The multimedia computer for low-literacy patient education: a pilot project of cancer risk perceptions.

OBJECTIVE: Inadequate reading literacy is a major barrier to better educating patients. Despite its high prevalence, practical solutions for detecting and overcoming low literacy in a busy clinical setting remain elusive. In exploring the potential role for the multimedia computer in improving office-based patient education, we compared the accuracy of information captured from audio-computer interviewing of patients with that obtained from subsequent verbal questioning. SETTING: Adult medicine clinic, urban community health center PATIENTS: Convenience sample of patients awaiting clinic appointments (n = 59). Exclusion criteria included obvious psychoneurologic impairment or primary language other than English. INTERVENTION: A multimedia computer presentation that used audio-computer interviewing with localized imagery and voices to elicit responses to 4 questions on prior computer use and cancer risk perceptions. MEASUREMENTS AND MAIN RESULTS: Three patients refused or were unable to interact with the computer at all, and 3 patients required restarting the presentation from the beginning but ultimately completed the computerized survey. Of the 51 evaluable patients (72.5% African-American, 66.7% female, mean age 47.5 [+/- 18.1]), the mean time in the computer presentation was significantly longer with older age and with no prior computer use but did not differ by gender or race. Despite a high proportion of no prior computer use (60.8%), there was a high rate of agreement (88.7% overall) between audio-computer interviewing and subsequent verbal questioning. CONCLUSIONS: Audio-computer interviewing is feasible in this urban community health center. The computer offers a partial solution for overcoming literacy barriers inherent in written patient education materials and provides an efficient means of data collection that can be used to better target patients' educational needs.

Revisiting the one-year geriatric fellowship option: a preliminary assessment.

OBJECTIVE: To ascertain early opinions of geriatric fellowship program directors regarding the 1-year clinical training option. DESIGN: A brief mail survey of the 100 program directors listed in Graduate Medical Education, 1998-1999. MEASUREMENTS: Answers (favorable (+), no effect (0), or negative (-)) to questions regarding the effect on the training program, position of the director, and geriatrics as a discipline. RESULTS: This preliminary assessment produced decidedly mixed results. Seventy-six program directors responded (76% response rate). The clearest positive effect on the program itself was on the quantity of applicants (63% +, 4% -) but less so on their quality (33% +, 15% -). The clearest negative impact was on research aspects of the fellowship (0% +, 67%-). Other effects on the program were either null (clinical aspects and faculty morale) or moderately negative (educational, administrative, and financial aspects and the position of the program director), with few effects on the geriatrics division as a whole. Overall, the 1-year option was felt to have adversely affected geriatrics as a respected professional field (11% +, 41% -). Nevertheless, the majority (61%) answered that introduction of the 1-year option was wise. Although not attributed to this training pathway, program directors overwhelmingly perceived (75 % +) that geriatrics has enjoyed enhanced strength and attractiveness as a discipline since introduction of the 1-year option in 1992. CONCLUSIONS: The 1-year geriatric fellowship option has, at best, proved a mixed blessing to program directors. However, optimism regarding the future would seem to justify continuing to offer this option because of several observations and trends: (1) the increase in quantity and also perhaps quality of applicants; (2) growth in numbers of fellows and higher percentage program fill rates; (3) success of both 1- and two-year fellows in passing the Certificate of Added Qualifications examination and consequent increased generation of certified fellowship-trained geriatricians; (4) strong sentiment that geriatrics is gaining strength and attractiveness; and (5) that introduction of the 1-year option was wise.