Effective provision of health information on leaflets in dental settings

Effective provision of health information on leaflets in dental settings

Yoriko Matsuoka, Kakuhiro Fukai

Abstract ：Information leaflets are used daily for supplemental materials with verbal advice in dental clinics.
This is because it is hard for dental caregivers to provide patients with health information without
misinterpretation within a limited consultation time. Previous researches have suggested that theappropriate way to offer health information for patients to make it understandable is to add visualor written information with verbal advice. It has been, however, in the process of research anddevelopment which elements be contained in health information leaflets in dentistry. This paper
aims to discuss the effective provision of health information on leaflets in dental settings coveringmain 4 points: quality of information leaflets from dental professionals' perspective; readability anddesign on leaflets; roles of leaflets as decision aids; prerequisites for leaflets on oral health instruction. In view of the effective offering of leaflets in dental settings, four functions will be included: touse leaflets for decision aids; to make use of leaflets relating to prevent oral diseases or to maintain patients' present good condition; to be available for approach towards patients' families ortheir colleagues; to use leaflets according to the life stages. Considering effective provision ofhealth information on leaflets may lead to enhance the quality of oral health instruction in eachcase.
Key words : leaflets, health information, readability, decision aids
Introduction

understandable and avoiding misinterpretation

In the scenes of oral health instruction, healthwithin a limited consultation time. Then, in addi-information is provided for patients to make ittion to verbal advice, ready-made leaflets, originalmaterials, or directly drawing pictures are used

【著者連絡先】〒341-0003 埼玉県三郷市彦成 3-86
深井歯科医院・深井保健科学研究所
松岡順子
TEL&FAX：048-957-3315
E-mail： yorikom@wg8.so-net.ne.jp

for a supplement explanation.
The content of information patients want toreceive varies according to personal trait, pastexperience of dental treatments, disease conditions, life styles, opinions about good health, andwith/without― 48 ―

subjectivesymptoms

suchasヘルスサイエンス・ヘルスケア

Volume 6，No.1（2006）

swelling and pain. On the other hand, from thety of health information they want to receive toviewpoint of dentists and dental hygienists, there

find answers for their questions at that time.

is a case to give intentional advice, suitable for
Readability and design on information leaflets

each patient at that time.
In order to inform appropriately according toEffective leaflets will be available to help healthindividual patient, if possible, it is desirable to offer

professionals explain to patients with ease in shorta certain additionally visual or written input withminutes. Besides, for patients, it will be compre-

verbal advice. Those materials include video-

hensible, readable, acceptable, and memorable

tapes, audiotapes, computers, or the Internet.

with ease. For these purposes, it is indispensable

Leaflets, however, remain widely used as athat dental caregivers carefully think over the suit-

method to convey health information even now.

able leaflets as to following elements: readability,Besides, written materials contain available infor-

font, layout, print size, diagrams, and color1）5）.

1-2）

mation to check uncertainty patients have missedThe minimum 12 point, simple typeface andto hear in the consultation or to clarify their own

unvaried font are considered as a readable type-questions by themselves for another day. This

face6-7）. Illustrations inserted into leaflets could aid

paper aims to discuss the effective provision ofpatients in text comprehension, especially withhealth information focusing on leaflets in dental

unfamiliar contents or doing methods8）.
Readability formulas were first developed in thesettings.

United States in the 1920s. They are predictions ofQuality of information leaflets

reading ease, designed to assess suitability of writ-

The quality of health information will be cov-

ten materials mathematically for readers. The two

ered following five minimum criteria : 1）to havemost representative formulas are Flesch Reading

clear aims 2）to make information sources explic-

Ease Formula (FRE) and Flesch-Kincaid Gradeit 3）to describe information date 4）to list further

Level Formula (FK) 10）. FRE and FK analyze twosources of reference materials 5）to indicate thefactors: the average number of syllables per word

scientific evidence at that time.

in every 100 words and the average number ofDISCERN instrument is one of the guidelines

words per sentence. FRE score maps to a reading

which enable health professionals, patients, publish-ease index from 0 to 100. The closer score to 100ers, and authors, without the need for specialists'means the easier content; the closer score to 0knowledge, to judge the quality and accuracy ofmeans the more difficult content. In general, awritten information on treatment choices 3-4）. DIS-

score below 30 is considered very difficult; a score

CERN instrument arose from a national projectof 40 to 50 is estimated to be written at the acade-funded by British Library from 1996-7. It is a brief

mic paper level; a score of 70 to 80 represents thequestionnaire consisted of 15 questions plus ancontent of fairy tales. For FK developed fromoverall quality, rated on a 5-point scale. It is orga-FRE, the scores reflect the approximate reading

nized in the content: clarification of information

grade level of content based on the American

sources, each date, to be balanced and unbiased,

grade level system9）.
According to the previous research assessed

benefits and risks of treatment.
Then, Clear logic and evidence on leaflets will

readability of published orthodontic patient infor-

lead patients to choose and apprehend good quali-mation leaflets (PILs), overall 42.3% was rated as― 49 ―

