Use of a Low-Literacy Patient Education Tool to Enhance Pneumococcal Vaccination Rates: A Randomized Controlled Trial
CONTEXT Pneumococcal immunization rates for elderly and high-risk patients are only one third to one half the target rate of 60% established by the US Public Health Service. Limited or marginal literacy, which affects nearly 100 million Americans, especially the elderly, may contribute to these low...
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| Veröffentlicht in: | JAMA : the journal of the American Medical Association 1999-08, Vol.282 (7), p.646-650 |
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| creator | Jacobson, Terry A Thomas, Donna M Morton, Felicia James Offutt, Gardiner Shevlin, Jennifer Ray, Susan |
| description | CONTEXT Pneumococcal immunization rates for elderly and high-risk patients are
only one third to one half the target rate of 60% established by the US Public
Health Service. Limited or marginal literacy, which affects nearly 100 million
Americans, especially the elderly, may contribute to these low rates of immunization. OBJECTIVE To determine whether the use of a simple, low-literacy educational tool
enhances patient-physician dialogue about pneumococcal vaccination and increases
rates of immunization. DESIGN A randomized controlled trial conducted between May and June of 1998. SETTING Ambulatory care clinic of a 900-bed public teaching hospital serving
a predominantly indigent, low-literate, African American, inner-city population. PARTICIPANTS Of 433 patients who presented for routine primary care, had vaccine
indications (age ≥65 years or chronic disease), and had not been previously
vaccinated, 221 were randomly assigned to the intervention group and 212 to
the control group. Of the total patient population (mean age, 63 years), 280
(64.7%) had less than a high school education, 401 (92.6%) were African American,
and 300 (69.3%) were female. INTERVENTION One-page, low-literacy (below fifth-grade level) educational handout
encouraging patients to "ask your doctor about the pneumonia shot" vs a control
group (1-page, low-literacy educational handout conveying information about
nutrition). MAIN OUTCOME MEASURES Vaccination rates (documented by chart audit) of patients who received
pneumococcal vaccination and rates of patients who self-reported having discussed
vaccination with their physicians. RESULTS Patients in the intervention group were 4 times more likely to have
discussed the pneumococcal vaccine with their physicians than patients in
the control group (87/221 [39.4%] vs 21/212 [9.9%]; relative risk [RR], 3.97
[95% confidence interval {CI}, 2.71-5.83]), and were more than 5 times as
likely to have received the pneumococcal vaccine than the control group (44/221
[19.9%] vs 8/212 [3.8%]; RR, 5.28 [95% CI, 2.80-9.93]). In a multivariate
analysis controlling for race, sex, education, insurance status, age, level
of physician training, health status, and vaccine indication, only assignment
to the intervention group was statistically significantly related to the probability
of being immunized or discussing the issue with their physicians (P |
| doi_str_mv | 10.1001/jama.282.7.646 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_70825075</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><ama_id>191237</ama_id><sourcerecordid>70825075</sourcerecordid><originalsourceid>FETCH-LOGICAL-a312t-d506b0ea2672cef122a5706483ed584d471891b98f1b1acb4b308b6993403a363</originalsourceid><addsrcrecordid>eNqF0c1L5DAYBvAgyjrr7lXwImFZvHXMmzQf9SbD7CoMrCzjXsvbNMUObaJNy6J_vZEZUbyYSx7Ij5D3CSHHwObAGJxvsMc5N3yu5ypXe2QGUphMyMLskxljhcl0bvJD8jXGDUsLhP5CDoFJ0Br0jEy30dHQUKSr8D9btaMb0D7SGxxb50e6rCebYvB0HUJHx0CX_g69dfTGu6kPNliLHf2H1rZ-C__i6OIFvUzB16Fvn1xNF8GPQ-i6FNdDi903ctBgF9333X5Ebn8t14urbPXn9_XicpWhAD5mtWSqYg650ty6BjhHqZnKjXC1NHmdazAFVIVpoAK0VV4JZipVFCJnAoUSR-Rse-_9EB4mF8eyb6N1XYfehSmWmhkumZafQtBCSy1Ygj8-wE2YBp-GKDmkcpWSIqHTHZqq3tXl_dD2ODyWr7Un8HMHMKb-miFV2sY3V3Bg8PKqky1Ln_zuELjQ4hlme5eS</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>211376653</pqid></control><display><type>article</type><title>Use of a Low-Literacy Patient Education Tool to Enhance Pneumococcal Vaccination Rates: A Randomized Controlled Trial</title><source>MEDLINE</source><source>American Medical Association Journals</source><creator>Jacobson, Terry A ; Thomas, Donna M ; Morton, Felicia James ; Offutt, Gardiner ; Shevlin, Jennifer ; Ray, Susan</creator><creatorcontrib>Jacobson, Terry A ; Thomas, Donna M ; Morton, Felicia James ; Offutt, Gardiner ; Shevlin, Jennifer ; Ray, Susan</creatorcontrib><description>CONTEXT Pneumococcal immunization rates for elderly and high-risk patients are
only one third to one half the target rate of 60% established by the US Public
Health Service. Limited or marginal literacy, which affects nearly 100 million
Americans, especially the elderly, may contribute to these low rates of immunization. OBJECTIVE To determine whether the use of a simple, low-literacy educational tool
