Form #4 Form #4 Health Education Materials & Questionnaire - Colonoscopy

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

Attachment F – Health Education Materials and Questionnaires – Colonoscopy
The following are the selected health education materials and the tailored questionnaires for each material. The factual questions have the correct responses indicated in brackets.

1. Colonoscopy Patient Education Video by Krames

Material Type	Audiovisual
Understandability Rating	Understandable
Actionability Rating	Actionable

Understandability Questions

1. Tell me what you think was the most important point or message in this material.

2. Please tell me in your own words what a colonoscopy is for? [used to diagnose unexplained changes in bowel habits, blood in stool, blood from rectum, and used to look for early signs of cancer]

3. Please tell me in your own words what will happen during a colonoscopy? [clinician looks inside the large intestine; allows clinician to see: inflamed tissue, abnormal growths, ulcers, bleeding, muscle spasms; sometimes small piece of tissue is removed for later testing. You will lie on your side, and might get mild sedative and pain medication. Clinician will insert a flexible tube called a colonoscope to see inside. You may be asked to change positions. The scope can blow air to inflate the colon to get a better view. Usually lasts 30-60minutes, rarely requires hospital stay.]

4. Please tell me in your own words what is a polyp? [a polyp is a small growth in lining of the colon and can be signs of cancer or future cancers.]

5. Could anything bad happen during a colonoscopy? If yes, what and how common is it? [A hole or tear in the tissue being examined by the colonoscope. It’s rare. Getting fluids in lungs - can help if a patient doesn’t drink before procedure. Bleeding from biopsy/polyp removal – usually minimal and stops on own. Reactions to medications- make certain clinicians are aware of previous reactions to medication. Local skin reactions to IV site.]

6. Was there any information that was difficult to understand? What was it?

7. Was there any information that was very easy to understand? What was it?

8. On a scale of 1 to 10, 1 being very difficult and 10 being very easy, how easy was this material to understand?

Actionability Questions

9. Does the material suggest any actions that you could or should take, or does it just give you information? What actions does it suggest? [May have to follow a liquid diet for 1-3 days, which means. Take medication to clean out your colon before the procedure. Call your doctor if you have: severe abdominal pain other than gas cramps; a firm, bloated abdomen; fever; vomiting; rectal bleeding more than a few tablespoons]

10. In as much detail as possible, please teach me what I would need to do to prepare for a colonoscopy based on this material?

11. Tell me in your own words what you should or should not do after a colonoscopy?

12. Was there anything in the material that was particularly helpful for understanding what you need to do to prepare for a colonoscopy?

13. After viewing this material, is there anything that is unclear about what you would need to do to prepare for a colonoscopy?

14. Can you think of any way this material could better explain how to prepare for a colonoscopy?

15. On a scale of 1 to 10, 1 being very poor and 10 being very good. How well did this material identify the actions or steps you need to prepare for a colonoscopy?
    
    
    

Public reporting burden for this collection of information is estimated to average 15 minutes per response, the estimated time required to complete the survey. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.

2. C

   Form Approved
   OMB No. 0935-XXXX
   Exp. Date XX/XX/20XX

   olorectal Cancer Awareness by St. Vincent’s Healthcare

Material Type	Audiovisual
Understandability Rating	Understandable
Actionability Rating	Poorly Actionable

Understandability Questions

1. Tell me what you think was the most important point or message in this material.

2. Please tell me in your own words what a colonoscopy is for? [check for colon cancer or polyps that can lead to colon cancer]

3. Please tell me in your own words what will happen during a colonoscopy? [while the patient is sedated the physician uses a special camera attached to a scope to look for polyps, and remove them]

4. Was there any information that was difficult to understand? What was it?

5. Was there any information that was very easy to understand? What was it?

6. On a scale of 1 to 10, 1 being very difficult and 10 being very easy, how easy was this material to understand?

Actionability Questions

7. Does the material suggest any actions that you could or should take, or does it just give you information? What actions does it suggest? [to get a colonoscopy if you are 50 years of age or older; to cleanse the colon the day before the surgery]

8. In as much detail as possible, please teach me what I would need to do to prepare for a colonoscopy based on this material?