Effective provision of health information on leaflets in dental settings

fairly difficult or difficult to read for patients10） .

directly see and touch inside of mouth; individual

For a national survey of written information pro-

can notice the change to better or worse oral con-vided to patients and their families, 64% of leaflets

dition; healthy and unhealthy sites are partlycould be unclear to be understood by an estimatedmixed in one mouth. To see the change of person-

60% of the British population11）.

al oral health condition by oneself means significantly effective to prevent oral diseases. Though

Roles of leaflets as decision aids

one may have dental caries and periodontal dis-

Decision aids are to support patients in choosing

ease throughout nearly all of the life stages, eachamong alternative treatment options. The con-prevalence pattern has age characteristics.

crete elements include treatment procedure, risks,

Dental caries and periodontal disease have sig-

benefits, prognosis, costs, and period of time. In

nificant relevance to everyday dietary habits andaddition to the most common combinations of oral

self oral hygiene. To enhance the effect of preven-and written information, decision aids take manytion and treatments will maintain one's mouth

forms such as decision boards, videotapes, interac-clean in daily life and to receive dental check-up

tive computer based information tool, and written

regularly as well as to improve skills of dental pro-brochures12）. The decision boards are visual aids

fessionals.

used in a bedside or chairside consultation to provide information regarding probabilities of treat-

Prerequisites for leaflets on oral health instruction

ment outcomes and quality of life associated with

Dental prerequisites on leaflets may have 4 fac-treatment choices, benefits and risks.

tors: 1） information quality 2） readability and13）

Decision aids have variable effect on patients'

design of information leaflets 3）decision aids 4）comprehension concerning treatments, relieving

materials (Table 1). The purposes to use leaflets

decisional conflict, making them more actively par-may be divided into four types of information: con-ticipate in decision making process without incen-

dition and subjective symptoms; important notices

tive anxiety. Decisional conflict defines uncer-

after care; to prevent or maintain the current con-tainty or difficulty in identifying the best alterna-dition; to choose among treatment options and totive due to have both desirable and undesirable

agree. It is essential that dental professionals use

outcomes on the course of action chosen among

different leaflets along with different importance ofseveral options15）.

aims and prerequisites.

14）

Patient decision aids relating to oral prevention

The aims of leaflet usage are different in eachhave some options to choose. Regarding dental

case: past to present, present, and future, from see-caries prevention, for instance, patients can decideing oral condition of patients. In a case throughto choose whether to use only dentifrice including

past to present, for instance, patients' tooth brush-

fluoride or to use it plus fluoride mouth rinsing; toing habits so far and frequency of taking snacks

choose frequency of having a snack between

between meals cause dental caries on a certain

meals or using of inter dental brush in a day.

spot of teeth. In a present case, dental careers
explain how to cope with patients' gum swelling

Dental characteristics

now. Then in view of the future, dental caregivers

The dentistry has some characteristics: bothoffer detail explanation how to prevent dental

oral professionals and patients themselves cancaries and periodontal disease or to keep person's― 50 ―

ヘルスサイエンス・ヘルスケア

Table 1Volume 6，No.1（2006）

Prerequisites classified by purposes of leaflet usage in oral health instruction

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― 51 ―

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歯科臨床におけるリーフレットの効果的な活用
松岡 順子，深井 穫博（深井保健科学研究所）

日常の歯科臨床の場面で，歯科医師や歯科衛生士は，限られた診療時間内にできるだけ患者にわかりやすく保健医療情報を伝えるために，既製のリーフレットや手書きの資料を用いて口頭の説明を補足している場合が多い。これらの媒体を用いた説明の患者側の理解や選択に対する効果は、これまでの研究でも報告されてきた。しかしながら，歯科領域において，リーフレットに記載される情報に関する体系的な研究報告は少ない。
そこで本稿では，歯科臨床場面で，リーフレットを利用した効果的な情報提供について、情報の質、わかりやすさ、保健指導における具備条件の観点から考察を試みた。歯科臨床におけるリーフレットに求められ役割には、患者の自己決定の支援，口腔疾患の予防と健康増進に関する情報提供，患者の家族や周囲へのアプローチ，そして各ライフステージの特性を踏まえた予知性などがあり、これらの追究を通して，臨床における歯科保健指導の質がより高められると考えられる。

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