Communication Plan For Arthritis Education Materials in Spanish July 31 2001 Department of Children and Families College of Public Health by oqb20829

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									            Communication Plan
For Arthritis Education Materials in Spanish
               July 31, 2001




    Department of Children and Families
         College of Public Health
        University of South Florida
                          Table of Contents


Introduction………………………………………………………………..                     3
       Goal…………………………………………………………………                       3
       Objectives…………………………………………………………..                  3
Methods…………………………………………………………………….                         4
       Protocol……………………………………………………………..                   4
       Test Used……………………………………………………………                    4
       Sample………………………………………………………………                      5
General Communication Guidelines……………………………………..           6
       Information Channels……………………………………………….             6
       Program Partners……………………………………………………                6
       Spokesperson……………………………………………………….                  6
       Message Design Elements………………………………………….            6
Print Material………………………………………………………………                     7
       Existing Material…………………………………………………….              7
              Material in Spanish………………………………………….         7
              Material in English………………………………………….         12
       New Materials……………………………………………………….                 19
              Information Needs and Content……………………………..   19
              Message Design Guidelines…………………………………       20
Audio Tapes…………………………………………………………………                       21
Video Tapes…………………………………………………………………                       22
Appendix A: Interview Guide…………………………………………….              23
Appendix B. Joint Assessment…………………………………………….             28




                                 2
I.      Introduction

        Arthritis is the leading cause of disability in the United States (Centers for Disease
Control and Prevention [CDC], 2001). Arthritis limits everyday activities for about 7
million Americans (CDC, 2001). Nearly, 43 million Americans suffer from at least one
type of arthritis (Hunder, 1999; John Hopkins Health, 1999). Arthritis costs the United
States approximately 65 billion dollars annually in medical costs and lost productivity.
According to the CDC (2001), the number of Americans suffering from arthritis is
expected to rise to 60 million, by 2020, as the baby boom generation ages.
        In Florida, the State Health Department initiated the Florida Arthritis Prevention
and Education Program. The goals of this program are to improve the quality of life and
to decrease the pain and disability of persons with arthritis residing in Florida (CDC,
2001). In their efforts to improve the quality of life of Hispanics in Florida, the Florida
Health Department contracted with Carol Bryant from the Department of Community and
Family Health, College of Public Health at the University of South Florida (USF), along
with colleagues at USF, and BestStart Social Marketing to research low literacy and
linguistically appropriate arthritis educational materials for Hispanic populations in Florida
and to develop a communications plan for the development of Hispanic materials on
arthritis.

Goal

        This project was designed to assist the Florida Health Department in selecting and
developing educational materials for Hispanics with arthritis.
Objectives

        The Florida Health Department contracted with the University of South Florida to:

                               Ø Review existing Spanish language arthritis education
                                 materials.

                               Ø Pre-test materials with Spanish speaking audiences to
                                 determine their effectiveness in helping them cope with
                                 arthritis.

                               Ø Identify materials that communicate effectively in their
                                 current form


                                               3
                              Ø Identify materials that need minor modifications to
                                communicate effectively

                              Ø Identify materials that need major revisions to
                                communicate effectively

                              Ø Identify information needs that should be addressed
                                through the development of new materials


II.    Methods

Protocol

       There are six critical components for pretesting education materials. The six
components are usefulness, attractiveness, comprehension, relevancy, acceptability, and
persuasiveness. Usefulness includes the ways the material will be used, anticipated
benefits, and anticipated problems. Attractiveness refers to whether the message or layout
of the material is getting the individual’s attention. Comprehension refers to the
participants’ understanding of the concept the material is highlighting. Relevancy refers to
people’s ability to identify with the concept or image being conveyed and their level of
interest in the information provided. Acceptability includes the participant’s reaction to
the material, including whether or not it is considered offensive, condescending, or
annoying. Finally, persuasiveness explores whether the message is motivational to
participants. The participant’s intent of following the recommended actions is measured
by this component.


Test Used
       In pretesting, it is necessary to assess the reading comprehension skills of the
interviewees. For this project the comprehension restatement test was utilized. Using this
method, participants were asked to read a section of the text and explain in their own
words what they had just read. If the participant showed difficulty in explaining the text,
questions were asked by the interviewer to determine comprehension of the text. This
method was considered to be most effective in putting the interviewee at ease. Compared




                                              4
to other methods, like the Smog or Cloze test in which the interviewee may feel like they
are taking an exam and instead become more concerned with their results on the test itself.


