Enhancing Postpartum Discharge Instructions

Study Overview
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Brief Summary
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Post-cesarean delivery discharge instructions are not currently at an appropriate health literacy level. Enhancing discharge instructions with a visual aid did not improve scores on comprehension quizzes, either immediately or two-weeks post-discharge. However, participants preferred to have access to visual images with discharge instructions.

Detailed Description
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Objective: To evaluate the effect of a visual aid on improving comprehension of hospital discharge instructions for cesarean wound care. Methods: A randomized control trial with a 1:1 allocation ratio and an intention to treat analysis was performed at an urban, tertiary care center from June-November 2017. Fifty English-speaking patients ages 18-50 who had undergone a cesarean delivery were randomized to receive either standard or enhanced discharge instructions regarding post-cesarean incision care. Enhanced instructions included a visual aid not present in the standard instructions. Participants completed a comprehension quiz prior to hospital discharge and again 2 weeks after discharge as well as the REALM literacy assessment prior to discharge.

Official Title
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Enhancing Postpartum Discharge Instructions for Cesarean Incision Care With Assessment of Comprehension: A Pilot Randomized Controlled Trial

Conditions
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Health Literacy, Randomized Controlled Trial, Postpartum, Cesarean Delivery Affecting Newborn

Intervention / Treatment
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* Other: Visual Aid
* Other: Standard Instructions


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Able to consent Identified as English speaking Had a cesarean delivery during the index hospitalization for delivery of their living newborn Exclusion Criteria: Non-English speaking Declined to participate Required a translator for communication Intellectual disability (as self-identified or as determined by healthcare provider) Currently incarcerated

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: Standard Instructions<br>Subjects enrolled in this arm received standardized teach-back regarding discharge instructions as well as the standard printed discharge instructions regarding post-cesarean wound care. | Other: Standard Instructions<br>* Standard discharge instructions WITHOUT supplement of visual aid.<br>|
| Experimental: Enhanced Instruction<br>Subjects enrolled in this arm received standardized teach-back regarding discharge instructions as well as the standard printed discharge instructions regarding post-cesarean wound care AND they received an additional printed visual diagram. | Other: Visual Aid<br>* The visual aid was a one-sheet diagram with illustrations of important features of post-cesarean wound care.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Comprehension Score Two Weeks Post-Discharge | Total score on 11-point quiz (Discharge Instructions Comprehension Quiz) administered via phone two weeks post-discharge, score range 1-11 with one point assigned for each correct answer (no subtractions for incorrect answers); higher scores are favorable indicating answers consistent with higher comprehension | Two weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Immediate Comprehension | Total score on 11-point quiz (Discharge Instructions Comprehension Quiz) administered immediately after discharge instructions reviewed, score range 1-11 with one point assigned for each correct answer (no subtractions for incorrect answers), higher scores are favorable indicating answers consistent with higher comprehension | 15 minutes |