Sheryl Burt Ruzek

Increasing Colorectal Cancer Screening among African Americans, Linking Risk Perception to Interventions Targeting Patients, Communities and Clinicians

Colorectal cancer (CRC) screening remains significantly underutilized by African Americans despite their increased risk compared to whites. The purpose of this article is to review recent research on patterns of screening, perceptions of CRC screening methods and outcomes of seven intervention trials specifically designed to increase screening among African Americans in light of the recommendation of the American College of Gastroenterologists to make colonoscopy the screening method of choice for this population. This review shows that progress has been made in understanding the complexity of perceived barriers to CRC screening among African Americans. Interventions that used community-based education targeting individuals and clinically based education targeting clinicians showed modest increases in screening rates. Targeting entire communities did not show significant results. However, because intervention studies use not only different types of interventions but different screening outcome measures, results are not easily comparable. While there is growing evidence that interventions can increase the use of fecal occult blood test (FOBT), it is not yet known if similar interventions can increase rates of screening colonoscopy. Clinicians, patients and policymakers also need to consider the array of social, cultural and financial issues associated with CRC screening in African-American communities.

Developing a Computer Touch-Screen Interactive Colorectal Screening Decision Aid for a Low-Literacy African American Population Lessons Learned

African Americans have higher colorectal cancer (CRC) mortality than White Americans and yet have lower rates of CRC screening. Increased screening aids in early detection and higher survival rates. Coupled with low literacy rates, the burden of CRC morbidity and mortality is exacerbated in this population, making it important to develop culturally and literacy appropriate aids to help low-literacy African Americans make informed decisions about CRC screening. This article outlines the development of a low-literacy computer touch-screen colonoscopy decision aid using an innovative marketing method called perceptual mapping and message vector modeling. This method was used to mathematically model key messages for the decision aid, which were then used to modify an existing CRC screening tutorial with different messages. The final tutorial was delivered through computer touch-screen technology to increase access and ease of use for participants. Testing showed users were not only more comfortable with the touch-screen technology but were also significantly more willing to have a colonoscopy compared with a “usual care group.” Results confirm the importance of including participants in planning and that the use of these innovative mapping and message design methods can lead to significant CRC screening attitude change.

Knowledge of stroke risk, signs of stroke, and the need for stroke education among children with sickle cell disease and their caregivers.

Objectives : This study assessed stroke knowledge and the need for stroke education among children with sickle cell disease (SCD) and their caregivers. Methods : A cross-sectional study was conducted and includes: (1) structured interviews of 44 children with SCD and their 50 caregivers, and (2) a self-administered survey completed by medical directors of 22 SCD centers. The participants were interviewed regarding stroke knowledge and stroke educational materials. Results : Among the caregivers, only 34% named stroke as a complication associated with SCD, 36% were aware that their children were at higher risk, and 46% were not able to identify any warning signs of stroke. Only 11% of the children could accurately describe a stroke. Although 82% of the medical directors provided stroke information to caregivers, only 50% provided stroke educational materials to children. Caregivers and children were interested in receiving information about stroke. The preferred format for the educational material was a pamphlet for adults and a video for the children. Conclusions : Children with SCD, caregivers, and healthcare providers need and desire educational materials about stroke. Educational materials to improve knowledge about stroke may be an important strategy to increase completion of stroke screening tests.

Understanding paediatric resident−continuity preceptor relationships through the lens of apprenticeship learning

Context  Apprenticeship learning is common in medical education, but is often situated in theoretical frameworks which highlight its cognitive but not its social dimension.

Mapping Perceptions Related to Acceptance of Smallpox Vaccination by Hospital Emergency Room Personnel

Emergency department personnel would be first responders in the event of a bioterror smallpox outbreak, yet few were willing to be vaccinated during the 2002 federal campaign. To better understand vaccination concerns, perceptual mapping methods were used to create multidimensional models of how emergency department personnel (N= 73) in the Philadelphia area perceive the risks and benefits of smallpox vaccination under 4 levels of threat: (1) today; (2) if another terrorist attack happened anywhere in the U.S.; (3) if a smallpox attack happened somewhere in the U.S.; (4) if a smallpox attack happened locally. The perceptual maps show significant shifts in factors that are important for motivating respondents to accept vaccination under increasingly higher levels of threat. In the today scenario, endorsement of vaccination from a credible source, such as a major hospital in the area, was a very important factor (mean =7.10 on a 0-10 scale).However, endorsement was not as important under the 2 higher levels of threat. Under these conditions, respondentssense of wanting to help in a disaster emerged as an important element the closer the hypothetical attack was to the respondent,ranging in importance from 3.87 under the least threat to 7.35 under the greatest threat scenario. The perceptual maps yield information that would assist planners in designing more effective risk communication strategies tailored to particular audiences and levels of threat. Such communications are important to prepare for a smallpox event or other uncertain outbreak, where it is essential to rapidly vaccinate a critical mass of healthcare workers.

