In the latest issue (attached below):

A systematic review was undertaken of observational studies that investigated men’s health literacy and its components related to ischaemic heart disease or type 2 diabetes mellitus, and their associated risk factors. Nine studies were included: only one study examined health literacy (nutrition literacy). The majority of included studies focused on only one component of health literacy, namely knowledge (n = 7) and personal skills (confidence) (n = 1). Twenty correlates were identified, primarily relating to the knowledge component, with the strength of the evidence for only one correlate, education, graded as being of moderate quality. The evidence for all other correlates was graded as being of low quality.

The authors conclude that the limited body of research identified may have resulted from a lack of consensus about the definition of health literacy, and a concordant set of validated health literacy measures. Despite these limitations, broadening the search to include components of health literacy has identified that several factors are associated with men’s knowledge and awareness of ischaemic heart disease and type 2 diabetes mellitus that will assist in the development of men’s health promotion strategies. However, addressing the broader knowledge gaps and controversy in the health literacy field will deliver policy and programme benefits to address these major contributors to the burden of disease among men.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1186/s12889-015-1900-5

Davey, J., et al. (2015). The correlates of chronic disease-related health literacy and its components among men: A systematic review. BMC Public Health, 15:589.

Reaching the community in new ways with comprehensive health and wellness advice, support and information.

Homecare Medical – a leading New Zealand tele-triage organisation - has been announced as the Ministry of Health’s partner to develop and deliver a new, enhanced, integrated, national telehealth service for New Zealand. The national telehealth service will see clinical and non-clinical staff provide phone and online advice, support, assessment of symptoms, triage, treatment advice, and preventative and educational aspects for a range of health, wellbeing and counselling services. Initial services available will be a health advice and triage service, quit smoking services, poisons advice, alcohol and drug advice, immunisation and vaccination advice, depression advice and services, and gambling advice and services.

Homecare Medical Board Chair Dr Martin Seers said today “People expect to get help and advice through a variety of channels, they expect to be able to talk to a ‘real’ person and they expect a joined up system that ‘knows’ them.” 

Dr Seers explained “We will work to deliver a service that can be accessed through multiple channels 24 x 7 – phone, websites, email, txt message, chat, and in the future, video calling and mobile applications. This will be a service where every door is the right door – where users’ needs are met directly, or by linking them to the appropriate service - their GP, nurse,   pharmacist, a midwife, paramedics, a counsellor or therapist.”

The service aims to provide accessible, people-centred, flexible and adaptable quality health and counselling services, where the individual who takes the call is responsible for ensuring the caller gets the help or advice they need. Key to this is that the service is integrated with local and regional services and that users get a consistent service no matter where or how they make contact, and where each caller should only have to tell their story once.

The benefits will be better care outcomes for New Zealanders, a reduction in acute and unplanned care - reducing emergency department admissions and pressure on ambulance services - improved health and wellness support for users, improved health literacy, more care delivered close to home, more self-management, and getting the right advice from well trained staff.

“While the current health and wellness phone advice lines work well and we’re starting from a strong base, there is an opportunity for them to be more connected and to significantly enhance the services currently offered. We will integrate with them and collaborate with other service providers over time. We are thrilled to have this once in a generation opportunity to fundamentally change the health services and agencies approach to health and wellness in New Zealand to meet growing demand, consumer expectations and the need for sustainable healthcare.”

From 1 November 2015 the following services will make up the 24 x 7, free national telehealth service:- 

Health triage and advice

• Homecare Medical will deliver the Healthline service, with experienced registered nurses providing high quality health advice. 

Poisons advice

• The National Poisons Centre will continue to provide a service to clinicians and the public; Homecare Medical will integrate and partner with the Poisons Centre to give the national telehealth service triage nurses access to elements of their extensive database. 
• The University of Otago have been involved in designing our approach. 

Quit smoking services

• Using suitably qualified and experienced staff, Homecare Medical will be responsible for delivering virtual smoking cessation support. We are delighted that throughout the procurement process we have built a constructive relationship with the Quit Group Trust who have agreed to support us during the transition period to 1 November. 

Alcohol and drug advice

• Homecare Medical, using highly experienced staff will deliver the Alcohol Drug Helpline services. We will continue to work very closely with Alcohol Drug Association New Zealand (ADANZ) who currently deliver this service. 

Immunisation and vaccination advice

• The Immunisation Advisory Centre (IMAC) team will train Homecare Medical nurses to provide advice to the public; IMAC will continue to provide clinical advice to GPs and hospital staff and support our nurses when required. 

Depression advice and services

• This will be provided by a well-resourced team with a thorough and deep understanding of mental health and depression.

Gambling advice and services

•  We will have leading New Zealand mental health and addiction specialists providing this service. 

No phone numbers or contact details that users access will change at this stage. 

The current services manage around 2 million calls per year.

In addition, Homecare Medical is working with Plunket to jointly manage calls to PlunketLine that are currently referred to Healthline, and with St John on extending the advice for non-urgent, not life threatening 111 calls for ambulance currently provided in Auckland by Homecare Medical nurses. 

Dr Seers explained “Our commitment has always been to innovate, create and deliver services that are focussed on giving all New Zealanders the best possible chance to live well. In developing our telehealth vision and designing the national telehealth service we worked closely with current service providers, with consumer organisations, nurses, pharmacists, doctors, counsellors and others to inform our proposal and our idea of the best ‘design’ for a national telehealth service. We kept focussed on developing better, easier ways of getting health and wellness support for the mum with an asthmatic child, for the middle aged overweight man who is depressed and struggling to monitor his diabetes, for the gen x smoker who needs help quitting. We named them and we built our models with them at the centre.”

“For them, the benefits of a new national telehealth service will be a pathway to the right information, care or service they need, whenever and wherever they need it.  And for their general practice team, the national telehealth service means additional, integrated support for their patients and better continuity of care. For DHBs it will mean fewer emergency department admissions.”

“This isn’t an exercise driven by costs – this is an initiative focussed on reaching the community in new ways with comprehensive health and wellness advice, support and information.”

Homecare Medical (formerly HML) is a New Zealand-owned healthcare organisation currently providing 24 x 7 telehealth services, including nurse-based teleconsults, care coordination, telephone-based screening and in and out of hours general practice support.

Health Minister Jonathan Coleman has announced that Homecare Medical is the preferred provider for the new national telehealth service.

