Maren Reder

The Concept of eHealth Literacy and Its Measurement

The objective of this study was to translate the eHealth Literacy Scale (eHEALS) into German, to evaluate this translation through psychometric testing in a German sample of adolescents, and to analyze whether the content-derived hypothesis of two eHEALS subscales was confirmed by the data. We hypothesized that the first subscale would cover self-perceived competence in seeking health information online, and the second subscale information appraisal of health information on the Internet. A cross-sectional survey among 18-year-old students (N = 327) using our translation of the eHEALS was conducted. A confirmatory factor analysis compared the 1-factor model based on Norman and Skinners’ analyses with the a priori specified 2-factor model. The results indicated a better fit for the 2-factor model (chi-square difference of 150.93, p < .0001), supporting the division into subscales.

A cross-sectional study on informed choice in the mammography screening programme in Germany (InEMa): a study protocol

Introduction Breast cancer is the most prevalent cancer among women. In Germany, women are invited to a population-based mammography screening programme for the first time at the age of 50. Since it is still discussed whether the benefits of mammography screening outweigh its harms, the concept of informed choice has gained importance. The objective of this cross-sectional study is to assess the proportion of informed choices in the mammography screening programme. A special focus is on the examination of the impact of Turkish migration background and educational level on informed choices. Methods and analysis The proportion of informed choices is evaluated in a cross-sectional study with 3-month follow-up for behavioural implementation of the screening intention. A randomly selected sample of 17 000 women aged 50 years living in Westphalia-Lippe, a region in the Federal State of North-Rhine Westphalia, is invited to participate in this study. To reach adequate numbers of Turkish women, all possibly Turkish women in the sample are identified through a name algorithm and contacted. The sample is drawn from women registered in the study area for which the registration offices consented to supply data for the study (88% of all towns/cities in the study region). Women identified through the Turkish name algorithm received all materials in German and Turkish. The primary outcome is informed choice. Data are collected on informed choice components (knowledge, attitude, decision/implementation) as well as on its possible determinants (eg, health behaviour, perceived behavioural control, subjective norms, invitation status, migration background and other demographic variables). Data are collected before the screening appointment and at 3 months follow-up. Ethics and dissemination The study was approved by the ethical committee of the Medical Faculty of Muenster University. Results will be published in a relevant scientific journal and communicated to respondents and relevant institutions.

Informed Choice in the German Mammography Screening Program by Education and Migrant Status: Survey among First-Time Invitees

Breast cancer is the most prevalent cancer among women and mammography screening programs are seen as a key strategy to reduce breast cancer mortality. In Germany, women are invited to the population-based mammography screening program between ages 50 to 69. It is still discussed whether the benefits of mammography screening outweigh its harms. Therefore, the concept of informed choice comprising knowledge, attitude and intention has gained importance. The objective of this observational study was to assess the proportion of informed choices among women invited to the German mammography screening program for the first time. A representative sample of 17,349 women aged 50 years from a sub-region of North Rhine Westphalia was invited to participate in a postal survey. Turkish immigrant women were oversampled. The effects of education level and migration status on informed choice and its components were assessed. 5,847 (33.7%) women responded to the postal questionnaire of which 4,113 were used for analyses. 31.5% of the women had sufficient knowledge. The proportion of sufficient knowledge was lower among immigrants and among women with low education levels. The proportion of women making informed choices was low (27.1%), with similar associations with education level and migration status. Women of low (OR 2.75; 95% CI 2.18–3.46) and medium education level (OR 1.49; 95% CI 1.27–1.75) were more likely to make an uninformed choice than women of high education level. Turkish immigrant women had the greatest odds for making an uninformed choice (OR 5.30, 95% CI 1.92–14.66) compared to non-immigrant women. Other immigrant women only had slightly greater odds for making an uninformed choice than non-immigrant women. As immigrant populations and women with low education level have been shown to have poor knowledge, they need special attention in measures to increase knowledge and thus informed choices.