Sample
       Individual interviews were conducted in Dade County from November 27 through
December 1, 2000. The purpose of the individual interviews was to pretest arthritis
education materials. (See appendix A for Interview Guide used). A total of fifty-four
interviews were conducted with Hispanic individuals in community clinics, community
centers and rheumatologists’ offices. Due to the difficulty in obtaining patients diagnosed
with osteoarthritis, participants were first asked if a doctor had diagnosed them with
arthritis. If the participant had been diagnosed with arthritis, then they were asked if they
knew the type of arthritis they had. Forty of the fifty-four participants had been diagnosed
with arthritis at the time of their interview. Participants were screened before the interview
to eliminate any individuals who did not have chronic joint symptoms utilizing a joint
assessment questionnaire developed by the Arthritis Foundation. (For additional
information about the methods used to assess eligibility see Appendix B).
       Recruitment of interview participants was accomplished through the collaboration
of previously established community contacts. Twenty of the 54 participants were
interviewed at a community clinic, twenty-four at a community center, and ten at
rheumatologists’ offices. The ethnicity of the respondents included Cubans (43), Central
Americans (5), South Americans (5), Puerto Ricans (1), and Dominicans (1). Seven of the
fifty-four participants were males between the ages of sixty and eighty. Female
participants’ ages ranged from their late thirties to their early seventies. The majority of
the participants had an education level of eight-grade or less.




                                               5
III.      General Communication Guidelines

       Information Channels

          Respondents recommended the following information channels for reaching the
       Hispanic population.

             Ø Local Spanish Newspapers
             Ø Health Magazines
             Ø Hospital or Rheumatologists’ Seminars
             Ø Spanish Radio
                   o Public Service Announcements
                   o Talk Shows, especially those with physicians
             Ø Television
                   o Talk shows
                   o Health Shows
                   o Public service Announcements
             Ø Newsletter or direct letters to patients
             Ø Fliers


       Program Partners

          The following is a list of potential program partners for disseminating information
          and educational materials about arthritis.

             Ø   Physicians
             Ø   Physical Therapist
             Ø   Arthritis Foundation
             Ø   Acupuncturists
             Ø   Individuals with arthritis

       Spokesperson:

          When asked whom they would trust for information about arthritis, respondents
          gave the following spokespersons:

             Ø Physicians, rheumatologists
             Ø Physical Therapist
             Ø Arthritis sufferers who have benefited from exercise. They can discuss the
               impact arthritis has had on their pain
             Ø Arthritis Foundation, an established organization




                                               6
Message Design Elements

The following guidelines are recommended for developing educational materials about
exercise and arthritis for Hispanic audiences:

           Ø   Emphasize benefits of exercise
           Ø   Utilize testimonials to emphasize benefits of exercise
           Ø   Show the consequences of not being physically active, losing mobility
           Ø   Identify exercise as an essential part of an arthritis treatment regimen

IV.        Print Materials

      A.       Existing Materials

               a.   MATERIALS IN SPANISH

                    1. TITLE:        Respuestas Sobre la Artritis

                      PUBLISHER:             Arthritis Foundation
                                             P.O. Pox 7669
                                             Atlanta, GA 30357-0669
                                             1-800-283-7800

                      DESCRIPTION:           A 24-page pamphlet designed to answer
                                             general questions about arthritis. The
                                             pamphlet gives information regarding causes,
                                             prevention, diagnosis, types, treatments, and
                                             research of arthritis. A few black-and-white
                                             diagrams are pictured throughout the
                                             pamphlet to illustrate how some types of
                                             arthritis affect joints. The cover features a
                                             colorful drawing of a human being in a self-
                                             embrace.

                      RECOMMENDATIONS: Do Not Adopt


                    2. TITLE:        ¿Tengo Artritis?

                      PUBLISHER:             National Institute of Arthritis and
                                             Musculoskeletal And Skin Diseases
                                             Information Clearinghouse
                                             National Institutes of Health
                                             1 AMS Circle
                                             Bethesda, MD 20892-3675
                                             (301) 495-4484



                                             7
     DESCRIPTION:        A 28-page pamphlet addressing general
                         information on arthritis. The pamphlet covers
                         signs and symptoms of arthritis, seeking
                         medical advice, medications, and ways to
                         cope with pain. This pamphlet does not
                         discuss information in-depth. The cover
                         features a colorful, bright drawing of an
                         elderly woman on a table writing on piece of
                         paper. Pencil sketches are used to illustrate
                         key concepts.

