dissuade them from initiating insulin at least some of the time. Conclusions PCPs perceived that patient resistance and poor self- management skills were significant barriers to initiating insulin. Future studies should investigate whether systems-level interventions to improve patient-provider communication about insulin and enhance providers’ perceptions of patient self-management capacity can increase guideline-concordant, patient-centered insulin initiation.
    Type of Medium: Online Resource
    ISSN: 0145-7217 , 1554-6063
    URL: Article
    DOI: 10.1177/0145721711432649
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2012
    detail.hit.zdb_id: 3062380-7
    detail.hit.zdb_id: 2173745-9
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  • 6
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    Type 2 Diabetes as a Socioecological Disease: Can Youth Poets of Color Become Messengers of Truth and Catalysts for Change?
    SAGE Publications ; 2022
    In:  Health Promotion Practice Vol. 23, No. 4 ( 2022-07), p. 583-593
    Details
    In: Health Promotion Practice, SAGE Publications, Vol. 23, No. 4 ( 2022-07), p. 583-593
    Abstract: Efforts to confront the type 2 diabetes (T2D) epidemic have been stymied by an absence of effective communication on policy fronts. Whether art can be harnessed to reframe the T2D discourse from an individual, biomedical problem to a multilevel, communal and social problem is not known. Method We explored whether spoken word workshops enable young artists of color to convey a critical consciousness about T2D. The Bigger Picture fosters creation and dissemination of art to shift from the narrow biomedical model toward a comprehensive socioecological model (SEM). Workshops offer (1) public health content, (2) writing exercises, and (3) feedback on drafts. Based on Freire and Boal’s participatory pedagogy, workshops encourage youth to tap into their lived experiences when creating poetry. We analyzed changes in public health literary and activation among participants and mapped poems onto the SEM to assess whether their poetry conveyed the multilevel perspective critical to public health literacy. Results Participants reported significant increases in personal relevance of T2D prevention, T2D discussions with peers, concern about corporations’ targeted marketing, and interest in community organizing to confront the epidemic. Across stanzas, nearly all poems (95%) featured 〉 three of five SEM levels (systemic forces, sectors of influence, societal norms, behavioral settings, individual factors); three-quarters (78%) featured 〉 four levels. Conclusions Engaging youth poets of color to develop artistic content to combat T2D can increase their public health literary and social activation and foster compelling art that communicates how complex, multilevel forces interact to generate disease and disease disparities.
    Type of Medium: Online Resource
    ISSN: 1524-8399 , 1552-6372
    URL: Article
    DOI: 10.1177/15248399211007818
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2036801-X
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  • 7
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    Online Resource
    Engaging Minority Youth in Diabetes Prevention Efforts Through a Participatory, Spoken-Word Social Marketing Campaign
    SAGE Publications ; 2017
    In:  American Journal of Health Promotion Vol. 31, No. 4 ( 2017-07), p. 336-339
    Details
    In: American Journal of Health Promotion, SAGE Publications, Vol. 31, No. 4 ( 2017-07), p. 336-339
    Abstract: To examine the reach, efficacy, and adoption of The Bigger Picture, a type 2 diabetes (T2DM) social marketing campaign that uses spoken-word public service announcements (PSAs) to teach youth about socioenvironmental conditions influencing T2DM risk. Design. A nonexperimental pilot dissemination evaluation through high school assemblies and a Web-based platform were used. Setting. The study took place in San Francisco Bay Area high schools during 2013. Subjects. In the study, 885 students were sampled from 13 high schools. Intervention. A 1-hour assembly provided data, poet performances, video PSAs, and Web-based platform information. A Web-based platform featured the campaign Web site and social media. Measures. Student surveys preassembly and postassembly (knowledge, attitudes), assembly observations, school demographics, counts of Web-based utilization, and adoption were measured. Analysis. Descriptive statistics, McNemar’s χ 2 test, and mixed modeling accounting for clustering were used to analyze data. Results. The campaign included 23 youth poet–created PSAs. It reached 〉 2400 students (93% self-identified non-white) through school assemblies and has garnered 〉 1,000,000 views of Web-based video PSAs. School participants demonstrated increased short-term knowledge of T2DM as preventable, with risk driven by socioenvironmental factors (34% preassembly identified environmental causes as influencing T2DM risk compared to 83% postassembly), and perceived greater personal salience of T2DM risk reduction (p 〈 .001 for all). The campaign has been adopted by regional public health departments. Conclusion. The Bigger Picture campaign showed its potential for reaching and engaging diverse youth. Campaign messaging is being adopted by stakeholders.
