Printed educational materials directed at Ontario family physicians do not improve adherence to guideline recommendations for diabetes management: a pragmatic, factorial, cluster randomized controlled trial [ISRCTN72772651]

Background Printed educational materials (PEMs) have long been used to inform clinicians on evidence-based practices. However, the evidence for their effects on patient care and outcomes is unclear. In Ontario, despite widely available clinical practice guidelines recommending antihypertensives and cholesterol-lowering agents for patients with diabetes, prescriptions remain low. We aimed to determine whether PEMs can influence physicians to intensify prescribing of these medications. Methods A pragmatic, 2 × 2 factorial, cluster randomized controlled trial was designed to ascertain the effect of two PEM formats on physician prescribing: a postcard-sized message (“outsert”) or a longer narrative article (“insert”). Ontario family physician practices (clusters) were randomly allocated to receive the insert, outsert, both or neither. Physicians were eligible if they were in active practice and their patients were included if they were over 65 years with a diabetes diagnosis; both were unaware of the trial. Administrative databases at ICES (formerly the Institute for Clinical Evaluative Sciences) were used to link patients to their physician and to analyse prescribing patterns at baseline and 1 year following PEM mailout. The primary outcome was intensification defined as the addition of a new antihypertensive or cholesterol-lowering agent, or dose increase of a current drug, measured at the patient level. Analyses were by intention-to-treat and accounted for the clustering of patients to physicians. Results We randomly assigned 4231 practices (39% of Ontario family physicians) with a total population of 185,526 patients (20% of patients with diabetes in Ontario primary care) to receive the insert, outsert, both, and neither; among these, 4118 practices were analysed (n = 1025, n = 1037, n = 1031, n = 1025, respectively). No significant treatment effect was found for the outsert (odds ratio (OR) 1.01, 95% confidence interval (CI) 0.98 to 1.04) or the insert (OR 0.99, 95% CI 0.96 to 1.02). Percent of intensification in the four arms was similar (approximately 46%). Adjustment for physician characteristics (e.g., age, sex, practice location) had no impact on these findings. Conclusions PEMs have no effect on physician’s adherence to recommendations for the management of diabetes-related complications in Ontario. Further research should investigate the effect of other strategies to narrow this evidence-to-practice gap. Trial registration ISRCTN72772651. Retrospectively registered 21 July 2005.

Incidência dos modos de simbolização da Linguagem Gráfica em Materiais Educativos Impressos para Promoção da Saúde | Incidence of Graphic Language Symbolization Modes in Printed Educational Materials for Health Promotion

O presente estudo teve como objetivos a sistematização de informações da incidência dos Modos de Simbolização da Linguagem Gráfica (LG) nos conteúdos dos Materiais Educativos Impressos-MEIs para Promoção da Saúde no Brasil, tal como a identificação de fragilidades. Como fonte de pesquisa, utilizou-se a Biblioteca Virtual em Saúde do Ministério da Saúde (BVS-MS), que disponibiliza virtualmente o maior acervo de MEIs sobre saúde do Brasil. Valeu-se de descritores referentes à temática em questão nas áreas de: Prevenção das IST/Aids; Prevenção ao mosquito Aedes aegypti; Doenças Crônico Degenerativas (Hipertensão e Diabetes) e o Aleitamento Materno/Alimentação Complementar. Após isso, categorizou-se as informações quantitativas e fez-se a análise dos elementos compositivos dos MEIs à luz do Design da Informação. Os resultados permitiram uma compreensão, por meio da análise, da representação dos conteúdos informacionais que servirão como base norteadora para adaptação de futuras estratégias para composição gráficas mais eficientes em saúde, com a contribuição do Design da Informação.****The present study aimed at systematizing information on the incidence of Graphic Language Symbolization Modes (GL) in the contents of Printed Educational Materials-PEMs for Health Promotion in Brazil, as well as the identification of weaknesses. As a source of research, it was used the Virtual Health Library of the Ministry of Health (BVS-MS), which provides virtually the largest collection of health PEMs in Brazil. Was used descriptors related to the theme in question in the areas of: Prevention of STI/AIDS; Aedes aegypti prevention; Chronic Degenerative Diseases (Hypertension and Diabetes) and Breast Feeding/Complementary Eating. After that, the quantitative information was categorized and the compositional elements of the PEMs were analyzed in the light of Information Design. The results allowed an understanding, through analysis, of the representation of informational contents that will serve as a guiding basis for the adaptation of future strategies for more efficient graphic composition in health, with the contribution of Information Design.