The Tele.TAnDem intervention: study protocol for a psychotherapeutic intervention for family caregivers of people with dementia

BackgroundFamily caregivers are confronted with high demands creating a need for professional support and at the same time hindering its utilization. Telephone support allows easier access than face-to-face support because there is no need to leave the person with dementia alone or find an alternative carer. It is also independent of transport possibilities or mobility. The objectives are to evaluate whether telephone-based cognitive-behavioral therapy, which is implemented in established care provision structures, improves outcomes compared to usual care and whether it is as effective as face-to-face cognitive-behavioral therapy.Methods/DesignIf participants live in the area of one of the study centers (Jena, Berlin, Munich) and indicate that attendance of a face-to-face therapy is possible, they will be assigned to the face-to-face group. The other participants will be randomized to receive either telephone-based cognitive-behavioral therapy or usual care. Data will be collected at baseline, post-intervention, and at a 6-month follow-up. The primary outcomes will be depressiveness, burden of care, health complaints, and problem-solving ability. The secondary outcomes will be anxiety, quality of life, violence in caregiving, utilization of professional assistance, and cost effectiveness.DiscussionThis paper describes the evaluation design of our telephone-based cognitive-behavioral therapy in a randomized controlled trial. If this intervention proves to be an effective tool to improve outcomes, it will be made accessible to the public and the use of this support service will be recommended.Trial registrationGerman Clinical Trials Register DRKS00006355.

Postalische Befragung von Frauen mit türkischem Migrationshintergrund – Identifizierung, Stichprobenbereinigung und Response im Rahmen der InEMa-Studie

AIM OF THE STUDY Migrants are an important target group for mailed surveys but also difficult to reach. For planning these surveys and invitational health measures, we assessed response figures for women with and without Turkish migration background. METHODS Women aged 50 years living in Westphalia-Lippe were invited to a postal survey at 2 time points about mammography screening. Turkish migrant women were identified in the contact database by a name-based algorithm. Possible differences in sample revision and response among women with and without Turkish migration background were assessed. RESULTS Women with Turkish migration background had unknown addresses significantly more often (4.6 vs. 1.7%) and responded to the questionnaires less often (first questionnaire: 14.3 vs. 35.9%; second questionnaire: 70.7 vs. 85.6%). CONCLUSIONS For postal invitation to participate in healthcare measures, or recruitment of Turkish migrants for studies, differences in current address and readiness to respond must be taken into consideration.

Does a decision aid improve informed choice in mammography screening? Study protocol for a randomized controlled trial

BackgroundWhen invited for the first time at age 50, most women in Germany have to decide whether they wish to participate in the German mammography screening programme. For ethical reasons, screening decisions should be informed choices, but this is rarely the case with mammography screening. Decision aids are interventions with the potential to support informed choice by improving the following factors: knowledge, clarity of personal attitude, and implementation of an intention. Currently, no systematically evaluated decision aid exists for the German mammography screening programme. Therefore, the objective of this randomized controlled trial is to assess the effectiveness of a decision aid for first-time mammography screening programme invitees.Methods/DesignWe have developed a decision aid for women invited to the mammography screening programme for the first time based on the criteria of the International Patient Decision Aids Standards Collaboration. The effectiveness of the decision aid will be evaluated in a randomized controlled trial with a 3-month follow-up. We will invite 7400 women aged 50 years from the district of Westfalen-Lippe, Germany, to participate. This sample will be drawn from registration office data. The primary outcome will be informed choice. The secondary outcomes will be the components of informed choice (knowledge, attitude, decision/implementation). Decisional conflict, decision regret, eHealth literacy, health behaviours, perceived behavioural control, subjective norms, invitation status, and demographic variables will be assessed. Data will be collected online at baseline, post-intervention, and at the 3-month follow-up. Participants will be randomized to receive either the decision aid or usual care (invitation and standard leaflet of the mammography screening programme).DiscussionThis paper describes the evaluation of a decision aid for the German mammography screening programme in a randomized controlled trial. If the decision aid proves to be an effective tool to enhance the rate of informed choice, it will be made accessible to the public and the use of this decision aid for first-time invitees will be recommended. The long-term effect could be an improvement in informed choices in women invited to the mammography screening programme.Trial registrationGerman Clinical Trials Register DRKS00005176.