New Zealand currently has multiple individual telehealth services that handle around two million calls a year. Some of these services are not available 24/7.

“In 2011 we committed to roll out a comprehensive telehealth advice service with access to nurses, GPs and pharmacists,” says Dr Coleman.

“The free national telehealth service will be available 24 hours a day, seven days a week. It will provide the public with better access to high quality consistent health advice across the country.

“The public can still contact services using current phone numbers. Behind the scenes, the new national service will be more seamless and ensure people access the right advice, at the right time, no matter where they live.

“The national telehealth service will also help encourage patients to use community based services and to self-care. This will help reduce the pressure on after-hours primary care and hospital emergency departments.”

Final contract negotiations are underway with Homecare Medical which is a partnership between Pegasus Health and ProCare Health. The service will go live on 1 November 2015. It will be delivered within current Ministry of Health funding.

It will integrate Healthline, Poisonline, Quitline, Gambing Helpline, Alcohol and Drug Helpline, the National Depression Initiative, and immunisation advice for the public. 111 calls and PlunketLine will not be affected.

The Ministry of Health will work closely with providers to ensure a smooth transition.

Fifty-eight studies were included, which addressed a wide array of health outcomes and risk behaviors. The review examined the effects of four types of strategies or interventions: community system-level change strategies; broad health and social care system-level strategies; interventions using lay community health outreach workers or group-based health education led by professional staff; and group-based health education.

The authors found that "... interventions led by community coalitions may connect health and human service providers with ethnic and racial minority communities in ways that benefit individual health outcomes and behaviors, as well as care delivery systems". However, they go on to say that "... because information on characteristics of the coalitions themselves is insufficient, evidence does not provide an explanation for the underlying mechanisms of beneficial effects".

This article is available to read in free full text at:  http://dx.doi.org/10.1002/14651858.CD009905.pub2

Anderson LM, Adeney KL, Shinn C, Safranek S, Buckner-Brown J, Krause LK. (2015). Community coalition-driven interventions to reduce health disparities among racial and ethnic minority populations. Cochrane Database of Systematic Reviews, 6, CD009905.

Designed with young people in mind, the JUST THE FACTS website aims to dispel myths and provide simple, up-to-date information about Sexually Transmitted Infections (STIs) and related issues to target those at most risk. Research indicates that Maori and Pasifica aged under 25 years have a disproportionate burden of STIs within the NZ population.

To read the full media release, go to:  http://www.scoop.co.nz/stories/GE1506/S00049/new-sexual-health-website-to-reach-at-risk-nz-youth.htm

For more information, visit JUST THE FACTS website.

• supports a ‘culture shift’ so that health literacy is core business at all levels of the health system
• reduces health literacy demands and recognises that good health literacy practice contributes to improved health outcomes and reduced health costs.

To access the framework, go to:  http://www.health.govt.nz/publication/framework-health-literacy

Ministry of Health  (2015). A Framework for Health Literacy. Wellington: Ministry of Health.

The Ministry of Health has launched a health literacy review guide and supporting resources on its website to help health organisations to complete health literacy reviews of their services and develop plans for improvement.

The Health literacy review: A guide is freely available online and is supported by information including videos of organisations who have used the Guide. 

The Guide helps organisations identify the confusing aspects of health services and health advice as well as barriers to accessing services.  A review will show what a health service is doing well and provide examples of good practice that could be used in other services.

The Guide was developed by Workbase, with feedback from international health literacy expert Dr Rima Rudd, Harvard School of Public Health.  Capital & Coast DHB, Counties Manukau Health, Northland DHB and Te Tai Tokerau PHO supported the development of the Guide by trialling the review process.  Along with highlighting some known service issues, each organisation found that their health literacy review uncovered new information.

Susan Reid, Workbase’s Consulting Manager said “health literacy is often understood as something patients do or don’t have.  The Guide takes a systems view about what organisations can do to reduce the demands on patients and build knowledge and skills to make it easier for patients to access and navigate services for better health outcomes”.

The website and Guide will be of interest to those wanting to create health literate organisations and services.  The Guide describes the six Dimensions of a health literate organisation in New Zealand and uses these as the framework for a health literacy review. 

For more information visit http://www.health.govt.nz/our-work/health-literacy/health-literacy-reviews

This guide and the health literacy reviews section on the Ministry of Health website have been developed with input from DHBs, to support health organisations undertake a health literacy review. They draw on international best practise for health literate organisations (the 6 Dimensions) tailored for the New Zealand health setting.

To access the guide and the health literacy reviews section, go to:  http://www.health.govt.nz/our-work/health-literacy/health-literacy-reviews

Ministry of Health (2015). Health literacy review: A guide. Wellington. Ministry of Health.

The South Island Alliance’s Health of Older Peoples group (HOPSLA) has announced the recent appointment of two new part-time Primary Care Dementia Education Co-ordinator roles, a move which looks set to support improved diagnosis and quality of life for dementia patients living in the South Island.

The new roles are in response to the fact that many people with dementia are receiving a diagnosis late in their illness as Jenny Keightley, Chair of HOPSLA explains, “helping GPs to make an early diagnosis of dementia and providing links to support services can make a real difference to the patient and their family. It can reduce stigma and enable people with dementia to understand their condition, access treatments that could help relieve their symptoms and improve their quality of life. It can also give them time to plan for the future. The new positions are an exciting development as they will specifically focus on primary care settings, looking at the education resources and the implementation of a dementia education programme across the South Island, so that we can help promote better, earlier diagnosis of dementia and continuity of care.”

One of the new appointees is Carole Kerr, a registered psychiatric nurse with an extensive career related to older people, in particular mental health services for older people, people with disabilities, and Planning and Funding.  Carole is currently the Walking in Another’s Shoes Dementia Educator for Nelson Marlborough DHB. Carole will be on secondment from 18 May 2015.

Carole will share her role with Rebecca Winsor, a registered nurse who works as a Clinical Nurse Specialist (CNS) for Older Person’s Health and NetP Nurse Educator for the Princess Margaret Hospital, Canterbury DHB.  Rebecca’s post graduate diploma study has focussed on patients with dementia or delirium, or patients with depression. Rebecca will commence on 11 May 2015 and will be based at the South Island Alliance Programme Office.

The work programme is being led by HOPSLA and positions are fixed-term until 30 June 2016. “We are delighted to have such excellent, experienced new recruits to join our team and look forward very much to working with them in the future,” says Keightley.

