Interventions to improve adherence to multiple CV medication in a CHD population significantly improved the odds of being adherent. Simple one-component interventions might be a promising way to improve medication adherence in a CHD population, as they would be easier to replicate in different settings and on a large scale.

People with chronic kidney disease (CKD) need usable information on how to live well and slow disease progression. This information is complex, difficult to communicate, and changes during the course of the disease. We examined lifestyle-related printed CKD patient education materials focusing on actionability and visual aids. From a previous systematic review assessing readability of CKD patient information, we identified materials targeting nutrition, exercise, and self-management. We applied the Suitability Assessment of Materials (SAM) and Patient Education Materials Assessment Tool (PEMAT) to evaluate how easy materials were to understand (understandability) and act on (actionability). We created the 5C image checklist and systematically examined all visual aids for clarity, contribution, contradiction, and caption. Of the 26 materials included, one fifth (n = 5, 19%) were rated "not suitable" on SAM and fewer than half (n = 11, 42%) were rated "superior." PEMAT mean subdomain scores were suboptimal for actionability (52) and visuals (37). Overall, more than half of all 223 graphics (n = 127, 57%) contributed no meaning to the text. Images in three documents (12%) directly contradicted messaging in the text. CKD lifestyle information materials require focused improvements in both actionability of advice given and use of visual aids to support people with CKD to self-manage their condition. The fifth C is culture and is best evaluated by user-testing.

Interventions for improving health literacy in people with chronic kidney disease.

Background:The timed up and go test (TUGT) is a functional test to assess mobility and balance, by moving from sit-to-stand, turn and walk three metres. It has been proposed as a useful outcome measure and falls identification in patients with heart failure. However test-retest reliability in this population has not previously been determined.Design: Prospective cross-sectional study. The aims of this study were to determine: test-retest reliability of the TUGT; relationships between the TUGT and other variables; and predictors of the TUGT.Methods: This represented a sub-study of participants enrolled in a multicentre randomised controlled trial of exercise training in recently hospitalised patients with heart failure (EJECTION-HF). Assessments occurred at baseline. The TUGT was conducted twice to determine reliability. Other variables include the six minute walk distance (6MWD), quality of life (AQOL) and falls history in the past 12 months. Test-retest reliability was examined using intra-class correlation coefficient; relationships through correlations; and differences between fallers and non-fallers through non-parametric. Predictors were identified through multiple linear regressions.Results: Analysis was undertaken on 278 participants (mean age 62 years and 75% male). The TUGT had excellent within-day test-retest reliability (with an intra-class correlation coefficient of 0.93). Shorter TUGT time was associated with higher AQOL (r s =-0.31, p<0.001) and longer 6MWD (r=-0.81, p<0.001). The TUGT time was also longer for fallers (p<0.001). Independent predictors were the 6MWD and age, which accounted for 66% of the variance.Conclusions: The TUGT appears to be a reliable outcome measurement in patients with heart failure and can be used in heart failure exercise programs.http://dx.Background: Evidence indicates that myocardial infarction (MI) can be precipitated by physical exertion although this has not been well defined in an Australian population.Aim: To evaluate the role of aerobic and isometric physical exertion as a trigger of acute coronary occlusion.Methods: 311 patients admitted to Royal North Shore Hospital with confirmed coronary occlusion by angiography completed a questionnaire within 4 days of admission, addressing physical exertion in the 48hrs before symptom onset and their usual annual frequency. Case-crossover study methodology was used to determine relative risk (RR) compared with usual frequency, focussing on the 1 hour hazard period prior to symptom onset, in those who reported either aerobic or isometric physical exertion.Results: The average age was 58 years (SD 12.5) and 85% were men. Eleven participants reported aerobic exertion level 5 on the Metabolic Equivalent of Task (MET) scale (range 1-8), associated with a RR of symptom onset of 5.5 (95% CI 3.0 to 10.0) and 4 reported isometric exertion with RR 6.5 (95% CI 2.5 to 16.8). Twenty-nine participants reported aerobic exertion ≥6 MET, associated with a RR of 17.6 (95% CI 11.3 to 27.4) and 8 reported isometric exertion with RR 23.6 (6.1...

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Background: Instruments to assess the quality and comprehensibility of printed patient education materials may lack proper consideration of how readers derive meaning from text. The Evaluative Linguistic Framework (ELF) considers how factors that influence readers' expectations about health care texts also affect their ability to understand them. The ELF has demonstrated value in improving the quality of patient materials about medication, consent, and self-reported questionnaires, but has not yet been used to evaluate a corpus of patient education materials about chronic disease self-management. Objective: This study sought to apply the ELF to examine specific elements of printed self-management patient education materials for chronic kidney disease (CKD) not captured by other tools. Methods: From a previously published systematic review, we identified 14 patient education materials (eight self-management, six diet and nutrition) for people with CKD. We used the ELF to identify the different ways the text could be structured, its intended purpose, the relationship established between reader and writer, presence of signposting, its complexity and technicality of language, and factual content. Key Results: Our analysis identified nine possible structural units, of which “introducing the problem” and “instructing the reader to self-manage” were common to all materials. However, there was no consistency or common sequence to these units of text. The intended readership and aims of the author(s) were not always clear; many materials made assumptions about what the reader knew, the language was often complex and dense, and the meta-discourse was sometimes distracting. Conclusions: Our analysis suggests CKD document developers can benefit from a theoretically grounded linguistic tool that focuses on the intended audience and their specific needs. The ELF identified structural units of text, aligned with rhetorical elements that can be uniformly applied for developing self-management education materials for CKD, and provided checks for language complexity. Further work can determine its usefulness for other (e.g., electronic) formats and other chronic diseases. [ HLRP: Health Literacy Research and Practice . 2018;2(1):e1–e14.] Plain Language Summary: Helping patients make meaning from information about their condition is a key goal of health care organizations. We analyzed chronic kidney disease patient education materials on self-management using the Evaluative Linguistic Framework. The purpose and intended audience were frequently unclear. We identified nine structural units of text that may assist information providers to plan and structure content.