9. Was there anything in the material that was particularly helpful for understanding what you need to do to prepare for a colonoscopy?

10. After viewing this material, is there anything that is unclear about what you would need to do to prepare for a colonoscopy?

11. Can you think of any way this material could better explain how to prepare for a colonoscopy?

12. On a scale of 1 to 10, 1 being very poor and 10 being very good. How well did this material identify the actions or steps you need to prepare for a colonoscopy?

Public reporting burden for this collection of information is estimated to average 15 minutes per response, the estimated time required to complete the survey. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

3. Prepare for a Colonoscopy by University of Texas, MD Anderson Cancer Center

Material Type	Audiovisual
Understandability Rating	Poorly Understandable
Actionability Rating	N/A

Understandability Questions

1. Tell me what you think was the most important point or message in this material.

2. Please tell me in your own words what a colonoscopy is for? [removing polyps help prevent colon cancer]

3. Please tell me in your own words what will happen during a colonoscopy? [your blood pressure, pulse and oxygen level in your blood will be watched. IV line for pain med and sedative. Lie on side. Doctor will advance an endoscope, examine lining. You may be asked to adjust your position. Camera on scope is transmitted to monitor. Scope blows air into colon. When coming out of colon, doctor looks for polyps and flat lesions. May take biopsy to be examined under microscope.]

4. Please tell me why it is important to follow the preparation instructions for a colonoscopy? [so the doctor can see inside the colon]

5. Can you eat or take the following before a colonoscopy: [Metamucil – no, oral laxative – yes, kiwi – no, cucumbers – no, water – yes; sesame seed bread – no]

6. Was there any information that was difficult to understand? What was it?

7. Was there any information that was very easy to understand? What was it?

8. On a scale of 1 to 10, 1 being very difficult and 10 being very easy, how easy was this material to understand?

Public reporting burden for this collection of information is estimated to average 15 minutes per response, the estimated time required to complete the survey. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

4. Getting Ready for your Colonoscopy by West Chester Endoscopy Suite

Material Type	Printable
Understandability Rating	Understandable
Actionability Rating	Actionable

Understandability Questions

1. Tell me what you think was the most important point or message in this material.

2. Please tell me in your own words what a colonoscopy is for? [To look inside your large intestine for cancer, other growths, ulcers, and other conditions and remove polyps. Ask what a polyp is if they say polyp.]

3. Please tell me in your own words what will happen during a colonoscopy? [I’ll get some medicine to make me sleepy, and they’ll put a camera up my colon. They may remove some growths.]

4. Can you eat the following foods the day before a colonoscopy: almonds, a peach, a piece of cheese, an apple, guava juice, diet cola, tea with honey [no, no, yes, yes, no, yes, yes]

5. Was there any information that was difficult to understand? What was it?

6. Was there any information that was very easy to understand? What was it?

7. Let’s take a look at the material together. What do you think this section is saying? What is this picture telling you?

8. On a scale of 1 to 10, 1 being very difficult and 10 being very easy, how easy was this material to understand?

Actionability Questions

9. Does the material suggest any actions that you could or should take, or does it just give you information? What actions does it suggest? [Arrange for someone to take me home, talk to my doctor about the medicines I take, plan to be home near a toilet when I prepare, drink only non-red and non-purple clear liquids beforehand, drink lots of water, take the stuff that clears out my colon.]

10. In as much detail as possible, please teach me what I would need to do to prepare for a colonoscopy based on this material?

11. Tell me in your own words what you should or should not do after a colonoscopy?

12. Was there anything in the material that was particularly helpful for understanding what you need to do to prepare for a colonoscopy?

13. After reading this material, is there anything that is unclear about what you would need to do to prepare for a colonoscopy?

14. Can you think of any way this material could better explain how to prepare for a colonoscopy?

15. On a scale of 1 to 10, 1 being very poor and 10 being very good. How well did this material identify the actions or steps you need to prepare for a colonoscopy?