To read the article, go to:  http://www.lianza.org.nz/sites/default/files/Library%20Life%20434%20May%202015.pdf

Thirty-eight articles were included in the review. Only four studies investigated the specific role of low health literacy in the evaluation of online health information. The other studies examined the association between educational level or other skills-based proxies for health literacy, such as general literacy, and outcomes. Results indicate that low health literacy (and related skills) are negatively related to the ability to evaluate online health information and trust in online health information. Evidence on the association with perceived quality of online health information and use of evaluation criteria is inconclusive.

The authors conclude that, as the findings indicate that low health literacy (and related skills) play a role in the evaluation of online health information, this topic is worth more scholarly attention. They go on to say that, based on the results of this review, future research in this field should (1) specifically focus on health literacy, (2) devote more attention to the identification of the different criteria people use to evaluate online health information, (3) develop shared definitions and measures for the most commonly used outcomes in the field of evaluation of online health information, and (4) assess the relationship between the different evaluative dimensions and the role played by health literacy in shaping their interplay.

This is an open access article and can be read in free full text at:  http://doi.org/10.2196/jmir.4018

Diviani, N., et al. (2015). Low health literacy and evaluation of online health Information: A systematic review. Journal of Medical Internet Research, 17(5):e112.

A UK population-representative sample of greater than or equal to 50 year-olds (n=6965) was surveyed using the Awareness and Beliefs about Cancer measure. These analyses examine six items on cancer beliefs (e.g., ‘cancer can often be cured’), and four on help-seeking barriers (e.g., ‘I would be too embarrassed’).
results: Smokers were more likely to hold pessimistic cancer beliefs than never-smokers or former-smokers on four of six items. For example, 34% agreed ‘a cancer diagnosis is a death sentence’, compared with 24% of non/former-smokers (P<0.001).

More smokers (18%) than non/former-smokers (11%) would not want to know if they had cancer (P<0.01). The only barrier to symptomatic help-seeking differing by smoking status was ‘worry about what the doctor might find’ (36% vs 28%, P<0.01). Associations were independent of demographics, self-rated health and cancer experience.

The authors conclude that smokers held more pessimistic and avoidant beliefs about cancer, which could deter early-detection behaviour. A better understanding of these beliefs is needed to increase engagement in early diagnosis by this high-risk group.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1038/bjc.2015.148

Quaife, S.L., et al. (2015). Smoking is associated with pessimistic and avoidant beliefs about cancer: results from the International Cancer Benchmarking Partnership. British Journal of Cancer, 112, 1799–1804

The committee concludes that this streamlined set of measures could provide consistent benchmarks for health progress across the nation and improve system performance in the highest-priority areas.

The report can be read for free online at:  http://www.iom.edu/Reports/2015/Vital-Signs-Core-Metrics.aspx

To read the full story, go to the Open for Better Care website:  http://www.open.hqsc.govt.nz/news-and-events-2/news/2060/

The booklet is available to read and download in full text at:  http://www.hqsc.govt.nz/publications-and-resources/publication/2046/

The workshop summary report is available to read free online - see: http://www.iom.edu/Reports/2015/Informed-Consent-Health-Literacy.aspx

The workshop summary report is available to read free online - see: http://www.iom.edu/Reports/2015/Communicate-to-Advance-Publics-Health.aspx

This study evaluated the readability of Australian online health information and investigated whether it matches the average reading level of Australians.

The small device measures the amount of carbon monoxide (CO), a toxic gas coming out of the lungs.  

Wintec Health Services Nurse Kaylene Henderson says the device encourages students to participate in the free smoking cessation programme.  

To read the full news story, go to:  https://www.midlandshn.health.nz/news/smokerlyzer-highlights-effects-of-smoking

In this issue:

A mixed methods qualitative evaluation was undertaken to understand self-management service provision to culturally diverse communities (i.e. how components such as lay workers, group-based design, and culturally-appropriate educational material are intended to encourage behavioural change). The authors interviewed lay educators delivering the Chronic Disease Educator programme along with attendees, whilst observing workshops. Data were thematically analysed using a content-based constant comparison approach through a number of interpretative analytical stages.

Lay educators felt part of the local community, relating to attendees from different races and ethnicities. However, lay educators faced challenges when addressing health beliefs and changing lifestyle practices. Culturally-tailored components aided communication, with educator’s cultural awareness leading to close relationships with attendees, while the group-based design facilitated discussions of the emotional impact of illness.

The authors conclude that lay educators bring with them a number of nuanced skills and knowledge when delivering self-management education. The development and training required for this role is inhibited by financial constraints at policy-level. The interpretation of being from the ‘community’ links with the identity and status of the lay role, overlapping notions of race, ethnicity, and language.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1186/s12913-015-0712-8

Sidhu, M.S., et al. (2015). A critique of the design, implementation, and delivery of a culturally-tailored self-management education intervention: a qualitative evaluation. BMC Health Services Research, 15:54

To find out more on the Open for Better Care website, go to:  http://www.open.hqsc.govt.nz/patient-safety-week/lets-plan/pharmacy-week/

This longitudinal study uses data from the International Tobacco Control Policy Evaluation Project in the USA, Canada, the UK and Australia "... to investigate, by gender and country, whether smokers who believe that smoking helps control weight are less responsive to tobacco control policies with regards to quit attempts than those who do not".

Available to read in free full text at:  http://tobaccocontrol.bmj.com/content/early/2015/02/02/tobaccocontrol-2014-051886.full

Shang C, Chaloupka FJ, Fong GT, et al. (2015). Weight control belief and its impact on the effectiveness of tobacco control policies on quit attempts: Findings from the ITC 4 Country Project. Tobacco Control, 24:iii41-iii47.

This study aimed to develop a conceptual model that describes the elements of cancer caregiver health literacy.

To erad the ful story, go to:  http://www.diabetes.org.uk/About_us/News/Launch-of-information-prescriptions-for-people-with-diabetes/

Patients presenting to an academic ED with a primary complaint of back pain had their consultations recorded. Coders reviewed each transcript to determine whether smoking was discussed and to build a corpus of smoking-related discussions. They developed coding categories to characterise how providers responded when patients endorsed smoking behavior.

Of 52 patient-provider encounters during which smoking was discussed, two-thirds of patients indicated that they were smokers. Providers missed opportunities for smoking cessation counseling 70% of the time. Eleven encounters contained teachable moments for smoking cessation. The authors identified four primary strategies for creating teachable moments: 1) positive reinforcement, 2) encouragement, 3) assessing readiness, and 4) offering concrete motivating reasons.