    Type of Medium: Online Resource
    ISSN: 0890-1171 , 2168-6602
    URL: Article
    DOI: 10.4278/ajhp.141215-ARB-624
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
    detail.hit.zdb_id: 2134271-4
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  • 8
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    Update on Health Literacy and Diabetes
    SAGE Publications ; 2014
    In:  The Diabetes Educator Vol. 40, No. 5 ( 2014-09), p. 581-604
    Details
    In: The Diabetes Educator, SAGE Publications, Vol. 40, No. 5 ( 2014-09), p. 581-604
    Abstract: Inadequate literacy is common among patients with diabetes and may lead to adverse outcomes. The authors reviewed the relationship between literacy and health outcomes in patients with diabetes and potential interventions to improve outcomes. Methods We reviewed 79 articles covering 3 key domains: (1) evaluation of screening tools to identify inadequate literacy and numeracy, (2) the relationships of a range of diabetes-related health outcomes with literacy and numeracy, and (3) interventions to reduce literacy-related differences in health outcomes. Results Several screening tools are available to assess patients’ print literacy and numeracy skills, some specifically addressing diabetes. Literacy and numeracy are consistently associated with diabetes-related knowledge. Some studies suggest literacy and numeracy are associated with intermediate outcomes, including self-efficacy, communication, and self-care (including adherence), but the relationship between literacy and glycemic control is mixed. Few studies have assessed more distal health outcomes, including diabetes-related complications, health care utilization, safety, or quality of life, but available studies suggest low literacy may be associated with increased risk of complications, including hypoglycemia. Several interventions appear to be effective in improving diabetes-related outcomes regardless of literacy status, but it is unclear if these interventions can reduce literacy-related differences in outcomes. Conclusions Low literacy is associated with less diabetes-related knowledge and may be related to other important health outcomes. Further studies are needed to better elucidate pathways by which literacy skills affect health outcomes. Promising interventions are available to improve diabetes outcomes for patients with low literacy; more research is needed to determine their effectiveness outside of research settings.
    Type of Medium: Online Resource
    ISSN: 0145-7217 , 1554-6063
    URL: Article
    DOI: 10.1177/0145721714540220
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2014
    detail.hit.zdb_id: 3062380-7
    detail.hit.zdb_id: 2173745-9
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  • 9
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    Safety Events during an Automated Telephone Self-Management Support Intervention
    SAGE Publications ; 2013
    In:  Journal of Diabetes Science and Technology Vol. 7, No. 3 ( 2013-05), p. 596-601
    Details
    In: Journal of Diabetes Science and Technology, SAGE Publications, Vol. 7, No. 3 ( 2013-05), p. 596-601
    Abstract: Interactive health information technology (HIT) can support the complex self-management tasks for diabetes. However, less is known about between-visit interactions and patient safety among chronic illness patients treated in the outpatient setting. Methods: We classified 13 categories for safety events and potential safety events within a larger trial evaluating a multilingual automated telephone self-management support system for diabetes using interactive voice response. Participants could trigger safety concerns by reporting hyperglycemia or hypoglycemia, inability to obtain medications, medication nonadherence and side effects, and needing appointments and/or supplies. We then examined these triggers across patient demographic and health characteristics to determine which patients were most likely to experience safety events. Results: Overall, there were 360 safety triggers that occurred among 155 participants, which represented 53% of individuals and 7.6% of all automated calls over the 27-week intervention. The most common triggers were for pain or medication side effects (22%) and not checking blood sugars (13%). In adjusted models, race/ethnicity and language were related to safety triggers; Spanish-speaking participants were significantly ( p = .02) more likely than English-speaking participants to experience a safety trigger, and black participants were marginally more likely ( p = .09) than white participants to experience a safety trigger. Conclusion: About half of patients enrolled in a self-management technology intervention triggered at least one potential safety event over the course of the trial, and this was more frequent among some patients. Systems implementing HIT strategies to improve self-care and remote monitoring should consider specific program design elements to address these potential safety events.
    Type of Medium: Online Resource
    ISSN: 1932-2968 , 1932-2968
    URL: Article
    DOI: 10.1177/193229681300700303
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2013
    detail.hit.zdb_id: 2467312-2
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  • 10
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    Online Resource
    Ethnic Differences in Geriatric Conditions and Diabetes Complications Among Older, Insured Adults With Diabetes : The Diabetes and Aging Study
    SAGE Publications ; 2015
    In:  Journal of Aging and Health Vol. 27, No. 5 ( 2015-08), p. 894-918
    Details
    In: Journal of Aging and Health, SAGE Publications, Vol. 27, No. 5 ( 2015-08), p. 894-918
    Abstract: Objective: The aim of this study was to evaluate ethnic differences in burden of prevalent geriatric conditions and diabetic complications among older, insured adults with diabetes. Method: An observational study was conducted among 115,538 diabetes patients, aged ≥60, in an integrated health care system with uniform access to care. Results: Compared with Whites, Asians and Filipinos were more likely to be underweight but had substantively lower prevalence of falls, urinary incontinence, polypharmacy, depression, and chronic pain, and were least likely of all groups to have at least one geriatric condition. African Americans had significantly lower prevalence of incontinence and falls, but higher prevalence of dementia; Latinos had a lower prevalence of falls. Except for end-stage renal disease (ESRD), Whites tended to have the highest rates of prevalent diabetic complications. Discussion: Among these insured older adults, ethnic health patterns varied substantially; differences were frequently small and rates were often better among select minority groups, suggesting progress toward the Healthy People 2020 objective to reduce health disparities.
    Type of Medium: Online Resource
    ISSN: 0898-2643 , 1552-6887
    URL: Article
    DOI: 10.1177/0898264315569455
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
    detail.hit.zdb_id: 2034469-7
    SSG: 5,2
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