The Tele.TAnDem Intervention: Telephone-based CBT for Family Caregivers of People With Dementia

Background and Objectives This study evaluated the effectiveness of a telephone-based cognitive-behavioral therapy for family caregivers of people with dementia in existing health care provision structures. Research Design and Methods Two hundred seventy-three family caregivers of people with dementia were randomly assigned to receive the intervention or usual care. Usual care included unrestricted access to community resources. Intervention group participants received twelve 50-min sessions of individual cognitive-behavioral therapy by trained psychotherapists within 6 months. Symptoms of depression, emotional well-being, physical health symptoms, burden of care, coping with the care situation and challenging behavior were assessed after the intervention ended and at a 6-month follow-up. Intention-to-treat analyses using latent change models were applied. Results Intention-to-treat analyses showed improved emotional well-being (γ = 9.59, p = .001), fewer symptoms of depression (γ = -0.23, p = .043), fewer physical health symptoms (γ = -0.25, p = .019), improved coping with the care situation (γ = 0.25, p = .005) and the behavior of the care recipient (γ = 0.23, p = .034) compared with usual care. Effects for coping (γ = 0.28, p = .006 and γ = 0.39, p < .001, respectively) and emotional well-being (γ = 7.61, p = .007) were also found at follow-up. Discussion and Implications The CBT-based telephone intervention increased mental and physical health as well as coping abilities of family caregivers of people with dementia. The intervention can be delivered by qualified CBT therapists after an 8-h training session in existing health care provision structures.

Uptake of Gynecological Cancer Screening and Performance of Breast Self-Examination Among 50-Year-Old Migrant and Non-migrant Women in Germany: Results of a Cross-Sectional Study (InEMa)

Our aim was to provide data regarding uptake of gynecological early detection measures and performance of breast self-examinations among migrant women in Germany. Cross-sectional self-reported data were collected using paper-and-pencil questionnaires. Descriptive analyses, Chi square-tests, and logistic regression were applied. Results were adjusted for educational level. Of 5387 women, 89.9% were autochthonous, 4.1% German resettlers, 2.8% Turkish, 3.1% other migrants. Participation rates regarding cancer screening differed significantly, with the lowest proportion in Turkish migrants (65.0%), resettlers (67.8%), other migrants (68.2%) and autochthonous population (78.2%). No differences in performance of breast self-examinations were detected. When adjusted for education, results indicated only slight changes in the odds to participate in screening irregularly or not at all. Results support existing evidence by showing lower participation rates in cancer screening among migrant women, but there were no differences regarding breast self-examinations. Migrant women form a potential high-risk group for late-stage diagnosis of cervical or breast cancer.

Crowd-figure-pictograms improve women’s knowledge about mammography screening: results from a randomised controlled trial

ObjectiveTo evaluate the effect of crowd-figure-pictograms on women’s numeric knowledge about mammography screening in a three-armed parallel randomised controlled trial.Results552 women were randomised to receive (1) non-numeric information (n = 192), (2) non-numeric and numeric information (n = 186), or (3) non-numeric and numeric information complemented by crowd-figure-pictograms (n = 174). Baseline numeric knowledge was low (control 0.61, numeric 0.66, and pictogram 0.51 on a scale ranging from 0 to 5). Women in the crowd-figure-pictogram group had a larger knowledge increase than women in the numeric group (2.42 vs 2.06, p = .03). Both groups had significant increases in knowledge compared to the control (0.20, p < .001). Providing numeric information in absolute numbers improves knowledge; even more so when crowd-figure-pictograms are added.Trial registration German Clinical Trials Register DRKS00014736, retrospectively registered 11 May 2018

Intervention Helps Family Caregivers of People With Dementia Attain Own Therapy Goals

Introduction: Caregiver intervention studies typically assess whether participants attain general goals (eg, improved mental/physical health) but not their own individual goals. We used goal attainment scaling to evaluate whether participants of a telephone intervention based on cognitive behavioral therapy (CBT) attained their personal goals. We also evaluated treatment compliance and implementation. Methods: A sample of 139 family caregivers of people with dementia received 12 telephone sessions over 6 months. Participants personal goals were specified during the first and second sessions. Participants and therapists assessed goal attainment at the end of the intervention. Results: Nearly all participants reported meaningful improvements with regard to their personal goals. Specifically, 20.9% exceeded, 56.4% completely attained, and 21.8% partially attained at least one of their personal goals. There was high agreement between self- and therapist ratings. Treatment compliance and implementation were highly satisfactory. Conclusions: The CBT telephone intervention successfully helped participants attain their personal goals.