The authors conclude that most providers missed opportunities to offer teachable moments for smoking cessation. In encounters that contained teachable moments, providers employed multiple strategies, combining general advice with motivation tailored to the patient's particular circumstances. Creating motivational links to enhance smoking cessation efforts may be possible with a minimal investment of ED resources.

This is  an open access article and can be read in free full text at:  http://dx.doi.org/10.1186/s12913-014-0651-9

Buchbinder, M., et al. (2014). Teachable moments and missed opportunities for smoking cessation counseling in a Hospital Emergency Department: A mixed-methods study of patient-provider communication. BMC Health Services Research, 14:651

The workshop summary is available as a free PDF download at:  http://iom.edu/Reports/2014/Facilitating-Patient-Understanding-of-Discharge-Instructions.aspx

In the videos, four Māori people share their experience of both working in a health service and being a patient or whānau of a patient. The participants work within a Māori health service so the videos include views both as a consumer and provider of services.

The videos explore the importance of relationships with whānau when working with Māori consumers, cultural considerations for health providers, and how to work with patients and whānau.

The videos are presented as four individual stories, and also as shorter clips edited into themes. The themes are:

• looking after Māori in hospital
• one Māori voice
• Māori cultural practices
• communicating with Māori in a health setting
• whānau support in health care
• health literacy among Māori.

The videos are available to view at:  http://www.hqsc.govt.nz/our-programmes/consumer-engagement/publications-and-resources/videos-maori-responsiveness/

Data from 5,024 newly-diagnosed breast cancer patients treated in 111 breast center hospitals in Germany were analysed and combined with data on hospital characteristics. Multilevel linear regression models were calculated taking into account hospital characteristics and adjusting for patient case mix.

Younger patients, those receiving mastectomy, having statutory health insurance, not living with a partner and having a foreign native language report higher unmet information needs. The data demonstrate small between-hospital variation in unmet information needs. In hospitals that provide patient-specific information material and that offer health fairs as well as those that are non-teaching or have lower patient-volume, patients are less likely to report unmet information needs.

The authors conclude that hospitals may contribute to reducing the patients? information needs by means that are not necessarily resource-intensive.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1186/s12913-014-0601-6

Kowalski, C., et al. (2014). Meeting patients’ health information needs in breast cancer center hospitals – a multilevel analysis. BMC Health Services Research, 14:601.

The authors identified 17 articles reporting on the development and validation of 17 instruments measuring health literacy. More than two thirds of all instruments are based on a multidimensional construct of health literacy. Moreover, there is a trend towards a mixed measurement (self-report and direct test) of health literacy with 41% of instruments applying it, though results strongly indicate a weakness of coherence between the underlying constructs measured. Overall, almost every third instrument is based on assessment formats modeled on already existing functional literacy screeners such as the REALM or the TOFHLA and 30% of the included articles do not report on significant reporting features specified in the SURGE guideline.

The authors conclude that scholars recently developing instruments that measure health literacy mainly comply with recommendations of the academic circle by applying multidimensional constructs and mixing up measurement approaches to capture health literacy comprehensively. Nonetheless, there is still a dependence on assessment formats, rooted in functional literacy measurement contradicting the widespread call for new instruments. All things considered, there is no clear "consensus" on HL measurement but a convergence to more comprehensive tools. Giving attention to this finding can help to offer direction towards the development of comparable and reliable health literacy assessment tools that effectively respond to the informational needs of populations.

This is a open access article and can be downloaded and read in free full text at: http://dx.doi.org/10.1186/1471-2458-14-1207

Altin, S.V., et al. (2014). The evolution of health literacy assessment tools: A systematic review. BMC Public Health, 4, 1207.

The November 2014 issue of the National Health IT Board (NHITB) newsletter is now available online. It contains information on the following:

To read the blog post, go to: https://blogs.otago.ac.nz/pubhealthexpert/2014/11/10/optimising-the-effects-of-plain-packaging-for-tobacco-making-quitline-information-more-salient/

The toolkit has been developed for easy reading and reference. Although many of the Standards are related, each is addressed separately with an introduction that includes academic rationale and evidence, implementation advice, implementation examples and innovations, assessment tools, and resources. Where possible, links are provided to take you directly to the corresponding website or resource.

For each standard

For each standard there are 7 key sections.

1. Introduction – A general description/expansion of the standard incorporating the evidence/academic rationale underlying the standard.
2. Guidelines – Specific guidelines of care pertaining to each standard. New Zealand Guidelines are presented with priority. International guidelines and/or expert/consensus/position statements are provided where New Zealand guidelines do not exist and/or to provide additional information.
3. Implementation advice – Suggestions for how the guidelines associated with the standard can be put into practice or realised.
4. Implementation examples/Innovations – Descriptions of models of service delivery/care which exemplify the standard in practice. These may describe a practice model or include the results of an evaluation with outcomes.
5. Assessment tools – A range of potential quality indicators and/or service evaluation/outcome measures for each Standard to measure effectiveness of implementation.
6. Resources – A repository for links to resources that might be useful in implementing the standards or recommendations linked to a standard. It may include:
   1. handouts for patients
   2. links to website resources for patients/professionals
   3. patient-specific assessment tools such as patient questionnaires.
7. References – References for each standard.

To view or download the Toolkit and the standards in full text, go to:  http://www.health.govt.nz/publication/quality-standards-diabetes-care-toolkit-2014

Nurses and other health professionals are welcoming the Health Quality & Safety Commission “Let’s PLAN for better care” initiative, aimed at improving health literacy.
PLAN stands for: ‘P = Prepare for your visit; L = Listen and share; A = Ask questions; N = Note down what you need to do next.’

NZNO professional nursing adviser Angela Clark says, “Our members can see the benefit of an initiative like this in all sectors of the health system, especially for Māori, Pacific and migrant communities, who are more likely to have unmet health needs than other groups. There are many reasons why people don’t get the health care they need when they need it, and low levels of health literacy are a major reason.”

“There is strong international evidence linking a person’s level of health literacy with their health status. When people are involved in their own health care and understand what’s happening they are less likely to be hospitalised, less likely to have to go to an Emergency Department and more likely to interpret health labels and health messages correctly.”