enhances patient-physician dialogue about pneumococcal vaccination and increases
rates of immunization. DESIGN A randomized controlled trial conducted between May and June of 1998. SETTING Ambulatory care clinic of a 900-bed public teaching hospital serving
a predominantly indigent, low-literate, African American, inner-city population. PARTICIPANTS Of 433 patients who presented for routine primary care, had vaccine
indications (age ≥65 years or chronic disease), and had not been previously
vaccinated, 221 were randomly assigned to the intervention group and 212 to
the control group. Of the total patient population (mean age, 63 years), 280
(64.7%) had less than a high school education, 401 (92.6%) were African American,
and 300 (69.3%) were female. INTERVENTION One-page, low-literacy (below fifth-grade level) educational handout
encouraging patients to "ask your doctor about the pneumonia shot" vs a control
group (1-page, low-literacy educational handout conveying information about
nutrition). MAIN OUTCOME MEASURES Vaccination rates (documented by chart audit) of patients who received
pneumococcal vaccination and rates of patients who self-reported having discussed
vaccination with their physicians. RESULTS Patients in the intervention group were 4 times more likely to have
discussed the pneumococcal vaccine with their physicians than patients in
the control group (87/221 [39.4%] vs 21/212 [9.9%]; relative risk [RR], 3.97
[95% confidence interval {CI}, 2.71-5.83]), and were more than 5 times as
likely to have received the pneumococcal vaccine than the control group (44/221
[19.9%] vs 8/212 [3.8%]; RR, 5.28 [95% CI, 2.80-9.93]). In a multivariate
analysis controlling for race, sex, education, insurance status, age, level
of physician training, health status, and vaccine indication, only assignment
to the intervention group was statistically significantly related to the probability
of being immunized or discussing the issue with their physicians (P<.001 for both trends). CONCLUSIONS A simple, low-literacy educational tool increased pneumococcal vaccination
rates and patient-physician discussions about the vaccine in an elderly, low-literate,
indigent, minority population.</description><identifier>ISSN: 0098-7484</identifier><identifier>EISSN: 1538-3598</identifier><identifier>DOI: 10.1001/jama.282.7.646</identifier><identifier>PMID: 10517717</identifier><identifier>CODEN: JAMAAP</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>Aged ; Bacterial Vaccines - administration & dosage ; Biological and medical sciences ; Educational Status ; Female ; Humans ; Logistic Models ; Male ; Medical sciences ; Middle Aged ; Multivariate Analysis ; Patient Education as Topic ; Physician-Patient Relations ; Pneumococcal Infections - prevention & control ; Prevention and actions ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Socioeconomic Factors ; Specific populations (family, woman, child, elderly...) ; Streptococcus pneumoniae ; Streptococcus pneumoniae - immunology ; Vaccination - statistics & numerical data</subject><ispartof>JAMA : the journal of the American Medical Association, 1999-08, Vol.282 (7), p.646-650</ispartof><rights>1999 INIST-CNRS</rights><rights>Copyright American Medical Association Aug 18, 1999</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jama/articlepdf/10.1001/jama.282.7.646$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.282.7.646$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,780,784,3340,27924,27925,76489,76492</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1921015$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10517717$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jacobson, Terry A</creatorcontrib><creatorcontrib>Thomas, Donna M</creatorcontrib><creatorcontrib>Morton, Felicia James</creatorcontrib><creatorcontrib>Offutt, Gardiner</creatorcontrib><creatorcontrib>Shevlin, Jennifer</creatorcontrib><creatorcontrib>Ray, Susan</creatorcontrib><title>Use of a Low-Literacy Patient Education Tool to Enhance Pneumococcal Vaccination Rates: A Randomized Controlled Trial</title><title>JAMA : the journal of the American Medical Association</title><addtitle>JAMA</addtitle><description>CONTEXT Pneumococcal immunization rates for elderly and high-risk patients are
only one third to one half the target rate of 60% established by the US Public
Health Service. Limited or marginal literacy, which affects nearly 100 million
Americans, especially the elderly, may contribute to these low rates of immunization. OBJECTIVE To determine whether the use of a simple, low-literacy educational tool
enhances patient-physician dialogue about pneumococcal vaccination and increases
rates of immunization. DESIGN A randomized controlled trial conducted between May and June of 1998. SETTING Ambulatory care clinic of a 900-bed public teaching hospital serving
