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An Enhanced Video for Adults With Low An Enhanced Video for Adults With Low Vision: Impact on Knowledge, Attitudes andVision: Impact on Knowledge, Attitudes and
the Use of Assistive Devicesthe Use of Assistive Devices
Beth Dugan, Ph.D.The Institute for Studies on AgingNew England Research Institutes
9 Galen StreetWatertown, MA 02472 USA(617) 923-7747 ext 210
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AcknowledgementAcknowledgement
Research supported by the National Eye Institute (EY012443).
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Project TeamProject Team
Sharon Tennstedt, PhD, InvestigatorEli Peli, OD, Co-InvestigatorRobert Goldstein, PhD, Co-InvestigatorFelicia Trachtenberg, PhD, BiostatisticianSteve Braun, BA, ProducerNancy Gee, BA, Data ManagerKristina Richards, BA, Field Supervisor
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OutlineOutline
• Low Vision• Patient education• Content of the video• Evaluation study• Implications
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Low Vision DefinitionLow Vision Definition
A visual impairment, not correctable by standard glasses, contact lenses, medicine, or surgery, that interferes with a person's ability to perform everyday activities.
Age-related macular degeneration (AMD) accounts for approximately one-half of all cases of low vision. There are two types of AMD, wet and dry type accounting for 10% and 90% of cases respectively.
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Low VisionLow Vision
In the US approximately 3-5 million adults have low vision.
Annual total costs exceed $22 billion on care and services for people who are blind or have visual impairments. (National Alliance for Eye and Vision Research, 1995.)
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Living With Central Vision Living With Central Vision LossLoss
Normal W/ Low Vision
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Why Patient Education?Why Patient Education?
During the often rushed clinical encounter when a person first gets the diagnosis – they may be so overwhelmed that they only hear
“legally blind” or “no known cure”…
….which may lead the person to stop visiting an eye care professional altogether.
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Why Patient Education?Why Patient Education?
• believe it is a natural part of aging• not aware of treatment options or how
to access help• believe services are only for the blind,
not those with central vision loss• cost
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????
A video for the A video for the visually impairedvisually impaired
????
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• Low vision is a loss of central vision, not total blindness.
• Most Americans have access to a television and many have access to a VCR.
• The video is informative for family members as well.
• Peli and colleagues have pioneered the use of computerized image enhancement to improve the visibility of the video images for low vision patients.
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This figure shows the difference between the enhanced (on the right) and original unenhanced version (on the left). The actual video only presented the enhanced images.
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The anatomy and basic pathology of AMD were illustrated – and showed the location and nature of changes that occur with macular degeneration.
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The virtual home animation included environmental adaptations and use of visual aids. Changes were depicted for the kitchen, bathroom, bedroom, and living room.
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Hope in SightHope in Sight Video Video
• Winner, 24th Annual Telly Award; 2003
• Finalist, International Health & Medical Media Awards, Health Education; 2003. (Freddie Award)
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Research QuestionsResearch Questions
1. Will the video intervention increase patient knowledge and improve attitudes?
2. Will the video intervention have a positive impact on adaptive behavior?
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Evaluation PlanEvaluation Plan
Proximal Outcomes:• Knowledge (eye anatomy and physiology;
types of rehab devices; resources).• Self-efficacy, emotional responses.• Willingness to use low vision aids.
Distal Outcomes• Behavior change (use assistive devices;
environmental changes; rehab svc).
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Eligibility:Eligibility:
Speak and understand English. Be diagnosed with low vision in both eyes. Not limited by hearing impairment (able to hear
a video). Access to a VCR and telephone.
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Sample description (N=151)Sample description (N=151)Gender Male Female
5497
36%64%
Race White All others
1465
97%3%
Years ARMD diagnosed (median) 4.0 8.23 (sd)
Live Alone2 person household3 or more person household
28117
6
19%78%3%
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Subject Pool
Informed consent and enrollment
T0 Interview (N=156)
T1 Interview at 2 weeks (n=75)
T1 Interview at 2 weeks (n=79)
T2 Interview at 3 mo. (n=74)
T2 Interview at 3 months (n=77)
Randomization
Watch the Video
Intervention Group
Control Group
Video
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MeasurementMeasurement
A. Demographics.B. Knowledge (eye anatomy, physiology,
pathology of macular degeneration).C. Assistive devices (knowledge of,
access to, attitude toward).D. Adaptive changes (home, lifestyle)E. Self-efficacyF. Social aspects of low visionG. Emotions re: low vision
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HypothesesHypotheses
Compared to the control group, the intervention group will show greater improvement in:
• Knowledge
• Attitudes (emotions; self-efficacy)
• Behavioral changes (use of assistive devices, adaptive changes in the home).
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Statistical AnalysesStatistical Analyses
Analysis of covariance (ANCOVA) was used to determine differences by treatment group.
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CovariatesCovariates
We controlled for baseline values and covariates: age gender marital status education length of vision impairment # people in household employment health
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ResultsResults
Descriptive statistics showed that the intervention and control group were equivalent with respect to all key baseline characteristics.
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KnowledgeKnowledge
The intervention group improved more in knowledge than the control group;
p <.001, Adj R2 = 0.39
Magnitude of Change? Control group 0.4 pts vs Video group 1.4
pts. (approx one question difference)
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KnowledgeKnowledge
• People who lived alone learned more (~never married, older age);
• those who had worse health learned less);
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AttitudesAttitudes
The intervention group improved more than the control group in their willingness to use assistive devices
Books-on-tape (those who lived alone were especially willing to use books on tape);
p<.001, Adj R2 = 0.53; Talking appliances (no significant covariates) p<.001, Adj R2 = 0.38;
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EmotionsEmotionsThe intervention group had a decline in
reported fear and sadness than the control group.
Less afraid (people in better health became less afraid, people in poor health showed no improvement in fear)
p<.001, Adj R2 = 0.34;
Less sad (age and gender trends) p<.001, Adj R2 = 0.28;
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Self-efficacySelf-efficacy
No difference between groups.
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BehaviorBehavior
No difference between groups in adaptive changes in the home, or actual use of assistive devices.
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ConclusionsConclusions
The video had an impact on our proximal but not the distal outcome measures.
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ConclusionsConclusions
The video was effective in:
• improving knowledge
• Improving a few attitudes (willingness to use books on tape, and talking appliances)
• Improving the emotional aspects of low vision (reducing fear, reducing sadness).
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ConclusionsConclusions
The video was not effective in:• Improving self-efficacy• Changing the actual use of assistive
devices or rehabilitation services.
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LimitationsLimitations
1. Relied on self-report data.
2. Three-month timeframe. It may take as long as 3 months to make an appointment with a low vision specialist and even longer to obtain devices.
3. The recruitment strategy and inclusion criteria limited the diversity of the sample, which limits the generalizability of the results.
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Future ResearchFuture Research
1. Will the distal outcomes (e.g., increase the use of assistive devices; increase the use of rehabilitation services) change if allowed more time?
2. If not, what intervention is needed to increase the use of assistive devices and rehabilitative services?
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