“Involving patients in the assessment and planning of their own healthcare significantly improves the quality of health care they receive and their feeling of satisfaction and empowerment. Raising health literacy levels is a win-win solution for New Zealanders, nurses and other health professionals.”

They found that the intervention was effective in enhancing the self-efficacy of hospitalised patients to recognize and report acute deteriorating conditions.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1016/j.pec.2014.07.003 or contact your DHB library, or organisational or local library for assistance.

See, M.T.A., et al. (2014). Effectiveness of a patient education intervention in enhancing the self-efficacy of hospitalized patients to recognize and report acute deteriorating conditions. Patient Education and Counseling, 97(1), 122–127.

The brochure was developed with funding from the Health Quality & Safety Commission and Southern Cross Hospitals Limited. 

To download the brochure, go to: http://hospitals.southerncross.co.nz/patient-information/patient-forms-leaflets.aspx

More detailed information is available at: http://hospitals.southerncross.co.nz/patient-information/blood-clots.aspx.

To find out more about the development of the brochure, go to: http://www.hqsc.govt.nz/our-programmes/reducing-perioperative-harm/news-and-events/news/1849/

Three interrelated categories are presented: (i) The vast amount of side effects and drug interactions commonly described in PILs provoke various emotional reactions in patients which (ii) lead to specific patient behavior of which (iii) consulting the GP for assistance is among the most common. Findings show that current description of potential risk information caused feelings of fear and anxiety in the reader resulting in undesirable behavioral reactions.

The authors conclude that future PILs need to convey potential risk information in a language that is less frightening while retaining the information content required to make informed decisions about the prescribed medication. Thus, during the production process greater emphasis needs to be placed on testing the degree of emotional arousal provoked in patients when reading risk information to allow them to undertake a benefit-risk-assessment of their medication that is based on rational rather than emotional (fearful) reactions.

This is an open access article and is available to read in free full text at: http://dx.doi.org/10.1186/1471-2296-15-163

Herber, O.R., et al. (2014). Patient information leaflets: Informing or frightening? A focus group study exploring patients’ emotional reactions and subsequent behavior towards package leaflets of commonly prescribed medications in family practices. BMC Family Practice, 15:163.

The Space to Breathe Programme was developed to promote appropriate use of asthma medicines and provide self-management education in order to improve health outcomes for children with asthma.  

For health professionals, tools and resources have been developed to help support and educate caregivers of children with asthma.  For caregivers, there are a range of resources to help understand and better manage asthma.  All resources  and tools can be found on the Space to Breathe website.

Let’s PLAN for better care is being launched by the Health Quality & Safety Commission in Patient Safety Week, November 3 to 9.

Let’s PLAN is a health literacy initiative to help consumers prepare well for their visit to the GP or other primary care health professional. It was developed because consumers felt they would like something to help them communicate better with their doctor and nurse and know more about the medicines they are on.

The A4 flyer, with an accompanying promotional poster, encourages people to plan ahead for practice visits and to ask questions when there so they fully understand their diagnosis and treatment. It also suggests questions they can ask pharmacy staff when they pick up their medicine.

PLAN stands for: ‘P = Prepare for your visit; L = Listen and share; A =Ask questions; N = Note down what you need to do next.’ The back of the flyer has space for patients’ questions and notes.

Let’s PLAN has been tested with different ethnic groups, and trialled in two PHOs. Considerable amendments were made to the flyer following both testing and trialling, based on the feedback from patients, GPs, practice administration staff and pharmacists.

If you would like copies of the Let’s PLAN A4 pads and posters, please email  stating the numbers you would like and where you would like them delivered.

Feedback on Let’s PLAN, and comments can be made on the Facebook page: Let's PLAN for better care.

Let's PLAN resources are available at: http://open.hqsc.govt.nz/patient-safety-week/publications-and-resources/publication/1826/

In the latest issue (attached below):

Eight systematic reviews were included and the authors found "... evidence that education and support programme interventions improved caregiver quality of life. Information-giving interventions improved caregiver knowledge for stroke caregivers".

They conclude that, "education, support and information-giving interventions warrant further investigation across caregiver groups. A large-scale funded programme for caregiver research is required to ensure that studies are of high quality to inform service development across settings".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/jan.12523 or contact your DHB library, or organisational or local library for assistance.

Corry M., While A., Neenan K. & Smith V. (2015) A systematic review of systematic reviews on interventions for caregivers of people with chronic conditions. Journal of Advanced Nursing, 71(4), 718–734.

The website has been developed by Diabetes NZ, the NZ Society of the Study of Diabetes, the Aotearoa College of Diabetes Nurses, and the Refract Group.

Over the next three years, the Ministry of Health will support action in nine key areas to improve the quality of life for people with dementia. These action areas are to:

• implement a nationally consistent approach to dementia care
• increase dementia awareness
• reduce the risk of dementia
• increase access to a timely diagnosis of dementia
• provide navigation of services and increase the quality of information and education
• increase the ability of people with dementia to remain living at home
• increase the quality of information and education for the workforce
• develop dementia-friendly health and social support services
• provide respectful and supportive end-of-life care.

The publication is available to download in full text at: http://www.health.govt.nz/publication/improving-lives-people-dementia

We have now met with around fifty-five individuals across six different focus groups and the dialogue from these  is now beginning to shape our approach to diabetes support and services.

Below is a summary of each focus group discussion, outlining the flow of conversation, along with the key findings and some of the recommendations that emerged as a result.

We'll provide more information about the next steps from here shortly.

Thanks again to all those who were kind enough to share their stories and experiences with us, and also to the various health workers and local practices that helped co-ordinate the focus group invitations.

We look forward to keeping in touch.

Focus Group Summaries

Coastal Focus Group - discussion with participants living in a coastal region

Type 1 Young Adults Focus Group - discussion with a number of tertiary students living with Type 1 diabetes

Urban Focus Group - discussion with patients living in an urban city environment

Low Literacy, High-Needs focus group - participants from one of Wellington's lower income communities

Rural Focus Group - discussion with people from one of the more rural North Island towns

Indo-Asian Focus Group - participants from Auckland's Indian and South-East Asian communnities

Most of the caravan’s stops will be in towns that don’t have easy access to breast health services.

“We want women everywhere to know all the signs and symptoms of breast cancer, to understand their family and lifestyle risk factors, and to know what to do if they have any worries. We’re inviting women – and men – to pop into the Pink Caravan with their questions,” said Nurse Janice Wood.