Validação de aspectos semânticos em diretrizes para elaboração de Materiais Educativos Impressos para Promoção da Saúde: contribuição do Design da Informação | Semantic aspects validation in guidelines for the elaboration of Printed Educational Materials for Health Promotion: contribution of Information Design

O presente estudo teve como objetivo aplicar o método de Validação de Conteúdos elaborado por Polit Beck (2011) na proposta de um Guia para Elaboração de Materiais Educativos Impressos para Promoção da Saúde. Foi utilizado um comitê de juízes especialistas por meio o sistema de classificação de Pasquali (2010), nas áreas do Design da Informação e Design Gráfico, para que julgassem como adequado determinados pontos de interesse que estavam presentes no artefato em questão. Para esse momento, considerou-se o desenvolvimento de um quadro sinóptico que serviu como um norteador dos aspectos semânticos que foram apreciados, adaptados da Linguagem Visual de Horn (1998). Dessa forma, foi possível edificar soluções mais adequadas para a linguagem visual proposta no Guia, considerando que sua abordagem gira em torno do uso dos elementos da linguagem visual por não-designers, sendo tais elementos, agentes que influenciam na percepção e contribuem para promoção de ações mais responsáveis no modo de vida da população.*****The present study aimed to validate the content of a Guide for the Development of Printed Educational Materials for Health Promotion, by judges in the areas of Information Design and Graphic Design. For content validation, seven judges participated in the study, selected via the Lattes Platform, who analyzed the material from semantic aspects. Based on the judges' considerations, a framework was developed that served as a guide for the aspects appreciated, adapted from Horn's Visual Language (1998). For consensus of the judges' judgment, the content validity index (CVI) was used. After validating the items, the Guide presented a CVI greater than 0.78, considered the gold standard. Thus, it was possible to propose an appropriate guide with accessible visual language aimed at health professionals. In the end, the content validation method proposed for the Guide proved to be reliable for identifying weaknesses and preparing the material. The comments/suggestions listed by the judges were relevant and strengthened the image representations throughout the content, based on valid guidelines about the layout of the elements on the page.

Educational practices for families of children and adolescents using a permanent venous catheter

ABSTRACT Objectives: to identify, in the scientific literature, the educational practices performed by nurses with the families of children and adolescents using long-term venous catheters, concerning home care. Methods: integrative review in LILACS, PubMed, SCOPUS, Web of Science and CINAHL databases, from August to September 2018. Results: we analyzed eight articles that met the inclusion criteria. The results showed that all studies are international, mostly North American and with low level of evidence. The educational practices found were home visits, production of printed educational materials, use of mannequins for simulation, creation of an educational video, and combined educational practices. Final Considerations: the care provided by families at home in the countries studied is more complex than in Brazil, and the conclusion is that Brazilian studies need to advance in publications related to this area.

Designing a Teacher’s Handbook: Perspectives of Pre-Service Elementary Teachers Regarding Activities and Songs

Printed educational materials such as teacher’s handbook may affect the quality of education as much as teachers, curriculum, educational environment, and the other course materials. Perspectives of eighty-two pre-service elementary teachers regarding the activities and songs included in the teacher’s handbook for music course were examined by content analysis for shedding light on the nature of the handbook and for producing knowledge about how an effective teacher’s handbook for music course may be like. Even though the question was deliberately worded to let respondents express their both positive and negative views, the number of respondents who expressed positive views and the frequency of such expressions were considerably lower compared to the negative ones. Inappropriateness for age group and learning outcomes, insufficiency for facilitating learning, requiring hard-to-attain materials, and difficulty of application raised as major concerns for both activates and songs. Additionally, activities were argued to be repetitive and lacking entertainment while songs were criticized for their rhythm, melody, lyrics, quality, and practicability in the classroom.

