Eva Bitzer

Development of a comprehensive list of criteria for evaluating consumer education materials on colorectal cancer screening

BackgroundAppropriate patient information materials may support the consumer’s decision to attend or not to attend colorectal cancer (CRC) screening tests (fecal occult blood test and screening colonoscopy). The aim of this study was to develop a list of criteria to assess whether written health information materials on CRC screening provide balanced, unbiased, quantified, understandable, and evidence-based health information (EBHI) about CRC and CRC screening.MethodsThe list of criteria was developed based on recommendations and assessment tools for health information in the following steps: (1) Systematic literature search in 13 electronic databases (search period: 2000–2010) and completed by an Internet search (2) Extraction of identified criteria (3) Grouping of criteria into categories and domains (4) Compilation of a manual of adequate answers derived from systematic reviews and S3 guidelines (5) Review by external experts (6) Modification (7) Final discussion with external experts.ResultsThirty-one publications on health information tools and recommendations were identified. The final list of criteria includes a total of 230 single criteria in three generic domains (formal issues, presentation and understandability, and neutrality and balance) and one CRC-specific domain. A multi-dimensional rating approach was used whenever appropriate (e.g., rating for the presence, correctness, presentation and level of evidence of information). Free text input was allowed to ensure the transparency of assessment. The answer manual proved to be essential to the rating process. Quantitative analyses can be made depending on the level and dimensions of criteria.ConclusionsThis comprehensive list of criteria clearly has a wider range of evaluation than previous assessment tools. It is not intended as a final quality assessment tool, but as a first step toward thorough evaluation of specific information materials for their adherence to EBHI requirements. This criteria list may also be used to revise leaflets and to develop evidence-based health information on CRC screening. After adjustment for different procedure-specific criteria, the list of criteria can also be applied to other cancer screening procedures.

A comparison of conventional and retrospective measures of change in symptoms after elective surgery

BackgroundMeasuring change is fundamental to evaluations, health services research and quality management. To date, the Gold-Standard is the prospective assessment of pre- to postoperative change. However, this is not always possible (e.g. in emergencies). Instead a retrospective approach to the measurement of change is one alternative of potential validity. In this study, the Gold-Standard conventional method was compared with two variations of the retrospective approach: a perceived-change design (model A) and a design that featured observed follow-up minus baseline recall (model B).MethodsIn a prospective longitudinal observational study of 185 hernia patients and 130 laparoscopic cholecystectomy patients (T0: 7-8 days pre-operative; T1: 14 days post-operative and T2: 6 months post-operative) changes in symptoms (Hernia: 9 Items, Cholecystectomy: 8 Items) were assessed at the three time points by patients and the conventional method was compared to the two alternatives. Comparisons were made regarding the percentage of missing values per questionnaire item, correlation between conventional and retrospective measurements, and the degree to which retrospective measures either over- or underestimated changes and time-dependent effects.ResultsSingle item missing values in model A were more frequent than in model B (e.g. Hernia repair at T1: model A: 23.5%, model B: 7.9%. In all items and at both postoperative points of measurement, correlation of change between the conventional method and model B was higher than between the conventional method and model A. For both models A and B, correlation with the change calculated with the conventional method was higher at T1 than at T2. Compared to the conventional model both models A and B also overestimated symptom-change (i.e. improvement) with similar frequency, but the overestimation was higher in model A than in model B. In both models, overestimation was lower at T1 than at T2 and lower after hernia repair than after cholecystectomy.ConclusionsThe retrospective method of measuring change was associated with a larger improvement in symptoms than was the conventional method. Retrospective assessment of change results in a more optimistic evaluation of improvement by patients than does the conventional method (at least for hernia repair and laparoscopic cholecystectomy).