The nurses will answer women’s questions about breast cancer and will use a new bioimpedance machine to help women who’ve had breast cancer monitor their risk of lymphoedema (a painful and debilitating condition that can occur many years after breast cancer surgery). In some locations, there will be opportunities for public seminars and training for GPs and practice nurses. A breast surgeon will be on board the caravan in several towns.

To read the full media release from the NZ Breast Cancer Foundation, go to: http://www.scoop.co.nz/stories/GE1409/S00045/kiwis-invited-to-pop-into-the-pink-caravan.htm

A total of 33 randomised controlled trials (RCTs)  (including 11 from the original 2008 review) involving 7453 participants were included. The interventions were very different from one study to another but most were based on recognisable theoretical models.

Based on their analysis, the authors conclude that "culturally appropriate health education has short- to medium-term effects on glycaemic control and on knowledge of diabetes and healthy lifestyles ... None of these studies were long-term trials, and so clinically important long-term outcomes could not be studied. No studies included an economic analysis. The heterogeneity of the studies made subgroup comparisons difficult to interpret with confidence". 

This article is available to read in full text at:  http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006424.pub3/full

Attridge, M., Creamer, J., Ramsden, M., Cannings-John, R., Hawthorne, K. (2014). Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews, 9, CD006424.

This focus group was made up of 14 participants who all had Type 2 diabetes, with a number of the group having had the disease for over 20 years. All of the participants were of South Asian ethnicity and either in their later working years or their retirement.

The most common themes in this group included the lack of information appropriate to the Indian diet and exercise, the cultural barriers faced regarding accepting and managing their diabetes and the types of support received and services available in their area.

One participant described, “Even saying ‘Eat less carbohydrates’ means absolutely nothing to an 80 year old Indian woman. What are carbohydrates? Why not tell her to just eat half her roti instead?’”

Another member added, “The medical system here has no understanding of Indian culture at all. The advice they give just doesn’t work for us. It’s about acknowledging that we eat rice and japarti. Just being told ‘don’t’ doesn’t help. We need to be told what we can eat or how we can observe our traditions and culture in a healthy way.”

Indian cooking is also done collectively. “One downside of that is it feels like it’s too much trouble to cook something separate for yourself so you end up thinking ‘oh well, I’ll just have a little…,’” added another partipant.

Nutritional advice that has been specifically referenced in Indian culture would be very helpful. “We need to have advice about how to manage diabetes even though our culture eats rice. Something similar to the Ministry’s plate portions and other nutritional advice – how do you translate that into an Indian context?” asked one of the participants.

There were also cultural barriers including encouraging diabetics to exercise. Many Indians feel embarrassed to go to a gym or swimming pool. “Indian people are never going to go - we wear saris. There should be an exercise programme especially for Indian people.”

The change in culture from Indian to New Zealand is also a challenge. “Back home a lot of us came from farms so our exercise was a lot more regular. Here we just tend to stay in our homes. We don’t walk and our jobs aren’t active,” added another participant.

Other cultural barriers faced included the influence of family. “You can tell people anything they need to know but they will go home and do nothing if it means conflicting with their family. It is very much a collective decision, not an individual one. You need to reach the whole family.”

Another participant agreed, “Family plays a huge role in the life of the South Asian. It is a huge influence that can be both positive and negative.”

Some of the group also mentioned that because so many people have got diabetes it is almost normalised in their culture and viewed as inevitable. It becomes a barrier to prevention when people they think there is nothing they can do. It’s hard to even get them to try.

Some logistical barriers they faced were the availability of support services in their area. Diabetes NZ is based in Mt Eden and one of the participants said, “Indian people are not comfortable going there. It’s intimidating for us. If there was something more local or it was in Hindu or Punjabi, that would be better.”

Gaining access to services like the diabetes clinic was also a challenge depending on your health status. “Why is it that you have to wait until things get really bad before you can access the useful support?” asked one participant. “If we could get that earlier that would help prevent things better.”

One of the health workers who helped host the group, a nurse that worked in Greenlane, said, “I am the only Indian nurse available who speaks Hindi. Auckland DHB provides ethnic programmes but they need to be offered in other areas where there are high Indian populations. It should be standardised.”

Another participant added that they needed more help than just from their GP. “Just giving us medication and a prescription doesn’t help – they are not diabetes specialists. Plus there isn’t enough time to talk to them.”

Another participant added, “There are asthma nurses that see patients regularly on a one-to-one basis but there is nothing like that for diabetes.”

“When people are diagnosed with a chronic disease, their next appointment after the GP should be with a specialist for their condition. Chronic conditions need separate monitoring rather than just with the GP.”

One of the participants was himself a doctor and he admitted that he previously had poor notions of what a good diet was. “When I attended the programme run by a Diabetes Educator and Nutritionist who is also Indian, it made much more sense.”

Other cultural issues also come into play. “In our culture we put it on the doctor – we treat our doctors and priests like gods and put everything on them. But this is our diabetes! We need to take control.”

There is also a perception that insulin is very bad. “If you are on insulin, it is seen that your diabetes in deteriorating and you will die. There is also an anxiety about hypos – people fear dying in their sleep.”

Another participant added “People think once you are on insulin it becomes addictive and you are hooked like with morphine.”

The session was concluded with a discussion about some of the volunteer workers who give their time and support to the community for free. There are a number of very willing volunteers who just need some additional support. It was suggested this is something that could be utilised, supported and recognised much more actively.

Key recommendations based on this focus group include:

• Providing support services and education for patients and their families in Hindi or Punjabi
• Nutritional advice that has been specifically referenced in Indian culture for both health professionals and diabetics, especially with regard to their food
• Support to identify and implement ways to engage in physical activity that are appropriate to their culture in terms of dress code, environment, location, collective vs individual in nature etc.
• Support to change the misinterpretation of insulin
• Approaches to health information and advice that incorporate the entire family and address the perceived inevitability (and therefore apathy) towards diabetes

This focus group was made up of six adults of Pacific Island descent and one Māori participant. The patients were all experiencing Type 2 diabetes, although one person had initially developed gestational diabetes and another participant was in the pre-diabetes stage. The group were mostly male.

This focus group were very appreciative of the opportunity for a shared discussion and expressed a lot of gratitude for members of the health system taking the time to hear their stories. They provided some excellent feedback on how to make information more meaningful and accessible to others like them.