     RECOMMENDATION: Adopt with major revisions.

          Ø Although the content is excellent, many people were
            confused by the bilingual format of this pamphlet. If the
            English sections were omitted, the pamphlet would be
            shorter and easier for Spanish-speakers to use.

3.   TITLE:       Ayude al Tratamiento Efectivo de su Artritis

     PUBLISHER:          Department of Health and Human Services
                         Food and Drug Administration
                         5600 Fishers Lane (HFI-40)
                         Rockville, MD 20857
                         May 1997 (out of print)
                         Publication No. 97-1270s

     DESCRIPTION:        This 12-page pamphlet highlights important
                         areas for effective treatment of arthritis. The
                         pamphlet contains colorful and descriptive
                         drawings throughout the brochure to
                         emphasize the concepts addressed.

     RECOMMENDATIONS: Do Not Adopt

4.   TITLE:       Ayude al Tratamiento Efectivo de su Artritis

     PUBLISHER:          Department of Health and Human Services
                         Food and Drug Administration
                         Communications Staff (HFI-40)
                         Rockville, MD 20857
                         September 1998
                         Publication No. 98-1270s




                         8
      DESCRIPTION:     This 6-page pamphlet is an abbreviation of
                       the original 1997 FDA publication. The
                       pamphlet highlights important areas on
                       effective treatment for arthritis, like
                       medications, false cures, exercise, and a
                       support system. This pamphlet is printed in
                       shades of green and pink. Drawings are also
                       drawn in the same shades of color.

      RECOMMENDATIONS: Do not Adopt


5.    TITLE:    Lo Que Usted Necesita Saber Sobre la Artritis: Una
                Perspectiva del Fisiopterapeuta

      PUBLISHER:       American Physical Therapy Association
                       1111 North Fairfax Street
                       Alexandria, A 22314-1488

      DESCRIPTION:     A 20-page pamphlet gives an in-depth
                       discussion of the different types of arthritis,
                       like osteoarthritis and rheumatoid arthritis. It
                       also concentrates on how physical therapy can
                       help alleviate the effects of arthritis as well as
                       how the person can become self-sufficient.
                       The pamphlet features some drawings to
                       better illustrate the information covered.

      RECOMMENDATIONS: Do Not Adopt

6.    TITLE:    Artritis: ¿Sabia Usted?

      PUBLISHER:       Arthritis Foundation
                       P.O. Box 7669
                       Atlanta, GA 30357-0669
                       1-800-283-7800

      DESCRIPTION:      This two-page fact sheet provides individuals
                       a brief summary on arthritis. This fact sheet
                       contains a few sketches to illustrate the points
                       covered.

      RECOMMENDATIONS: Do Not Adopt

 7.   TITLE:    Informacion Sobre la Artritis: Guia de Medicinas




                       9
     PUBLISHER:       Arthritis Foundation
                      P.O. Box 7669
                      Atlanta, GA 30357-0669
                      1-800-283-7800

     DESCCRIPTION:    This is a 20-page pamphlet discussing
                      medications for the treatment of arthritis. It
                      addresses how medicine works, where they
                      should be stored, how to reduce the cost, and
                      how and when to take them. There are no
                      pictures in the pamphlet.

     RECOMMENDATIONS: Do Not Adopt

8.   TITLE:    Informacion Sobre la Artritis: Osteoartritis

     PUBLISHER:       Arthritis Foundation
                      P.O. Box 7669
                      Atlanta, GA 30357-0669
                      1-800-283-7800

     DESCRIPTION:     A 28-page pamphlet focused on osteoarthritis.
                      The pamphlet contains a few black and white
                      illustrations and a discussion of the causes,
                      diagnoses, treatments, and daily life issues
                      associated with osteoarthritis.

     RECOMMENDATIONS: Do Not Adopt

9.   TITLE:    Adultos Mayores: Nunca es Demasiado Tarde Para
               un Buen Estado Físico

     PUBLISHER:       Channing L. Bete Co., Inc
                      200 State Road
                      South Deerfield, MA 01373
                      (800) 628-7733
                      item #75324A-2-00

     DESCRIPTION:     A 7-page pamphlet in Spanish for individuals
                      with low-literacy skills. This pamphlet
                      targets physical activity among older adults.
                      This pamphlet features various black-and-
                      white sketches throughout to illustrate
                      concepts covered. Green is used
                      to highlight titles and topics. The cover
                      features an elderly man interacting with a



                      10
                       little girl and her dog. The little girl is
                       grabbing the man as if persuading
                       him to come with her to walk the dog.

