The results presented include scores and ratings interpreted accordingly.(12,13,14) The varicoceole embolisation leaflet scored 54.4 and is therefore rated as fairly difficult to read. It also had a rating of 9.4 meaning that the reading age is suitable for a 14-15 year old.
The FLGJI leaflet achieved a score of 62.2 and is therefore of plain English standard. It also had a rating of 7.6,
meaning that the reading age is suitable for a 12-13 year old.
The total cohort of 64 participants interviewed overall for both procedures : varicoceole embolisation (n=17) males only, and fluoroscopy guided joint injection (n=47);18 (38%) males and 29 (62%) females). The ratio of male: female is comparable to that stated by Peterson’s group15 where out of 348 guided joint injections 39% where males and 61% where females.
Figure 5 shows frequency compared with age for the varicoceole embolisation patients. Ranging minimum to maximum ages: 18-70,
median 34 and mode 33. The 8 patients in the 30–35 group constituted 47% of participants showing that 30 to 35 years stand out as the ages when most varicocoele embolisation procedures are carried out at participating centre.
FLGJI patients are more common in the over 50 age range at the participating centre (age ranged: 19-81,
median age = 58,
mean = 55.3 and mode 34),
with a percentage of nearly 66% and with a mean age of 54 years,
similar for the large Peterson group trial.15 The frequency of the participants is summarised in Figure 6.
Level of education of participants
The level of education for varicoceole embolisation patients was generally high.
70.6% of the varicocoele cohort is made up of the two higher level education categories – post-secondary and tertiary education,
whereas the remaining 29.4% is to be attributed to secondary education.
The level of education for the FLGJI patients was generally lower than the varicoceole embolisation group. 34 out of a total of 47 fall in the lower two education level categories making up 72.3% of the sample population (table 2).
Education and Age Effects
Comparing age and education for the FLGJI cohort proved to be significant with (p=0.006). Above 80% of patients,
who had passed the 60 years of age,
had only primary education and these made up nearly 40% of the whole FLGJI sample. Interestingly,
varicoceole embolisation participants who did not read the leaflet,
made up 40% of those in the secondary school level category only – the lowest education category recorded for the varicoceole group.
Significant findings for education vs.
language preference were demonstrated (p value=0.007). No participant with primary education chose to read the English leaflet,
whereas 75% of the FLGJI cohort with tertiary education preferred to read the English leaflet. This highlights the importance of having PILs presented in the native language especially for the lower literacy groups.
Both varicoceole embolisation patients and FLGJI patients stated they preferred the Maltese to the English leaflet.
Combing both groups of participants,
78.1% preferred Maltese and 22.9% preferred English.
Feedback of returning patients
Only the FLGJI group included returning patients (n= 22), stating that the leaflet was an improvement.
Some recalled being unsure and nervous on previous visits and several patients (n=16) also claimed that they might not have taken care of their joint sufficiently after the procedure due to lack of aftercare knowledge.
Compliance and Satisfaction
From the feedback gathered while interviewing the whole cohort of patient receiving both leaflets the vast majority did understand what they needed to know and the leaflets presented had satisfactory information that when asked if the they wanted to add information or even remove,
no participant felt that addition or removal of information was required. The participants were also asked about the length of the leaflet and they reported this as appropriate and not lengthy. The amount and quality of information present allowed the patient to be more participant in their own healthcare and it gave them a responsibility towards taking care of themselves because the leaflet gave them enough knowledge to enable them to be autonomous,
making them aware and conscious that they were part of the process and that their participation was important for the success of their procedure. Thus knowing the basic information and how to take care of oneself made the patient aware of the possibilities and what to expect.
Two patients who stated they had joint injections,
but without the aid of x-rays in the past,
claimed that they would have declined the procedure if they had not read that this was x-ray guided. This indicates that the role of the PIL is to help the patient make an informed choice.
The paragraph describing drink instructions for varicocoele embolisation patients was one which created some misunderstanding as 5 patients (29.4%) claimed that they were unsure whether they could drink before the procedure. The radiologist always states that the patient needs to be hydrated and so this sentence needs to be adjusted to reflect the the radiologist's recommendation.
Patient ratings for the varicocoele embolisations leaflet themes and sub-headings
Figure 7 presents a summary of subheadings that varicoceole embolisation participants identified as very important.
The findings indicate that patients did not attribute a high rank to the subject: ‘knowing the length of the procedure’,
even though some people stated that it would be good to know the approximate time for the procedure length. The least rated was ‘the location of the radiology department’. Whereas ‘Knowing the performer’ and ‘What is a varicoceole?’ were highly rated.
How did varicocoele embolisation patients rate the leaflet?
For this section the participants were presented with a likert scale with 3 choices: (1) not at all; (2) to some extent; (3) to a large extent (fig.
8). All the participants rated the leaflet as easy to read. Moreover most of the other components were also highly rated since they received over 80% except for explanation of procedure which is probably the hardest paragraph to understand as it is the most technical.
Patient ratings for the FGJI leaflet themes and sub-headings
A summary of subheadings FLGJI participants identified as very important is outlined in figure 9.
A summary of participant responses in rating the FLGJI leaflet is highlighted in figure 10. All participants found the leaflet helpful and thus this was attributed the maximum value of 100%.