They suggested making information more personally relevant to the patient and providing the information in easily understood and culturally appropriate ways – either face to face or in their own language.

One participant was diagnosed and referred to a dietician but “I saw about five different people before I listened. They all said ‘don’t do this, don’t do that’ which I found very negative. There was little guidance about what I could do,” he added.

The other participants agreed with this positive approach and also suggested personalising the information. “There is plenty of information out there but it’s either written in a language that’s difficult to understand or it’s presented in neutral, general terms - and because it’s not personal it’s easy to ignore,” the participant added.

There was a strong desire for people who can deliver the information in their language as ‘most of it is too clinical’ and ‘some of it is not culturally appropriate.’

“You need to get the Church Pastors and Ministers involved. If they promote it, the people listen,” one participant added.

Another commented that they had heard a Cook Islands doctor on Radio NZ talking about diabetes in his own language and “this really helped me understand - it finally sunk in”.

The participants indicated there were a number of nurses that attended church themselves and they were particularly helpful. They do heart and diabetes checks onsite and take people’s bloods. For most of the group, they found the follow up conversations with the nurses is what helped them keep on track.

“Diabetes is a lifestyle change. You need to support people with that. If they don’t look after it, it has an impact on other organs in their bodies and most people don’t realise that. It’s the silent killer – you don’t see it until it’s too late,” one of the participants added.

In their experience, they had either not received sufficient information about diabetes or had not found the information they had received very accessible. Consequently, low levels of understanding and awareness about diabetes was a common theme amongst the group despite the fact that for most of the participants they were at least second generation diabetics.

Most of the group had diabetes in their families but some didn’t see the significance of this until later as it wasn’t really talked about and the general understanding of the disease within the family was quite low. Perhaps as a result, several participants didn’t see the relevance of medication (one person described taking medication only while they experienced specific symptoms and then discontinuing it until the symptoms reappeared). Others were more comfortable with traditional remedies from home (especially the Noni fruit, which is well known for it’s curative properties for those with diabetes).

One of the participants suggested a pamphlet that focussed the motivation to look after yourself on the patient’s kids or grandkids because that is one motivation they all seemed to have in common that finally got through to a lot of them.

Another participant mentioned the economic barriers people faced to eating well and the ease of denial of diabetes, “Because it isn’t visible like smoking, alcohol or obesity, people tend to ignore it until something happens and then it is too late.”

The key recommendations based on this focus group include:

• Exploration of some form of translation app that translates medical advice, explanations and instructions into Pacific languages so people can ‘hear’ the information in a language they understand
• Exploring other ways to provide personalised information and explanation to Pacific patients – if in English it needs to be in person or orally, if in writing it needs to be in their language
• Visual diagrams or illustrations that explain diabetes in visual terms so that people can ‘see’ it and understand the concept more easily
• Exploring ways to work more directly with patient families to increase understanding of diabetes and support inter-generational health outcomes.

This focus group involved five people, all young adults, who had Type 1 diabetes. All but one of the group were NZ European while the other was British.

The common themes expressed amongst this group ranged from the common misconceptions between Type 1 and Type 2 diabetes, to the difficulties they faced with policies in schools and work places, frustrations with the prescription process and the types of support that were available.

One participant who was studying biomed at University said her teacher told the class that “’you can prevent diabetes – you get it by overeating, obesity and not exercising’. My friends were like ‘I thought it wasn’t your fault’. My teacher made no distinction between the two diseases.”

Another member of the group said he would welcome changing the name “as using diabetes to cover gestational, Type 1 and Type 2 leads to all sorts confusion and some prejudice, thinking that we have diabetes because we overeat and are lazy.”

A further theme expressed by the group was difficulties around policies in schools and workplaces, where staff were not willing to help or unsure of where they stood around helping diabetics.

One participant said “’I had a teacher aide who had refused to help me get my glucose tablets even though I was shaking so severaly I could barely hold them’. Ultimately I felt so unsafe and unsupported in that school so my mother enrolled me in another school. That school was much more supportive.”

Another participant explained how their school had a policy that you couldn’t eat outside of school while you were in your school blazer. “That simply wasn’t practical for people with diabetes but we talked with them and were able to have that policy changed.”

Another of the group described positive experiences at their school and said they only thing they had been requested was “that we kept our supplies and needles in the school office.”

One of the participant’s mothers was also present at the focus group and she told another story of “how four kids at a local school had diabetes and the school were asking for clarification of where their duty of care lies but felt no one wanted to define it for them. They had been to both the Ministry of Education and the Ministry of Health.”

Another challenge the group faced was the prescription process for needles, where they were limited to only one box per script. This only lasted them a month which was not practical for Type 1 diabetics. Some of the group said they had better experiences going through hospital clinics with nurses who gave them several scripts at one time.

One participant also said “Doctors are generally not supportive of going onto pumps for young people. They don’t feel it is necessary, which is a shame, because they are so helpful – do we really have to wait until everything else fails before we can access good care?”

When talking about the type of support that is available, one of the participants suggested the online support they found via a few groups on Facebook to be helpful but it would be better supported with professional advice. He added, “We also need more mental health support. I was part of a clinical trial that included four psychological sessions where I expressed how I felt about my experience with diabetes. It was one of the most therapeutic things I’ve done.”

Another participant suggested we need resources for the parents as well, “When I was diagnosed in my teens, I was adamant I wanted to do my clinic visits on my own, which my parents found quite hard. It would have been good if they had somewhere to go.”

Diabetes Youth Wellington host youth camps which most of the group had attended. Several of the group had been doing camps for 8 or 9 years and they enjoyed it because they ‘felt normal there’. The parent who joined the focus group helps co-ordinate these camps and felt the camps offer opportunities to “address some of the issues that no one else seems to talk about or provide information on. We talk about sex and remind people that it is like exercise and can lead to a hypo if you are not careful. We’ve also done evenings on alcohol and teens with diabetes.”

She also mentioned the lack of positive diabetes role models in any of the advertising or health campaigns.

“The amount of changes you go through in your 20s and 30s and then this on top. It’d be great having someone there to say you are going to get through all these changes and you might experience this or that but it’s ok,” added another participant.

“Practical travel advice such as staying in your old time zone in terms of measuring your levels and routines if you are travelling is useful and advice you usually only get from others who had been there. A lady at work has a five year old daughter who has just been diagnosed with diabetes and she keeps bouncing ideas off me. I think she finds it helpful to speak to someone who has been there,” added another participant.