    RECOMMENDATIONS: Adopt with major revisions

         Ø While this pamphlet was designed to target older adults
           and promote physical activity, not necessarily individuals
           with arthritis, participants preferred this pamphlet due to
           its size and the layout of the information. This pamphlet
           specifically utilizes the guidelines for development of
           low literacy materials. This pamphlet should be used as a
           template for the development of materials targeting older
           Hispanic with arthritis.

10. TITLE:      Como Empezar a Hacer Ejercicio: En el Camino
                Hacia la Buena Condición Física

    PUBLISHER:         Channing L. Bete Co., Inc
                       200 State Road
                       South Deerfield, MA 01373
                       (800) 628-7733
                       item #70599A-4-97

    DESCRIPTION:       A 7-page pamphlet developed for individuals
                       with low-literacy skills of all ages and ethnic
                       backgrounds. This pamphlet discusses
                       benefits of exercise, types of exercises, and
                       recommendations for getting started. The
                       pamphlet features various three-color
                       sketches throughout of individuals of different
                       ages and ethnic backgrounds. The cover
                       features a middle-age woman lifting weights,
                       a young woman jogging, and a man wearing
                       exercise gear.


    RECOMMENDATIONS: Adopt with major revisions

         Ø This pamphlet was designed to target people who intend
           to start exercising. Although not designed for people
           with arthritis, respondents preferred this pamphlet
           because of its size and the way the information was
           presented. This pamphlet specifically utilizes the
           guidelines for development of low literacy materials. It
           should be used as a template for the development of



                       11
                materials targeting Hispanics with arthritis getting ready
                to start an exercise program.

 11. TITLE:        ¡A Moverse!

       PUBLISHER:          American Heart Association
                           National Center
                           7272 Greenville Avenue
                           Dallas, Texas 75231-4596
                           www.americanheart.org
                           item #50-2024 01/00

       DESCRIPTION:        A 21-page bilingual pamphlet, in Spanish and
                           English, designed to promote physical
                           activity. The pamphlet covers the benefits of
                           being physically active, types of physical
                           activities, and recommendations. The cover
                           features a silhouette of a woman running
                           outdoors. The pamphlet features a few
                           realistic images of individuals of different
                           ages and ethnic backgrounds.

       RECOMMENDATIONS: Do Not Adopt

b. MATERIALS IN ENGLISH

  1.   TITLE:      Questions and Answers About Arthritis Pain

       PUBLISHER:          National Institute of Arthritis and
                           Musculoskeletal And Skin Diseases
                           Information Clearinghouse
                           National Institutes of Health
                           1 AMS Circle
                           Bethesda, MD 20892-3675
                           (301) 495-4484

       DESCRIPTION:        This 7-page handout focuses on arthritis pain.
                           Short-term/long-term relief treatments,
                           therapies, and coping strategies to manage
                           arthritis pain.

       RECOMMENDATIONS: Do not Adopt

  2.   TITLE:      Managing your Arthritis Symptoms: Taking
                   an Active Role in Your Arthritis Care




                           12
     PUBLISHER:      Searle and Pfizer

     DESCRIPTION:    This green colored pamphlet features
                     photographs of people from diverse
                     ethnicities throughout. The 12-page pamphlet
                     is designed for individuals with arthritis. The
                     pamphlet highlights the importance of
                     medications, diet, weight, exercise, and daily
                     activities as effective methods for managing
                     the effects of arthritis.

     RECOMMENDATIONS: Do Not Adopt

3.   TITLE:    Managing your Pain

     PUBLISHER:      Arthritis Foundation
                     P.O. Box 7669
                     Atlanta, GA 30357-0669
                     1-800-283-7800

     DESCRIPTION:    This 24-page pamphlet is designed to help
                     individuals manage their arthritis pain. The
                     cover features a woman with her arms
                     wrapped around her legs giving the
                     appearance of suffering from pain. The
                     pamphlet contains only one sketch in the text
                     to demonstrate how pain signals travel
                     through the body.