Transforming doctor-patient relationships

Historians often ponder how books change history. Our Bodies, Ourselves, the enormously popular and influential work, will long be studied for igniting and sustaining a worldwide women’s health movement. It should also be studied for how it transformed doctorpatient relationships and why it is such a trusted source of health information. The book began in a small discussion group on ‘women and their bodies’ at a Boston women’s conference in 1969. It grew into a course on women and their bodies and finally into a book with global appeal. Between 1973 and 2005, the Collective published seven English language and two Spanish language editions in the USA and over 20 foreign language editions. Within five years of its first publication it was a bestseller, and by 1999 had sold over four million copies. In her history of the women’s health movement, Morgan argues that it would be difficult to exaggerate the impact of Our Bodies, Ourselves. It filled the void where there existed few popular books on women’s health. Many colleges, universities and medical schools adopted it as a text. It was unique in that it gave voice to women’s own experiences of reproductive health and body issues. Elevating and validating women’s experiential knowledge, the Collective broke new ground in medical communication. The authors urged women to demand answers and explanations and to insist on enough information to negotiate the health care system. They envisioned creating a new type of partnership between patient and doctor that bore almost no resemblance to the model that existed. In the new model, it was envisioned that doctors and patients would have different responsibilities with the latter having ultimate control. Our Bodies, Ourselves evolved through a dialogue whereby ordinary readers communicated with the Collective to get information, lodge concerns and complaints, and suggest revisions to the book. The Collective was urged to add information relevant to an ever-growing array of ‘people like me’. As they corresponded with their readers, they enhanced coverage for women with disabilities and women of colour, weathered tumultuous storms over how to address lesbian health issues, and expanded the scope and coverage of a growing array of issues. Kline’s research on letters from women to members of the Collective during the 1970s and 1980s details how critical a role readers played in the evolution of this work. Finding ways to include many voices and yet retaining control over the final product posed many challenges. Invited contributors and people who corresponded sometimes had conflicting views on what was important. Keeping the book affordable was always at odds with expanding coverage. Editorial effort increased exponentially. For the 2005 edition, editors Judy Norsigian, Heather Stephenson and Kiki Zeldes managed and coordinated the work of 102 contributors and hundreds of ‘voices’ with the help of a ‘tone and voice editor’ and a photo editor. The evolution of Our Bodies, Ourselves is visible in the front matter of each edition. For example, the preface to the 25th Anniversary Edition, written by feminist luminaries Byllye Avery, Helen Rodriguez-Trias and Gloria Steinem anchored the volume in a continuation of second wave feminism. The current edition takes a very different approach. Reaching out to a new generation of women for whom second wave feminism is history, not lived experience, the front matter includes only a brief ‘Introduction’. A short letter from the founders tells readers that the history of the book is available on the web. How has the content evolved? The 1973 edition focused heavily on women’s changing sense of self in response to the second wave of feminism. It encouraged women to change internalized sexist volume covered the anatomy and physiology of reproduction and sexuality, the social and cultural aspects of sexuality and relationships, and included a controversial chapter written by a Boston gay collective that was replaced in later editions. Short chapters on nutrition, exercise, rape, self-defence, venereal disease, birth control, abortion, deciding about having children and childbearing were followed by a limited discussion of the menopause. A well-formulated critique of the American health care system rounded out the 275-page paperback that sold for

Randomized Trial of a Computerized Touch Screen Decision Aid to Increase Acceptance of Colonoscopy Screening in an African American Population with Limited Literacy.

2.98, but with substantial discounts to clinics and women’s groups. The 2005 edition, an 832-page encyclopedic version, opens with chapters on body image, eating well, drugs, exercise, complementary health practices, emotional wellbeing, environmental and occupational health, and Correspondence to: sruzek@temple.edu Sheryl Burt Ruzek PhD, Professor, Department of Public Health, 1700 N Broad Street, College of Health Professions, Temple University, Philadelphia, PA 19122, USA.

Preparedness for a smallpox outbreak: comparing metrics for assessing levels of vaccination among health-care workers by state

ABSTRACT The goal of this study was to assess the effectiveness of a touch screen decision aid to increase acceptance of colonoscopy screening among African American patients with low literacy, developed and tailored using perceptual mapping methods grounded in Illness Self-Regulation and Information-Communication Theories. The pilot randomized controlled trial investigated the effects of a theory-based intervention on patients’ acceptance of screening, including their perceptions of educational value, feelings about colonoscopy, likelihood to undergo screening, and decisional conflict about colonoscopy screening. Sixty-one African American patients with low literacy, aged 50–70 years, with no history of colonoscopy, were randomly assigned to receive a computerized touch screen decision aid (CDA; n = 33) or a literacy appropriate print tool (PT; n = 28) immediately before a primary care appointment in an urban, university-affiliated general internal medicine clinic. Patients rated the CDA significantly higher than the PT on all indicators of acceptance, including the helpfulness of the information for making a screening decision, and reported positive feelings about colonoscopy, greater likelihood to be screened, and lower decisional conflict. Results showed that a touch screen decision tool is acceptable to African American patients with low iteracy and, by increasing intent to screen, may increase rates of colonoscopy screening.

The Case For A National Patient Library

By mid-2005, less than 17% of smallpox vaccine doses distributed to American states for health-care workers (HCWs) during the CDC campaign had been used. To understand how states responded, vaccination patterns were studied. Metrics were calculated to compare the level of preparedness for a smallpox outbreak in terms of absolute numbers of HCWs vaccinated compared to the percentage of doses distributed to each state, the rate of vaccination per capita population, and the percentage of HCWs vaccinated compared to the number the CDC recommended. States were then ranked. Results showed that rankings for all four metrics were statistically different (P<0.0001). In addition, when ranks were assigned to quartiles, the states directly affected on 9/11/01 ranked lowest and states widely perceived to be at lower terror risk ranked in the top. These results underscore the need to critically examine how to define an appropriate level of preparedness for a smallpox outbreak.

Defining reducible risk : Social dimensions of assessing birth technologies.

A national patient library that stored and communicated findings from research on the comparative effectiveness of health services could be a valuable resource for patients and clinicians. It could assist in improving the quality of health care and help reduce inappropriate costs. Public confidence in a national patient library would require that its activities be insulated from government as well as from professional, provider, payer, and commercial groups and advocacy organizations. This article describes why such a library is possible and desirable, what it would do for whom, how it could be governed and financed, and how it could overcome initial challenges.