Literature Search

The first article in this paper that was researched by Lee and colleagues aimed at identifying the effective intervention strategies so as to enhance health outcomes in patients suffering from cardiovascular disease (CVD) and low literacy skills. In the research article, there are three key criteria for a randomized controlled trial namely randomization, intervention and control that have been identified. The research focuses on cardiovascular disease which is the leading cause of morbidity and mortality worldwide among all the complex chronic diseases. Patients with cardiovascular disease require long-term medication therapy as well as significant lifestyle changes such as balanced nutrition, smoking cessation, and exercise. It is hence necessary to evaluate these patients level of health literacy so as to improve their healthcare outcomes through effective interventions. In the methodology, the study selection criteria limited its previous discussed searches to randomized control trial (RCTs) and patient control group studies so as to assess strategies for intervention and outcome. There were different criteria used to include studies available on both domestic and international databases. These include 1) selecting studies on CVD patients with known health literacy, 2) selecting studies using intervention studies, 3) selecting studies published in English and Korean, and 4) selecting studies with reported intervention strategies so as to enhance health outcomes. The study automatically excluded any studies that included a) non-adult patients, b) with published abstracts and all non-original articles (Lee, et. al., 2012). A methodology checklist was used to independently assess the quality of the nine resulting studies, in which one of the checklist criteria was randomization including blinding of treatment allocation. The interventions in the research article were classified in three key features namely periodic reminders, tailored counseling and education with self-monitoring.

The research article "RCT of a psychological intervention for patients with cancer" by Andersen and colleagues examines the therapeutic processes contributing to the efficacy of psychosocial interventions for cancer patients. The data acquired from a randomized clinical trial producing sound biobehavioral and health effects is used to determine the relations between process variables, treatment utilization, and outcomes. Psychological interventions for cancer patients play a crucial role in reducing the many burdens and sequelae of the disease and treatment. In the study, the population (N) was 227 in which the patients were randomized to initial assessment only (n=113), or intervention plus assessment (n=114) study arms (Andersen, Shelby & Golden-Kreutz, 2007). There did not exist a significant difference between arms in sociodemographic, disease or prognostic factors; type of surgery attained or adjuvant treatments planned. The intervention arm was further discussed in the study. From the initial assessment of the patients to 4 months, 83 percent of the participants received chemotherapy, and 43 percent received radiotherapy; whereas the rates from 4 months to 8 months were 17 % and 22 % respectively; and from 8 to 12 months the rates were 0 percent and 4 percent respectively. A biobehavioral conceptualization guided the selection of intervention targets in the study. The intervention components included conceptual model, strategies for low-fat/high fiber food consumption, food intake diary and energy balance information, relaxation training, social support and assertive communication training, strategies for physical and stress-related symptom management and walking protocol and strategies to increase daily activity level (Andersen, Shelby & Golden-Kreutz, 2007).

2. Assessment 1B: Summary of articles

The population of interest in the first research article was adult population as in the search for relevant databases all those that dealt with non-adult patients were excluded. The inclusion criteria in search of relevant databases included 1) selecting studies on CVD patients with known health literacy, 2) selecting studies using intervention studies, 3) selecting studies published in English and Korean, and 4) selecting studies with reported intervention strategies so as to enhance health outcomes. The exclusion criteria in search of relevant databases from both domestic and international databases included a) studies that included nonadult patients, (b) studies that had only published abstracts, and (c) studies that were not original research articles. The sampling method employed in the research article is stratified sampling in which the relevant sample studies were selected from the database using a specified criteria. The sample size of the nine studies, in which seven of the studies were RCTs, one was a nonrandomized controlled trial, and the other was a before and after study, ranged from between 25 to 636. The search results found 295 results, and after exclusions, n which was the studies included in quality synthesis was nine studies. The nine studies were assessed using a methodology checklist comprising of nine criteria namely (a) suitable research question, (b) randomization, (c) concealment method, (d) similarity between control group and treatment group, (e) dropout rate, (f) relevant outcomes measurement, (g) description of the intervention, (h) intention to treat analysis, and (i) confidence of multi-site studies. The overall quality was rated using three grades namely (-) meaning no criteria was fulfilled, (+) meaning some criteria were met and (++) meaning all or most criteria were fulfilled. No studies obtained (++), three studies were (-) while six studies wee (+). Therefore, six studies were employed in the analysis of effective intervention. The research determined that tailored counseling was an effective intervention strategy for patients with CVD and limited health literacy skills.

The population in this study (N = 227) were breast cancer patients with stage II (90 percent) and stage II (10 percent) treated with segmental (57 percent) or modified radical mastectomy (43 percent). The age of the cancer patients participating in the study was between 28 and 84 years (with medium equal 50.82 and standard deviation equal 10.76), and the majority of the participants (74 percent) had spouses or partners. The ethnic composition of the patients was Caucasian equal 90 percent, African American equal 9 percent and Hispanic equal 1 percent. At least 28 percent had attained high school education, 47 percent had attained a college education, and 25 percent had achieved a postgraduate education. At least 67 percent of the participants had at least part time jobs with the annual household incomes being 15,000 equal 10 percent; $15,000? 29,000 equal 16 percent, $30,000? 49,000 22 percent, $50,000? 79,000 equal 23percent, and $80,000 or more equal 29percent. The only criterion used was the suffering of breast cancer. The population of the study was N= 227 and sample size after randomization was n = 114. The intervention strategies were provided in small (8 to 12 patients) cohorts or groups (n = 13). The sessions lasted for one and half an hour with an intensive phase of, 18 weekly sessions during the first four months and a maintenance phase of 8 monthly sessions, for a total of 26 sessions (39 therapy hours) for the entire treatment period of 12 months. The study determined that the characteristics of the trial had some benefits to the study of process and outcome.

References

Andersen, B. L., Shelby, R. A., & Golden-Kreutz, D. M. (2007). RCT of a psychological intervention for patients with cancer: I. Mechanisms of change. Journal of Consulting and Clinical Psychology, 75(6), 927.

Lee, T. W., Lee, S. H., Kim, H. H., & Kang, S. J. (2012). Effective intervention strategies to improve health outcomes for cardiovascular disease patients with low health literacy skills: a systematic review. Asian Nursing Research, 6(4), 128-136.

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