     RECOMMENDATIONS: Do Not Adopt


4.   TITLE:    Managing you Activities

     PUBLISHER:      Arthritis Foundation
                     P.O. Box 7669
                     Atlanta, GA 30357-0669
                     1-800-283-7800

     DESCRIPTION:    This 12-page pamphlet is designed to help
                     people who have arthritis deal with their daily
                     activities. The pamphlet cover features a
                     series of line drawings of individuals
                     undertaking everyday activities, like lifting a
                     box and sitting down on a chair. The
                     pamphlet contains a few gray colored



                     13
                        sketches within the text to demonstrate
                        correct ways to perform certain activities.

     RECOMMENDATIONS: Do Not Adopt

5.   TITLE:      Exercises for Arthritis

     PUBLISHER:         Channing L. Bete Co., Inc
                        200 State Road
                        South Deerfield, MA 01373
                        (800) 628-7733
                        item #97661A-2-00

     DESCRIPTION:       A 2-page sheet designed as an exercise guide
                        for individuals with arthritis. Range-of-
                        motion exercises for the shoulders, hands,
                        hips, knees, and ankles are described.
                        Colorful graphics of various individuals are
                        featured to illustrate how to perform the
                        exercises discussed.

     RECOMMENDATIONS: Adopt with the following revisions

          Ø The size and simplicity of this 2-page information sheet
            caught the attention of many participants. Many
            participants expressed the usefulness of an information
            sheet in providing instructions and guidance for specific
            exercises. The format of this 2-page sheet should serve
            as a template in the development of Spanish materials
            illustrating specific exercises, recommended by the
            doctor, for the individuals to perform.

6. TITLE:        Starting an Exercise Program

     PUBLISHER:         Channing L. Bete Co., Inc
                        200 State Road
                        South Deerfield, MA 01373
                        (800) 628-7733
                        item #97244A-7-99

     DESCRIPTION:       A 2-page sheet designed as a guide for
                        individuals starting to exercise.
                        Recommendations on how to warm-up before
                        starting and cool down after exercising are
                        provided. Information on safety tips and
                        ways of staying motivated are also included.



                        14
     RECOMMENDATIONS: Adopt with the following revisions.

          Ø The size and simplicity of this 2-page information sheet
            caught the attention of many participants. Many
            participants expressed the usefulness of an information
            sheet such as this one in providing guidance for
            individuals starting an exercise program. While the
            safety tips are not specific to individuals with arthritis,
            the format of this 2-page sheet should serve as a template
            in the development of Spanish materials targeting
            Hispanics with low literacy skills intending to start
            exercising.

7. TITLE:        Living with Arthritis

     PUBLISHER:         Channing L. Bete Co., Inc
                        200 State Road
                        South Deerfield, MA 01373
                        (800) 628-7733
                        item #38257D-01-99

     DESCRIPTION:       A 15-page pamphlet designed for individuals
                        affected with arthritis. The pamphlet
                        discusses causes, symptoms, types of arthritis,
                        medications, treatments, coping methods, and
                        resources for individuals with arthritis. The
                        pamphlet features black-and-white sketches to
                        illustrate the concepts covered.

     RECOMMENDATIONS: Do not Adopt

8.   TITLE:      An Inside Look at Osteoarthritis

     PUBLISHER:         Channing L. Bete Co., Inc
                        200 State Road
                        South Deerfield, MA 01373
                        (800) 628-7733
                        item #75324A-02-00

     DESCRIPTION:       A 15-page pamphlet on osteoarthritis. This
                        pamphlet discusses causes, symptoms,
                        treatments, remedies for pain, and resources
                        for individuals with osteoarthritis. The
                        pamphlet features colorful graphics of
                        individuals of various ages and ethnic



                        15
                         backgrounds.

      RECOMMENDATIONS: Adopt with major revisions.

           Ø This pamphlet should be translated into Spanish. It
             provides the ideal format for people with low-literacy
             skills, who need information about the causes of arthritis,
             treatments, and exercise.

9.    TITLE:      Living Well With Osteoarthritis: Self-Care Handbook

      PUBLISHER:         Channing L. Bete Co., Inc
                         200 State Road
                         South Deerfield, MA 01373
                         (800) 628-7733
                         item #97146-7-99

      DESCRIPTION:       A 31-page handbook for individuals with
                         osteoarthritis. This handbook serves as a self-
                         care manual for individuals caring for
                         osteoarthritis. The handbook also provides
                         general information on the disease. Full color
                         graphics are used to illustrate the concepts
                         discussed. The handbook provides blank
                         areas for individuals to write down their
                         goals, thoughts and concerns regarding
                         osteoarthritis.