Provision of group psychoeducation for relatives of persons in inpatient depression treatment - a cross-sectional survey of acute care hospitals in Germany

BackgroundDepressive disorders are often recurrent and place a high burden on patients and their relatives. Psychoeducational groups for relatives may reduce relatives’ burden, help prevent relapses in patients, and are recommended by the German “National Disease Management Guideline Unipolar Depression”. Since there is limited knowledge on the provision of psychoeducational groups for relatives of persons in inpatient depression treatment, we conducted a survey among acute care hospitals in Germany.MethodsWe conducted a two-step cross-sectional survey. Step I consisted of a questionnaire asking the heads of all psychiatric/psychosomatic acute care hospitals in Germany (Nu2009=u2009512) whether psychoeducational groups for relatives were provided within depression treatment, and if not, the reasons for not implementing them. In group offering hospitals the person responsible for conducting psychoeducational groups received a detailed questionnaire on intervention characteristics (step II). We performed descriptive data analysis.ResultsThe response rate was 50.2% (Nu2009=u2009257) in step I and 58.4% in step II (Nu2009=u200945). 35.4% of the responding hospitals offered psychoeducational groups for relatives of patients with depressive disorders. According to the estimates of the respondents, relatives of about one in five patients took part in psychoeducational groups in 2011. Groups were mostly provided by two moderators (62.2%) as continuous groups (77.8%), without patients’ participation (77.8%), with up to ten participants (65.9%), consisting of four or fewer sessions (51.5%) which lasted between one and one and a half hours each (77.8%). The moderators in charge were mostly psychologists (43.9%) or physicians (26.8%). Approximately one third used published manuals. Reasons for not conducting such psychoeducational groups were lack of manpower (60.1%), time (44.9%) and financial constraints (24.1%). 25.3% mentioned adequate concepts of intervention as a required condition for initiating such groups.ConclusionsOnly a small proportion of relatives of patients with depressive disorders participated in psychoeducational groups in 2011 in Germany. Mostly short interventions were favoured and main implementation barriers were scarce resources. Brief interventions that fit with healthcare routine should be developed and tested within randomised controlled trials. This could promote the provision of psychoeducational groups for relatives as evidence-based practice in inpatient depression treatment in Germany.

Was motiviert Patienten mit atopischen Erkrankungen zur Suche nach Informationen im Internet? Ergebnisse einer Fokusgruppenstudie zu Erwartungen und Anforderungen