Based on the discussions, the key recommendations we are considering are:

• Better support to schools and workplaces regarding policy barriers
• More attention to mental wellbeing of children as they progress through life with diabetes
• Improving awareness of Type 1/Type 2 differences among medical schools - correcting misrepresentations
• Consider availability of pumps for younger Type 1s
• Improved support for parents of Type 1s

Ten trials were included. Participants perceived probabilities presented in verbal terms as higher than in numeric terms: commonly used verbal descriptors systematically led to an overestimation of the absolute risk of adverse effects. Numbers also led to an overestimation of probabilities, but the overestimation was smaller. The difference in means ranged from 3.8% to 45.9%, with all but one comparison showing significant results. Use of numbers increased satisfaction with the information and likelihood of medication use. Outcomes were measured on a 6-point Likert scale, suggesting small to moderate effects.

The authors conclude that verbal descriptors including "common", "uncommon" and "rare" lead to an overestimation of the probability of adverse effects compared to numerical information, if used as previously suggested by the European Commission. Numbers result in more accurate estimates and increase satisfaction and likelihood of medication use. They suggest that providers of consumer health information should quantify treatment effects numerically. Future research should focus on the impact of personal and contextual factors, use representative samples or be conducted in real life settings, measure behavioral outcomes and address whether benefit information can be described verbally.

This is an open access article and can be downloaded and read in full text at: http://dx.doi.org/10.1186/1472-6947-14-76

Büchter, B., et al. (2014). Words or numbers? Communicating risk of adverse effects in written consumer health information: A systematic review and meta-analysis. BMC Medical Informatics and Decision Making, 14, 76.

That’s why it’s so important that the Cancer Society’s new handbook for people with lung cancer, Lung Cancer (Matepukupuku Pūkahukahu) has been awarded the WriteMark. The WriteMark is New Zealand's internationally recognised quality mark for plain English documents. The WriteMark shows that the handbook reaches a rigorous standard of clarity, writing, and presentation. Most of all, it shows that the handbook works for the people who need it.

The handbook was developed by the Cancer Society with the help of Write Limited, after the Society won the premier award in the 2012 WriteMark New Zealand Plain English Awards. The prize was $10,000 of consulting work from Write Limited. The Cancer Society chose to apply the prize to developing a new resource for people with lung cancer.

The Cancer Society worked with Write to review and refine the handbook, through a detailed process. The handbook was user-tested with readers twice. Each test round included both people with lung cancer and their supporters. The Cancer Society left no stone unturned in its quest to get the handbook as clear and as useful as it could possibly be.

To read the full media release from WriteMark, go to: http://www.scoop.co.nz/stories/GE1408/S00077/new-lung-cancer-handbook-achieves-writemark-standard.htm

Recent research from the University of Auckland has highlighted that Māori patients and whānau face barriers in accessing palliative care services for reasons relating to tikanga, unfamiliar and complex services, health professionals avoiding or mismanaging the ‘hard conversations’ around the shift from active treatment to palliative care, and the cultural character of specialist palliative care services.

However many of the Māori patients and whānau involved in the study used a range of high level health literacy practices to inform their critical thinking and decision making. Health literacy is the ability to find, read and use health-related information to make decisions about one’s own health care. Palliative care is provided for people with life-limiting conditions. It focuses on quality of life rather than on cure.

Many of the palliative care providers interviewed for the University of Auckland’s research report, ‘Kia Mau te Kahu Whakamauru: Health Literacy in Palliative Care’ identified that palliative care was perceived as a “Pākehā service”. Small numbers of Māori staff in most organisations, the organisation of services, and even the physical structure of the buildings, points to the palliative care sector being not able to respond well to culturally specific needs.

To read the full media release from the University of Auckland, go to: http://www.scoop.co.nz/stories/GE1408/S00007/more-maori-patients-finding-ways-to-access-palliative-care.htm

Participants discussed health warning labels, plain packaging and anti-smoking television advertisements. The authors found that "highly emotive warnings delivering messages of negative health effects were most likely to capture the attention of the study participants; however, these warning messages did not prompt quit attempts and participants were sceptical about the effectiveness of cessation programmes such as telephone quitlines. Active avoidance of health warning messages was common, and many expressed false and self-exempting beliefs towards the harms of tobacco".

The authors discuss the implications of this research for development of message content and medium for disadvantaged smokers who consider themselves desensitised to warnings. 

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1093/her/cyu037 or contact your DHB library, or organisational or local library for assistance.

Guillaumier, A., et al. (2015). Tobacco health warning messages on plain cigarette packs and in television campaigns: A qualitative study with Australian socioeconomically disadvantaged smokers. Health Education Research, 30(1),57-66.

After several months of gestation, health professionals and educators up and down the coast would like to announce the birth of the West Coast maternity services web pages.

Organised through the West Coast District Health Board, the web pages deliver information including: How to find and register with a midwife; what women can do to help themselves and baby during pregnancy; what to take with them for a hospital birth; car seat hire; and links to support groups and services.

West Coast DHB Quality Coordinator, Hospital Services, Vicki Piner has been working closely with West Coast and Canterbury DHB Maternity Quality and Safety Programme Coordinator Lesa Freeman to collate information that is now available on a one stop online shop, www.westcoastdhb.health.nz/maternity.

“We wanted to make it simple for newly pregnant women to get information all in the one place.  Having this information online means it can be updated at any time, so it stays relevant and timely,” Ms Piner says.

Business card-sized “purse pack” cards will be distributed around the coast, so women can easily find the web address and understand what the web pages contain.

A celebration to launch the pages was held today (Wednesday 9 July) at the Grey Base Hospital, Buller and South Westland DHB facilities.

The authors identified 74 randomised trials of smoking cessation with follow-up of at least six months, where at least one arm tested a print-based self-help intervention. Based on the results of their analysis, they conclude that "standard, print-based self-help materials increase quit rates compared to no intervention, but the effect is likely to be small". They found no evidence of an additional benefit when they were used alongside other interventions such as advice from a healthcare professional. They do note that "materials that are tailored for individual smokers are more effective than non-tailored materials, although the absolute size of effect is still small".

This review is available to download and read in free full text at: http://dx.doi.org/10.1002/14651858.CD001118.pub3

Hartmann-Boyce J, Lancaster T, Stead LF. Print-based self-help interventions for smoking cessation. Cochrane Database of Systematic Reviews, 6, CD001118.