      RECOMMENDATIONS: Do not Adopt

10.    TITLE:     Questions and Answers About Arthritis and Exercise

      PUBLISHER:         National Institute of Arthritis and
                         Musculoskeletal And Skin Diseases
                         Information Clearinghouse
                         National Institutes of Health
                         1 AMS Circle
                         Bethesda, MD 20892-3675
                         (301) 495-4484

      DESCRIPTION:       This 6-page handout focuses on arthritis and
                         exercise. Topics covered in this handout
                         include types of exercises, how to get started,
                         pain relief methods, and exercise frequency.




                         16
   RECOMMENDATIONS: Do Not Adopt

11. TITLE:   Walking and Arthritis

   PUBLISHER:       Arthritis Foundation
                    P.O. Box 7669
                    Atlanta, GA 30357-0669
                    1-800-283-7800

   DESCRIPTION:     This tri-fold 6-page pamphlet is designed to
                    promote walking as an exercise to individuals
                    with arthritis. The cover features a man and a
                    woman walking in the woods. The pamphlet
                    discusses the benefits of exercise, how to get
                    started, and ways for individuals to remain
                    motivated.

   RECOMMENDATIONS: Do Not Adopt


12. TITLE:   Exercise and Your Arthritis

   PUBLISHER:       Arthritis Foundation
                    P.O. Box 7669
                    Atlanta, GA 30357-0669
                    1-800-283-7800

   DESCRIPTION:     This 23-page pamphlet is designed to promote
                    physical activity in individuals with arthritis.
                    The pamphlet contains pencil sketches to
                    demonstrate certain types of exercises. The
                    cover features a drawing of three women
                    doing aerobics. The pamphlet discusses
                    reasons to exercise, types of exercises, and
                    ways to stay motivated.

   RECOMMENDATIONS: Do Not Adopt

13. TITLE:   It Hurts When I Move…Help!

   PUBLISHER:       Arthritis Foundation
                    P.O. Box 7669
                    Atlanta, GA 30357-0669
                    1-800-283-7800




                   17
      DESCRIPTION:       A 12-page pamphlet designed to increase
                         awareness among individuals who may have
                         arthritis. This pamphlet provides basic
                         information on arthritis, seeing a doctor,
                         getting diagnosed and the importance of
                         exercise.

      RECOMMENDATIONS: Do not Adopt.

           Ø The cover of this pamphlet was liked by majority of
             participants. The participants liked the pictures of real
             life individuals in the cover. Many participants preferred
             this pamphlet for its cover.

14. TITLE:        Water Exercise Pools, Spas and Arthritis

      PUBLISHER:         Arthritis Foundation
                         P.O. Box 7669
                         Atlanta, GA 30357-0669
                         1-800-283-7800

      DESCRIPTION:       This 19-page pamphlet illustrates water
                         exercises that people with arthritis can do.
                         The cover features a Caucasian woman
                         and man and an African American woman
                         inside a pool. The pamphlet features pencil
                         sketches throughout the text to demonstrate
                         the recommended aquatic exercises.

      RECOMMENDATIONS: Do Not Adopt


15.   TITLE:      Osteoarthritis

      PUBLISHER:         Arthritis Foundation
                         P.O. Box 7669
                         Atlanta, GA 30357-0669
                         1-800-283-7800

      DESCRIPTION:       This 20-page pamphlet is designed for
                         individuals with osteoarthritis. The pamphlet
                         discusses causes, diagnoses, treatments, and
                         ways of managing osteoarthritis. The
                         pamphlet contains a few pencil sketches to
                         illustrate the specific joints osteoarthritis
                         tends to affect. The cover features a human



                         18
                                  being positioning their hands around a spiral
                                  symbol.

            RECOMMENDATIONS: Do Not Adopt

      16.   TITLE:        Handout on Health: Osteoarthritis

            PUBLISHER:            National Institute of Arthritis and
                                  Musculoskeletal And Skin Diseases
                                  Information Clearinghouse
                                  National Institutes of Health
                                  1 AMS Circle
                                  Bethesda, MD 20892-3675
                                  (301) 495-4484

            DESCRIPTION:          This 17-page handout provides
                                  comprehensive information on osteoarthritis.
                                  All aspects of this disease are covered in this
                                  handout from its cause to treatments.

