Development and evaluation of an educational interactive CD-ROM for teens with cancer.

BACKGROUND: Cancer is the number one disease killer of children and adolescents in North America. For adolescents, this diagnosis comes at a particularly vulnerable stage. Educating adolescents with cancer from diagnosis through treatment teaches and empowers them. Increasing evidence shows that these adolescents want more information. Few educational tools exist for young cancer patients; none are interactive; therefore, a CD-ROM was developed to meet this need. PROCEDURE: Animation, voiceover, music, videos, and games were combined to develop a comprehensive multimedia CD-ROM to teach 12- to 18-year-olds with solid tumors about their disease, treatment, coping skills, and late effects in an interactive and non-threatening way. The CD-ROM was evaluated in a pre-post design with 65 subjects recruited from four pediatric oncology centers randomized to the CD-ROM or a "Handbook" containing analogous information. Pre-post questionnaires measured coping strategies, health locus of control, quality of life, cancer knowledge, and self-efficacy; post-test variables also included acceptability and use by teens, their families, and healthcare professionals. RESULTS: Teens receiving the CD-ROM were significantly more likely to increase their internal locus of control scores; however, no significant differences were observed on other measures, attributable in part to the study sample size. Among teens, acceptability was higher in the CD-ROM versus the Handbook group, but not different between the two parent groups. Pediatric oncology healthcare providers gave positive feedback on the CD-ROM. CONCLUSIONS: This CD-ROM is an innovative and engaging educational tool--the first portable interactive product with access on demand for adolescents with solid tumors.

Healthy children's perceptions of medicines: a review.

BACKGROUND: Chronically ill children's perceptions of medicines have been widely studied, but healthy children's less often. However, information on healthy children's beliefs and attitudes about medicine use is needed to be able to target health education messages about medicines appropriately. OBJECTIVES: A literature review was performed to determine schoolchildren's attitudes, beliefs, and knowledge about medicines; autonomy in using medicines; expectations of using medicines; and questions about medicines, so as to guide the development of a medicine education curriculum and to inform health care professionals who communicate with children. METHODS: This study was a review of literature from 17 countries. RESULTS: The review indicated that children of school age tend to view medicines cautiously. Although age is a factor, children have very limited ideas about how medicines work and issues around medicine efficacy are confusing to them. Even young children recognize that medicines may have harmful effects and, children of all ages and cultures studied want to learn more about medicines. Autonomy in medicine use is surprisingly high and disturbing given that knowledge of medicines is poor. CONCLUSIONS: Primary conclusions drawn are (1) children of the same age in different cultures appear similar in their attitudes, beliefs, behaviors, and desires to learn about medicines; (2) children lack information about medicines, especially in view of their levels of autonomy; and (3) health educators and health care professionals should educate children about rational medicine use, at appropriate cognitive development levels, before the children become independent medicine users.

Reducing antibiotics for colds and flu: a student-taught program.

A student peer-taught program, to decrease antibiotic use for colds and flu, was developed and implemented in one school district (21 schools) in Chisinau, Moldova, in 2003-04. A second district (20 schools) served as the control (C). Students (12-13 years) and adults most responsible for the family's health care completed surveys in March pre-post intervention. The surveys determined the reported incidence of colds and flu during the past winter, treatment, beliefs about cause and usefulness of antibiotics. The intervention included peer-education sessions, parents' meetings, booklet, vignette video, newsletters, poster and poster contest. The intervention also provided basic information on appropriate use of medicines. Pre-post intervention survey results indicated that the intervention was successful. Adjusted for Cs, students who reported they did not treat colds or flu with antibiotics increased 33.7%; the comparable increase for adults was 38.0%. Adjusted for Cs, intervention students who did not know if they had used an antibiotic decreased 15.1% and for intervention adults the comparable decrease was 5.0%. All relative responses related to beliefs about the cause of colds and flu and the usefulness of antibiotics to treat them changed in a positive direction. In all groups, beliefs and behaviors relative to antibiotic use were related.

How well can children understand medicine related topics?

The aim of this study was to discover how well children understand medicine related topics and in this way to evaluate their preparedness for two-way communication about these matters. The data were collected by conducting 14 focus group discussions (FGDs) among Finnish schoolchildren aged 7-8, 10-11 and 13-14 years. The main theme during the FGDs was the management of diseases with medicines. Both inductive and deductive analyses were used to analyse the data [Patton M. Qualitative evaluation and research methods. 2nd ed. Newbury Park: Sage Publications; 1990]. Children had superficial knowledge of and a negative attitude towards medicine use. They used medicine related vocabulary uncertainly implying that they do not fully comprehend all the information that they have gained. Children realized that there may be risks when using medicines and this understanding tended to increase by age. The results of this study indicate a need to educate children about medicines. In addition to school-based medicine education, health care professionals should communicate directly with children about their medicines at an appropriate cognitive level in order to increase their understanding and skills concerning health issues.

Developing a medicine education program in Finland: lessons learned.