BACKGROUNDnPeople affected by allergies with mild-to-moderate symptoms are often not treated adequately, despite the availability of prevention and self-therapy measures. Given their good and quick accessibility when seeking information, evidence- and web-based services that are user-friendly may strengthen axa0more independent way of handling an allergy and may also increase health literacy. In order for such services to be found and read, developers and providers need to know about information needs, demands and users behavior.nnnOBJECTIVESnOn which occasions does the target group search for allergy-specific information? Which preferences and demands do affected persons have regarding axa0web-based service?nnnMATERIALS AND METHODSnThree individual interviews and four focus groups with 37xa0participants (19-81xa0years; hay fever, nu202f=u200930; asthma, nu202f=u200917; eczema, nu202f=u200915) were conducted in four German cities. These were recorded and transcribed verbatim. Axa0multiprofessional team developed axa0system for coding the texts (two independent encoders, MAXQDA analysis software).nnnRESULTSnThose who are affected usually seek information only in case of axa0concrete need for action. Impulses are, among others, symptoms, suggestions from the social environment, the beginning of the allergy season or an allergy-related contact with the health system. Axa0web-based service should primarily include information about treatment options, provide individualized support for everyday life action strategies, and promote adequate self-management skills.nnnDISCUSSIONnIn order to promote self-management skills, axa0web-based service should focus on allergy symptoms, treatment options and day-to-day help.ZusammenfassungHintergrundMenschen mit leichten bis mittelschweren Allergien sind häufig nicht ausreichend therapiert, obwohl gute Möglichkeiten zur Prävention und Selbsttherapie existieren. Nutzerfreundliche, webbasierte, evidenzgeleitete Angebote könnten den eigenständigen Umgang mit der Allergie und die Gesundheitskompetenz stärken, da diese niedrigschwellig sind und schnell verfügbar, wenn Menschen Unterstützung suchen. Damit sie gefunden bzw. gelesen werden, sollten Anbieter und Entwickler Kenntnisse über Informationsbedarf, -bedürfnisse und das aktuelle Nutzerverhalten haben.FragestellungWas gibt den Anstoß, nach Informationen zum Thema Allergie zu suchen? Welche Anforderungen stellen die Betroffenen an webbasierte Angebote?Material und MethodeIn 4 deutschen Städten wurden 3xa0Einzelinterviews und 4xa0Fokusgruppen mit 37xa0Teilnehmenden (19 bis 81xa0Jahre; Heuschnupfen, nu202f=u200930; Asthma, nu202f=u200917; Neurodermitis, nu202f=u200915) durchgeführt, aufgezeichnet und wortgetreu transkribiert. Ein multiprofessionelles Team entwickelte ein System zur Kodierung der Texte (2 unabhängige Kodierer, Analysesoftware MAXQDA).ErgebnisseBetroffene suchen in der Regel erst bei konkretem Handlungsbedarf nach Informationen. Impulse sind u.u202fa. Symptome, Hinweise aus dem sozialen Umfeld, der Beginn der Allergiesaison oder ein allergiebedingter Kontakt mit dem Gesundheitssystem. Ein webbasiertes Angebot sollte inhaltlich v.xa0a. zu Behandlungsmöglichkeiten informieren, individualisierte Unterstützung bei konkreten Handlungsstrategien für den Alltag liefern und adäquate Selbstmanagementkompetenzen der Betroffenen fördern.DiskussionUm die Selbstmanagementfähigkeit zu fördern, sollte ein Informationsangebot auf allergische Symptome, die Therapiemöglichkeiten und auf Hilfestellung bei der Alltagsbewältigung ausgerichtet sein.AbstractBackgroundPeople affected by allergies with mild-to-moderate symptoms are often not treated adequately, despite the availability of prevention and self-therapy measures. Given their good and quick accessibility when seeking information, evidence- and web-based services that are user-friendly may strengthen axa0more independent way of handling an allergy and may also increase health literacy. In order for such services to be found and read, developers and providers need to know about information needs, demands and users’ behavior.ObjectivesOn which occasions does the target group search for allergy-specific information? Which preferences and demands do affected persons have regarding axa0web-based service?Materials and methodsThree individual interviews and four focus groups with 37xa0participants (19–81xa0years; hay fever, nu202f=u200930; asthma, nu202f=u200917; eczema, nu202f=u200915) were conducted in four German cities. These were recorded and transcribed verbatim. Axa0multiprofessional team developed axa0system for coding the texts (two independent encoders, MAXQDA analysis software).ResultsThose who are affected usually seek information only in case of axa0concrete need for action. Impulses are, among others, symptoms, suggestions from the social environment, the beginning of the allergy season or an allergy-related contact with the health system. Axa0web-based service should primarily include information about treatment options, provide individualized support for everyday life action strategies, and promote adequate self-management skills.DiscussionIn order to promote self-management skills, axa0web-based service should focus on allergy symptoms, treatment options and day-to-day help.

Herzenssache — Randomisierte, multizentrische Lebensstilinterventionsstudie zur Primärprävention von Herz-Kreislauf-Krankheiten

In einer randomisierten, multizentrischen Interventionsstudie wird untersucht, ob ein uber sechs Jahre angelegtes multimodales Praventionsangebot zur Reduktion des Risikos fur Herz-Kreislauf-Erkrankungen wirksamer ist als ein auf sechs Monate beschranktes Angebot und ob es im Vergleich dazu zu Einsparungen aus der Sicht der gesetzlichen Krankenversicherung und aus gesellschaft licher Perspektive fuhrt. Zielgruppe sind Manner (35–50 J.) bzw. Frauen (40–55 J.), die aufgrund einer uber der altersentsprechenden Norm liegenden maximalen Wanddicke der Intima Media (IMT) der A. carotis communis (ACC) ein erhohtes Risiko fur kardiovaskulare Erkrankungen aufweisen. Vorgestellt werden das Studienkonzept sowie die Ergebnisse der Teilnehmerrekrutierung.