            RECOMMENDATIONS: Do Not Adopt

      17. TITLE:          Fact Sheet: Osteoarthritis

            PUBLISHER:            American College of Rheumatology
                                  www.rheumatology.org
                                  (404) 633-3777

            DESCRIPTION:          This 2-page fact sheet provides individuals
                                  with a quick overview on osteoarthritis.

            RECOMMENDATIONS: Do Not Adopt

B.   New Materials

     a. Information needs and content

            i. Provide general information on osteoarthritis
                         a. Causes
                         b. Common treatments

            ii. Provide information on the importance of exercise
                           a. Benefits of exercise
                           b. Consequences of not exercising




                                 19
       iii. Give specific instructions on recommended exercises for
            arthritis.
                       a. Range-of-motion exercises
                       b. Stretching exercises
                       c. Aerobic exercises
                       d. Other recommended exercises

       iv. Give specific instructions for recommended exercises for
           specific body joints.
                      a. Knee exercises
                      b. Hip exercises
                      c. Hand exercise
                      d. Other joints affected by osteoarthritis

       v. Explain methods of relieving pain before and after exercise
                    a. Proper use of cold and hot pack application

       vi. List safety tips to prevent injury or increased pain from exercise

b. Message Design Guidelines

   Appearance:

   Ø Use happy colors, not too bright
   Ø Keep the title simple, one or two words – for example, Arthritis and
     Physical Activity
   Ø Use a pamphlet with a limited number of pages, if too lengthy
     individuals with low-literacy skills may be intimidated

   Photographs/Illustrations:

   Ø   Use real individuals in the cover of the brochure
   Ø   Use illustrations/images with detail
   Ø   Use individuals that appear to be of Hispanic descent
   Ø   Use individuals in the same age range of the target audience
   Ø   Use individuals that look considerably healthy, happy, and content

   Tone:

   Ø Use an encouraging and persuasive tone
   Ø Use an interactive tone – utilize the word ‘you’
   Ø Avoid using ‘fear arousing’ messages and a condescending tone.

   Format:




                              20
                   Ø Present information in a clear, direct fashion. Leave out any
                     unfamiliar terms.
                   Ø Use short sentences, 30 to 50 characters and spaces.
                   Ø Present information in a bullet-list format to avoid confusing the
                     individual.
                   Ø Avoid solid text, leave white spaces between text to avoid the
                     appearance of solid text.
                   Ø Use Sans-serif font with a font size of 13pt or higher
                   Ø Make materials friendly to the reader
                   Ø Avoid poor contrast between the ink and the paper
                   Ø Use familiar and acceptable language
                   Ø Pretest material with target audience throughout the developmental
                     phase

                   Content:

                   Ø List the benefits of exercise
                   Ø List the reasons why individuals with arthritis should exercise
                   Ø Acknowledge the immediate effect of exercise, which may be pain,
                     but reinforce the long-term effect of exercise, relief.

V.    AudioTapes

     A. Existing Audiotapes

                   1.   TITLE:      Programas Educativos Para la Salud: Relajación
                                    muscular Progresiva & Un Jardín de Flores

                        PUBLISHER:          Stanford University, California
                                            1995

                        DESCRIPTION:        A 40-minute audiocassette designed to help
                                            individuals practice relaxation techniques.
                                            The audiocassette features a soft-spoken
                                            female voice guiding the individual along
                                            the relaxation techniques.

                        RECOMMENDATIONS: Adopt with no revisions

                   2.   TITLE:      Programas Educativos Para la Salud: ¡Hagamos
                                    ejercicio!

                        PUBLISHER:          Stanford University, California
                                            1995

                        DESCRIPTION:        This audiocassette is designed for individuals



                                           21
                                          affected by arthritis. The cassette guides the
                                          individual through a series of recommended
                                          exercises for those affected by arthritis.
                                          The cassette last approximately 80 minutes
                                          and can be listened to in segments of 15-20
                                          minutes if preferred.

                   RECOMMENDATIONS: Adopt with the following revisions

                            Ø This tape was well liked by participants. However, needs
                              to have accompanying illustrations to clarify the exercise
                              being performed.
                            Ø There needs to be clarification of the phrase ‘haga una
                              papada’ utilize when narrating the neck exercises. The
                              majority of participants did not understand the meaning
                              of the phrase.