a predominantly indigent, low-literate, African American, inner-city population. PARTICIPANTS Of 433 patients who presented for routine primary care, had vaccine
indications (age ≥65 years or chronic disease), and had not been previously
vaccinated, 221 were randomly assigned to the intervention group and 212 to
the control group. Of the total patient population (mean age, 63 years), 280
(64.7%) had less than a high school education, 401 (92.6%) were African American,
and 300 (69.3%) were female. INTERVENTION One-page, low-literacy (below fifth-grade level) educational handout
encouraging patients to "ask your doctor about the pneumonia shot" vs a control
group (1-page, low-literacy educational handout conveying information about
nutrition). MAIN OUTCOME MEASURES Vaccination rates (documented by chart audit) of patients who received
pneumococcal vaccination and rates of patients who self-reported having discussed
vaccination with their physicians. RESULTS Patients in the intervention group were 4 times more likely to have
discussed the pneumococcal vaccine with their physicians than patients in
the control group (87/221 [39.4%] vs 21/212 [9.9%]; relative risk [RR], 3.97
[95% confidence interval {CI}, 2.71-5.83]), and were more than 5 times as
likely to have received the pneumococcal vaccine than the control group (44/221
[19.9%] vs 8/212 [3.8%]; RR, 5.28 [95% CI, 2.80-9.93]). In a multivariate
analysis controlling for race, sex, education, insurance status, age, level
of physician training, health status, and vaccine indication, only assignment
to the intervention group was statistically significantly related to the probability
of being immunized or discussing the issue with their physicians (P<.001 for both trends). CONCLUSIONS A simple, low-literacy educational tool increased pneumococcal vaccination
rates and patient-physician discussions about the vaccine in an elderly, low-literate,
indigent, minority population.</description><subject>Aged</subject><subject>Bacterial Vaccines - administration & dosage</subject><subject>Biological and medical sciences</subject><subject>Educational Status</subject><subject>Female</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Patient Education as Topic</subject><subject>Physician-Patient Relations</subject><subject>Pneumococcal Infections - prevention & control</subject><subject>Prevention and actions</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Socioeconomic Factors</subject><subject>Specific populations (family, woman, child, elderly...)</subject><subject>Streptococcus pneumoniae</subject><subject>Streptococcus pneumoniae - immunology</subject><subject>Vaccination - statistics & numerical data</subject><issn>0098-7484</issn><issn>1538-3598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqF0c1L5DAYBvAgyjrr7lXwImFZvHXMmzQf9SbD7CoMrCzjXsvbNMUObaJNy6J_vZEZUbyYSx7Ij5D3CSHHwObAGJxvsMc5N3yu5ypXe2QGUphMyMLskxljhcl0bvJD8jXGDUsLhP5CDoFJ0Br0jEy30dHQUKSr8D9btaMb0D7SGxxb50e6rCebYvB0HUJHx0CX_g69dfTGu6kPNliLHf2H1rZ-C__i6OIFvUzB16Fvn1xNF8GPQ-i6FNdDi903ctBgF9333X5Ebn8t14urbPXn9_XicpWhAD5mtWSqYg650ty6BjhHqZnKjXC1NHmdazAFVIVpoAK0VV4JZipVFCJnAoUSR-Rse-_9EB4mF8eyb6N1XYfehSmWmhkumZafQtBCSy1Ygj8-wE2YBp-GKDmkcpWSIqHTHZqq3tXl_dD2ODyWr7Un8HMHMKb-miFV2sY3V3Bg8PKqky1Ln_zuELjQ4hlme5eS</recordid><startdate>19990818</startdate><enddate>19990818</enddate><creator>Jacobson, Terry A</creator><creator>Thomas, Donna M</creator><creator>Morton, Felicia James</creator><creator>Offutt, Gardiner</creator><creator>Shevlin, Jennifer</creator><creator>Ray, Susan</creator><general>American Medical Association</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7QL</scope><scope>7QP</scope><scope>7TK</scope><scope>7TS</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope></search><sort><creationdate>19990818</creationdate><title>Use of a Low-Literacy Patient Education Tool to Enhance Pneumococcal Vaccination Rates: A Randomized Controlled Trial</title><author>Jacobson, Terry A ; Thomas, Donna M ; Morton, Felicia James ; Offutt, Gardiner ; Shevlin, Jennifer ; Ray, Susan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a312t-d506b0ea2672cef122a5706483ed584d471891b98f1b1acb4b308b6993403a363</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Aged</topic><topic>Bacterial Vaccines - administration & dosage</topic><topic>Biological and medical sciences</topic><topic>Educational Status</topic><topic>Female</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Patient Education as Topic</topic><topic>Physician-Patient Relations</topic><topic>Pneumococcal Infections - prevention & control</topic><topic>Prevention and actions</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Socioeconomic Factors</topic><topic>Specific populations (family, woman, child, elderly...)