The aim of this article is to describe the process of developing a medicine education program for elementary and middle schools in Finland and the lessons learned during the process. Further described is how teachers evaluated the usefulness of the medicine education materials created during the process. By medicine education we mean education about the proper use of medicines, abuse of medicines being just a small part of it. The development process started in 2002 by conducting focus group discussions with children in order to discover how children of different ages understand medicine-related topics. Moreover, teachers completed questionnaires in 2002 to assess their opinions about the importance of medicine education as a part of school health education. Based on the results of these two studies, materials were created during 2002-2003 (, in Finnish with an English introduction). These materials gave the teachers information about the proper use of medicines and some ideas for assignments. As a last part of this research project in autumn 2003, the materials were piloted by a group of elementary and middle school teachers (n=14), and the usefulness of the materials were evaluated during focus group discussions after a teaching period. Based on the evaluation, we learned that the Website should contain a simple structure and ready-to-use materials in order to be used by teachers. Moreover, the fact that teachers need information in order to be able to teach this unfamiliar topic became clear. Teachers of younger children need concise information, but teachers of adolescents need more in-depth information. Furthermore, teachers may have negative attitudes towards medicines, and therefore, medicine education should be rationalized for them. We conclude our article with recommendations on what should be taken into consideration when medicine education programs are planned.

Physician use of a participatory decision-making style with children with ADHD and their parents.

The purpose of this study was to examine the extent to which physicians reported using a participatory decision-making (PDM) style with children and their parents during attention-deficit/hyperactivity disorder visits and the physician characteristics that were related to physician use of a PDM style. The survey was sent to a stratified random sample of 250 pediatricians and 250 family practitioners that were licensed and actively practicing in North Carolina. A second mailing of the survey was sent to non-responders approximately 3 weeks after the first mailing was sent. Approximately 47% of the physicians responded. Physicians were significantly more likely to rate themselves as more participatory with parents than with children. Younger physicians were more likely to use a participatory style with attention-deficit/hyperactivity disorder (ADHD) children. Physicians who rated themselves as using a more participatory style with parents, also rated themselves as being more participatory with children. Pediatricians and younger physicians were more likely to use a participatory style with parents of ADHD children. The majority of physicians believed that ADHD children could begin to contribute to decisions about the diagnosis and treatment of ADHD during medical visits from age 7 to 11 years.

Do pictograms improve children's understanding of medicine leaflet information?

There is a growing need for balanced drug information customized for special target groups such as children [Food and Drug Administration. Prescription Drug Product Labeling; Medication Guide Requirements; Proposed Rule. Part VII. Department of Health and Human Services, 21 CRF Part 201, et al. Federal Register 1995;60:44182-252; Dickinson D, Raynor DK, Duman M. Patient information leaflets for medicines: using consumer testing to determine the most effective design. Patient Educ Couns 2001;43:147-59]. Pictograms are one aid that may be used to make information easier to read and understand. The aim of this study was to test whether children understand pictograms developed by the United States Pharmacopeia (USP) [The United States Pharmacopeial Convention Inc. USP Pictograms. Retrieved 11 March 2002 from http://www.usp.org/], and especially, if the pictograms improve children's understanding of medicine leaflet information. Finnish elementary school children aged 7 years (n=28), 11 years (n=31) and 13 years (n=31) were interviewed and asked what they thought 15 USP pictograms mean. The two older age groups were also asked to read an "easy-to-read" leaflet for penicillin-V. Every second child was given a leaflet with a plain text and the others received the same text accompanied by pictograms. After reading the leaflet, the children were asked seven questions related to the text. Most of the children understood the meanings of the selected 15 pictograms correctly, the proportion of the correct explanations varying from 30 to 99% according to the pictogram. Even well-understood pictograms did not help the children understand the leaflet information, although they reduced the need for probing. This study shows that the context in which pictograms are tested makes a difference in the results. Testing plain pictograms without incorporating them in their real context, e.g., in the patient information leaflet may exaggerate their usefulness in leaflet information.

Development and evaluation of an interactive CD-ROM for children with leukemia and their families.

To meet the need for an interactive software product to educate children with leukemia, ages 4-11 years, and their families about the disease and its treatment, we developed and evaluated an interactive, comprehensive, multimedia CD-ROM product, Kidz with Leukemia: A Space Adventure. The prototype was tested using a randomized controlled experimental design. Children with leukemia and their parents were randomized to receive either the newly developed CD-ROM or the book You and Leukemia by Lynn Baker. Health care providers (HCPs) and other content/technical experts evaluated only the CD-ROM. Data were collected on children's health locus of control, their understanding of leukemia, and the satisfaction of participants with their assigned intervention. Children in the CD-ROM group, compared with those in the book group, showed increased feelings of control over their health. Although there was a high level of satisfaction with the CD-ROM among all users, younger children and their parents were most satisfied. In conclusion, the CD-ROM, Kidz with Leukemia: A Space Adventure, was found to be a useful, engaging, and empowering tool for children with leukemia and can serve as a model for developing future health-related educational materials.