Public reporting burden for this collection of information is estimated to average 15 minutes per response, the estimated time required to complete the survey. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

5. Colonoscopy by National Digestive Diseases Information Clearinghouse (NDDIC)

Material Type	Printable
Understandability Rating	Understandable
Actionability Rating	Poorly Actionable

Understandability Questions

1. Tell me what you think was the most important point or message in this material.

2. Please tell me in your own words what a colonoscopy is for? [To look for cancer or explanations of why you’re having trouble with pooping, abdominal pain, bleeding from where the poop comes out, or losing weight without trying to.]

3. Please tell me in your own words what will happen during a colonoscopy? [They’ll put a camera up my colon. They may remove some growths or take a tissue sample.]

4. Could anything bad happen during a colonoscopy? If yes, what and how common is it? [It could cause bleeding or make a hole in my colon or cause problems with my heart, but that’s not common. Some kinds of colonoscopies – the kinds that treat a problem you already have – could kill me, but that’s very uncommon.]

5. Of the different kinds of screening tests, which one is least likely to find cancer in a person that has cancer? About how often will it miss cancer? [Testing that looks only at your poop, not inside you (FOBT).]

6. Can you eat the following foods the day before a colonoscopy: guava juice, seltzer, iced tea, diet cola, lemon jello, cranberry juice [no, yes, yes, non, yes, no]

7. Was there any information that was difficult to understand? What was it?

8. Was there any information that was very easy to understand? What was it?

9. Let’s take a look at the material together. What do you think this section is saying? What is this picture is telling you?

10. On a scale of 1 to 10, 1 being very difficult and 10 being very easy, how easy was this material to understand?

Actionability Questions

11. Does the material suggest any actions that you could or should take, or does it just give you information? What actions does it suggest? [Drink non-red and non-purple clear liquids beforehand, contact your doctor immediately if you have severe abdominal pain, fever, bloody poop, dizziness, weakness, arrange to get home after the colonoscopy]

12. In as much detail as possible, please teach me what I would need to do to prepare for a colonoscopy based on this material?

13. Was there anything in the material that was particularly helpful for understanding what you need to do to prepare for a colonoscopy?

14. After reading this material, is there anything that is unclear about what you would need to do to prepare for a colonoscopy?

15. Can you think of any way this material could better explain how to prepare for a colonoscopy?

16. On a scale of 1 to 10, 1 being very poor and 10 being very good. How well did this material identify the actions or steps you need to prepare for a colonoscopy?

Public reporting burden for this collection of information is estimated to average 15 minutes per response, the estimated time required to complete the survey. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

6. Colonoscopy by the American College of Surgeons Division of Education

Material Type	Printable
Understandability Rating	Poorly Understandable
Actionability Rating	N/A

Understandability Questions

1. Tell me what you think was the most important point or message in this material.

2. Please tell me in your own words what a colonoscopy is for? [To detect or treat problems in your colon, such as cancerous or non-cancerous polyps. Ask what a polyp is.]

3. Please tell me in your own words what will happen during a colonoscopy? [They’ll put a camera up my colon. They may remove some growths or take a tissue sample. They could widen a narrow part of my colon and put a tube in it to keep it open.]

4. Could anything bad happen during a colonoscopy? If yes, what and how common is it? [It could cause bleeding or make a hole in my colon, but that’s not common.]

5. Can you eat the following foods the day before a colonoscopy: almonds, a peach, a piece of cheese, an apple, guava juice, diet cola [no, no, yes, yes, no, yes]

6. Was there any information that was difficult to understand? What was it?

7. Was there any information that was very easy to understand? What was it?

8. Let’s take a look at the material together. What do you think this section is saying? What is this picture is telling you?

9. On a scale of 1 to 10, 1 being very difficult and 10 being very easy, how easy was this material to understand?

Public reporting burden for this collection of information is estimated to average 15 minutes per response, the estimated time required to complete the survey. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.

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