Background Chronic kidney disease (CKD) patients undergoing hemodialysis (HD) often face challenges in self-management, treatment adherence, and fluid control. Video-based education has shown promise in improving these outcomes, but evidence comparing interactive versus conventional approaches is limited. Aim To compare the effects of interactive and conventional video education on patient activation, treatment adherence, and interdialytic weight gain (IDWG) in patients receiving HD. Design A randomized clinical trial was conducted. Methods In this three-arm randomized clinical trial, 126 HD patients were randomized to interactive video education, conventional video education, or usual care (42 per group). A total of 123 (41 per group) participants completed the study. The intervention comprised ten 30-minute video modules and a one-hour consolidation workshop. Patient activation (PAM-13), adherence (ESRD-AQ), and interdialytic weight gain (IDWG) were assessed at baseline, post-intervention, and 1- and 3-month follow-ups. Results Baseline characteristics were comparable across groups. Significant group × time interactions were observed for all outcomes. Compared with Conventional Video and Usual Care, the Interactive Video group achieved greater and more sustained improvements in patient activation, treatment adherence, and IDWG over the 3-month follow-up. Immediately post-intervention, PAM-13 scores were 9.66 and 19.17 points higher than those of the Conventional Video and Usual Care groups, respectively, while IDWG was 0.34 kg lower than in the Usual Care group. Treatment adherence also improved significantly, with the Interactive Video intervention consistently outperforming Conventional Video education at all follow-up assessments. Conclusion Interactive video-based education significantly improved patient activation, treatment adherence, and weight management in HD patients, with greater and more sustained benefits than conventional video education or usual care. These findings highlight the added value of interactivity beyond video education alone. Implications for patient care Incorporating interactive digital education into routine dialysis care may improve self-management and clinical outcomes.
Objective To examine whether gain- versus loss-framed messages affect women’s responses to negative family cancer history (FCH) screening results, and whether these effects differ by race. Methods From March to April 2025, we conducted a two-arm parallel-group randomized online trial of message framing (gain vs. loss), stratified by race (Black, non-Hispanic vs. non-Black), among U.S. women aged 40 years and older who screened negative on FCH (N = 655) recruited through the Ipsos nationally representative consumer panel. Participants were blinded to message-framing condition, completed a baseline survey, then viewed either a gain- or loss-framed message. The primary outcomes were understanding of inherited and general cancer risk, acceptance of the negative FCH screening result, and intentions to undergo mammography and update family history. Chi-square tests, ANOVA, and multivariable regression models examined message effects and race-by-framing interactions. Results Of 655 participants, 61% were Black, non-Hispanic (n = 400) and 39% were non-Black (n = 255). Black participants reported higher mammogram screening intention but lower result understanding and result acceptance than non-Black participants. Message framing was not significantly associated with understanding, acceptance, or behavioral intentions (all p > 0.10), and framing effects did not significantly differ by race (all interaction p-values > 0.34); an exploratory analysis identified a non-significant trend toward higher acceptance of loss-framed messages among Black participants (mean difference = 0.56, p = 0.075). Conclusions In a nationally representative sample in which the majority of participants were Black, brief message framing alone did not influence women’s responses to negative FCH results. As family history risk assessment expands in public health practice, equitable communication of negative results appears to require more than optimizing message wording. Future research should test simple, low cost communication strategies that actively engage patients and address result comprehension in population-based screening settings.
Background People living with endometriosis commonly experience sexual difficulties and associated distress, yet these concerns are frequently overlooked in primary care. Consequently, sexual wellbeing remains under-addressed, despite its substantial impact on overall health-related quality of life (HRQoL). Objectives We aimed to develop and assess the acceptability of an online patient-centred sexual wellbeing communication tool for people living with endometriosis experiencing sexual difficulties. Methods In collaboration with a patient advisory panel (PAP), a co-designed website was created, providing psychoeducation, communication tools, and practical guidance to support people living with endometriosis in discussing their sexual wellbeing with their general practitioner (GP). Results The tool was received positively, with participants reporting increased confidence in discussing sexual wellbeing with their GP. Qualitative feedback was largely positive and constructive, identifying minor co-design refinements to the website’s layout and navigation that could further enhance acceptability. Practice Implications For people living with endometriosis, this communication tool can increase their confidence and preparedness to discuss sexual concerns in healthcare settings, which may be associated with improvements in sexual wellbeing and overall HRQoL outcomes. Strengths & Limitations This study, and the development of a sexual wellbeing communication tool, addresses a substantial gap in the recognition and management of sexual difficulties and related distress in primary care. The tool was co-designed with a PAP comprising individuals with endometriosis who have lived experience of sexual difficulties. A limitation of the study is the sole reliance on an online resource, which may not be as accessible for all individuals, e.g., those with low digital literacy. Conclusion The sexual wellbeing communication tool is the first to our knowledge to be designed in consultation with people living with endometriosis and, based on quantitative and qualitative data, deemed to be acceptable for use in this group.
Introduction Gynecologic examinations expose women to particular vulnerability, making relational and ethical aspects essential beyond technical skills. While professional societies outline recommended behaviors, the importance women attribute to these non-technical elements remains insufficiently characterized. This study aimed to assess how women value key relational components of gynecologic examinations. Methods In this exploratory cross-sectional study, a questionnaire was developed from gynecologic and ethical guidelines, and distributed via QR codes in outpatient gynecology and general practice settings. Eleven items (Q1-Q11) were rated on a numeric scale (0−10). Principal component analysis (PCA) assessed internal coherence and identified thematic dimensions. Descriptive and comparative analyses were conducted, including stratification by age and prior gynecologic examination. Results A total of 540 women participated (mean age 37 ± 10 years). PCA identified three dimensions: consent (Q1, Q5, Q9-Q11), privacy (Q6-Q8), and feelings/experience (Q2-Q4). Consent-related items received the highest scores (all >9/10 except Q1). Privacy items showed greater variability, with lower importance assigned by women over 50 to partial undressing (p = 0.006) and draping (p = 0.007), while women undergoing their first examination assigned greater importance to undressing out of the provider’s sight (p = 0.01). Feelings-related items were more heterogeneous, although attention to patients’ feelings during the examination was highly rated (9.7 ± 0.8). Conclusion Women consistently prioritized explicit and ongoing consent and sustained attention to their feelings. Privacy was also important, though more variable. These findings support the integration and structured assessment of non-technical competencies in training related to gynecologic examinations.