VI. Video Tapes

   A. Existing Videotapes

               1. TITLE:           Senderos para Vivir Mejor con la Artritis y
                                   condiciones afines

                   PUBLISHER:             Arthritis Foundation
                                          P.O. Box 7669
                                          Atlanta, GA 30357-0669
                                          1-800-283-7800

                   DESCRIPTION:           This 52-minute video includes breathing,
                                          stretching, and strengthening routines. The
                                          video also includes low-impact aerobic and
                                          total relaxation techniques. The video is
                                          separated into 5 segments. Throughout the
                                          segments the individuals go from sitting (15
                                          min), standing (7 min), aerobics (9 min),
                                          laying down (8 min) to relaxation exercises (8
                                          min).

                   RECOMMENDATIONS: Adopt

                            Ø The videotape was enthusiastically received by
                              participants. They liked the spokesperson and the
                              diversity of the group.




                                          22
APPENDIX A




    23
                             Osteoarthritis and Exercise
                         INDIVIDUAL INTERVIEW GUIDE


Introduction:

        Explain purpose of pretesting: Need your help in deciding best ways to
design a pamphlet for individuals with osteoarthritis. I have several versions of
graphics and text that I would like to show you and get your advice about the best
way to design the pamphlet. We find that we save a lot of money and make much
better educational booklets when we ask individuals like yourself, for advice before
we print hundreds of copies.

It will not take long.

I will first ask you to read a small paragraph about Osteoarthritis/exercise and ask
you a few questions. Then, I will ask you to look at several graphics and then ask a
few questions about what you like and dislike about each. I did not make the
booklet so you can give me your honest opinion, what you like and what you think
should be changed.

Will take about 15 minutes. Will give you a small gift ($5/10) to thank you for your
help.




                                         24
TEXT: (readability)


   1. Read a section and Explain
         Have the participant read a section at a time and explain in their own
         words what they just read.

   2. Circle difficult words
         Have individual circle any words they find difficult to read or that they
         think may be difficult for someone else to read.




Possible questions about the text: (relevancy, persuasion, self-efficacy)

What is the main thing this text is saying to individuals with osteoarthritis?

Who do you think this text was written for?

What part of the text is confusing?

What part is offensive or annoying?




                                          25
                                    GRAPHICS

METHOD #1:

I would like to show you some pictures that they are considering using.

      SHOW#1
          1. What do you think this person is like?
          2. Do you think this picture would be appropriate for a pamphlet on
             exercise and osteoarthritis? Why?
          3. Is there anything you would change?

      SHOW#2
          REPEAT #1-3


      Which of these do you recommend we use? Why?
           PROBE-PROBE


METHOD #2:

Show the participant two graphics, ask him to pick the one he likes most:

What do you like about the (first choice)?
      Probe: What else do you like about it?

What do you like better about the other one?

Now, would you look at the two graphics:

      Which graphic do you like the best, the one you selected first or this one?
           Probe: What makes it better than the other one?




                                        26
Ideal Pamphlet: (show different types of pamphlet-sizes, color, BW, etc)

Which size do you like the best for a pamphlet?

       What about that size do you like?

Which type of letters do you like the best?

       What about that type of letters do you like?

Which colors do you think we should use?

Which graphics do you think we should use?

       What do you like in the graphic?


Do you have any other advice for the people who are going to make these booklets?
OR
If you were going to design the ideal pamphlet, what would it be like?

              Probe:        Size
                            Colors
                            Type of letters
                            Graphics
                            Other advice?




                                           27
APPENDIX B




    28
                               Joint Health Assessment
          (Questions used by the Arthritis Foundation in assessing joint health.)

   1. Has you doctor ever told you that you have arthritis?
   2. During the past12 months, have you had pain, aching, stiffness or swelling in or
      around a joint?
   3. In a typical month, were these symptoms present daily for at least half of the days
      in that month?
   4. Do you have pain in your knee or hip when climbing stairs or walking 2-3
      blocks(1/4 mile) on flat ground?
   5. Do you have daily pain or stiffness in your hand joints?
   6. Are you now limited in any way in any activities because of joint symptoms (pain,
      aching, stiffness, loss of motion)?

If participant answered yes to two or more of these questions, it was assume that the
individual may be suffering from symptoms of arthritis. The majority of participants
answered yes to four of five questions.




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