Patient self-care with double catheter lumen for hemodialization: validation of instructional folder

The use of venous catheters for hemodialysis is associated with high rates of morbidity and mortality in patients with chronic renal failure. The implant of the dual lumen catheter (DLC) assists the patient in a worsening situation but commonly the patient remains with the DLC back home and this requires a series of important measures. The use of printed educational materials becomes an important tool to assist this type of care. Thus, the objective was to create and validate an instructive folder for the self-care of the patient using a catheter for hemodialysis. It is a methodological study of creation and evaluation of technology, in three stages. For validation of the content and style the material was submitted to the evaluation by experts in the area. 92.3% of the participants stated that the folder demonstrates clarity in their language, 53.8% of the participants suggested change and addition of information, and the same percentage also states that the instrument is attractive. The main suggestions were to change some term/word used in the folder, suggest changes to the images used, and include some information in the content. It is presumed then that the use of educational materials results in benefits to the patients who will receive the guidelines for self-care. Thus, the importance of nurses to use these resources for chronic renal patient care is emphasized.

Estratégias educativas para pessoas com estomia intestinal: revisão integrativa

Objetiva-se analisar o conhecimento científico sobre as estratégias educativas empregadas pela enfermagem para oensino-apredizagem das pessoas com estomia intestinal. Trata-se de uma revisão integrativa realizada nas bases dedados PubMed, LILACS e CINAHL, entre 1996 a 2014. Obteve-se amostra de 11 estudos. O Brasil liderou o numero depublicações e dos artigos incluídos na revisão e todos foram publicados em periódicos de enfermagem. Estes dadosrevelam o envolvimento dos enfermeiros com a temática em questão. O uso de tecnologias educativas foi identificado emsete estudos que desenvolveram atividades de cunho individual e/ou em grupo por meio de uma abordagem interativa.Foi realizada em consultas ambulatoriais ou apenas pela distribuição de materiais educativos, como: cartilhas, materiaiseducativos impressos, cursos on-line e programas multimídias, intensificando os cuidados com pele periestoma e/oureforçando os cuidados gerais. Para que o processo de ensino aprendizagem seja efetivo no campo da saúde, os recursosdidáticos empregados devem capacitar e motivar os pacientes com vistas a conseguirem incorporar novos significados,propiciando mais autonomia. Esta revisão permitiu identificar que estratégias de educação com o uso de tecnologiaseducativas são mais consistentes nas mensagens transmitidas ocasionando rápida mudança de comportamento.Palavras-chave: Estomia; Educação em Saúde; Materiais de Ensino.ABSTRACTThe study aimed to analyze the scientific knowledge of the educational strategies used by nurses for teachinglearning programs for ostomy people. This is an integrative review carried out in the databases: PubMed,LILACS, SciELO and CINAHL from 1996 to 2014, was obtained sample of 11 studies. Brazil led the the numberof publications and articles included in the review (11-100%) were published in magazines in general nursingjournals. These data reveal the nurses’ involvement with the questioned theme. It was carried out in outpatientclinics or only through the distribution of educational materials, such as: booklets, printed educational materials,online courses and multimedia programs, intensifying peristaltic skin care and / or reinforcing general care.In order for the teaching-learning process to be effective in the health field, the didactic resources employedmust enable and motivate patients in order to incorporate new meanings, providing more autonomy. This reviewidentified that education strategies with the use of educational technologies are more consistent in the messagestransmitted causing rapid change of behavior.Keywords: Stoma; Health education; Teaching Materials.