</topic><topic>Streptococcus pneumoniae</topic><topic>Streptococcus pneumoniae - immunology</topic><topic>Vaccination - statistics & numerical data</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jacobson, Terry A</creatorcontrib><creatorcontrib>Thomas, Donna M</creatorcontrib><creatorcontrib>Morton, Felicia James</creatorcontrib><creatorcontrib>Offutt, Gardiner</creatorcontrib><creatorcontrib>Shevlin, Jennifer</creatorcontrib><creatorcontrib>Ray, Susan</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Physical Education Index</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>JAMA : the journal of the American Medical Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jacobson, Terry A</au><au>Thomas, Donna M</au><au>Morton, Felicia James</au><au>Offutt, Gardiner</au><au>Shevlin, Jennifer</au><au>Ray, Susan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Use of a Low-Literacy Patient Education Tool to Enhance Pneumococcal Vaccination Rates: A Randomized Controlled Trial</atitle><jtitle>JAMA : the journal of the American Medical Association</jtitle><addtitle>JAMA</addtitle><date>1999-08-18</date><risdate>1999</risdate><volume>282</volume><issue>7</issue><spage>646</spage><epage>650</epage><pages>646-650</pages><issn>0098-7484</issn><eissn>1538-3598</eissn><coden>JAMAAP</coden><abstract>CONTEXT Pneumococcal immunization rates for elderly and high-risk patients are
only one third to one half the target rate of 60% established by the US Public
Health Service. Limited or marginal literacy, which affects nearly 100 million
Americans, especially the elderly, may contribute to these low rates of immunization. OBJECTIVE To determine whether the use of a simple, low-literacy educational tool
enhances patient-physician dialogue about pneumococcal vaccination and increases
rates of immunization. DESIGN A randomized controlled trial conducted between May and June of 1998. SETTING Ambulatory care clinic of a 900-bed public teaching hospital serving
a predominantly indigent, low-literate, African American, inner-city population. PARTICIPANTS Of 433 patients who presented for routine primary care, had vaccine
indications (age ≥65 years or chronic disease), and had not been previously
vaccinated, 221 were randomly assigned to the intervention group and 212 to
the control group. Of the total patient population (mean age, 63 years), 280
(64.7%) had less than a high school education, 401 (92.6%) were African American,
and 300 (69.3%) were female. INTERVENTION One-page, low-literacy (below fifth-grade level) educational handout
encouraging patients to "ask your doctor about the pneumonia shot" vs a control
group (1-page, low-literacy educational handout conveying information about
nutrition). MAIN OUTCOME MEASURES Vaccination rates (documented by chart audit) of patients who received
pneumococcal vaccination and rates of patients who self-reported having discussed
vaccination with their physicians. RESULTS Patients in the intervention group were 4 times more likely to have
discussed the pneumococcal vaccine with their physicians than patients in
the control group (87/221 [39.4%] vs 21/212 [9.9%]; relative risk [RR], 3.97
[95% confidence interval {CI}, 2.71-5.83]), and were more than 5 times as
likely to have received the pneumococcal vaccine than the control group (44/221
[19.9%] vs 8/212 [3.8%]; RR, 5.28 [95% CI, 2.80-9.93]). In a multivariate
analysis controlling for race, sex, education, insurance status, age, level
of physician training, health status, and vaccine indication, only assignment
to the intervention group was statistically significantly related to the probability
of being immunized or discussing the issue with their physicians (P<.001 for both trends). CONCLUSIONS A simple, low-literacy educational tool increased pneumococcal vaccination
rates and patient-physician discussions about the vaccine in an elderly, low-literate,
indigent, minority population.</abstract><cop>Chicago, IL</cop><pub>American Medical Association</pub><pmid>10517717</pmid><doi>10.1001/jama.282.7.646</doi><tpages>5</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0098-7484 |
| ispartof | JAMA : the journal of the American Medical Association, 1999-08, Vol.282 (7), p.646-650 |
| issn | 0098-7484 1538-3598 |
| language | eng |
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| source | MEDLINE; American Medical Association Journals |
| subjects | Aged Bacterial Vaccines - administration & dosage Biological and medical sciences Educational Status Female Humans Logistic Models Male Medical sciences Middle Aged Multivariate Analysis Patient Education as Topic Physician-Patient Relations Pneumococcal Infections - prevention & control Prevention and actions Public health. Hygiene Public health. Hygiene-occupational medicine Socioeconomic Factors Specific populations (family, woman, child, elderly...) Streptococcus pneumoniae Streptococcus pneumoniae - immunology Vaccination - statistics & numerical data |
| title | Use of a Low-Literacy Patient Education Tool to Enhance Pneumococcal Vaccination Rates: A Randomized Controlled Trial |
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