Background: Two trials were conducted to compare emergency department patient comprehension of rapid HIV pre-test information using different methods to deliver this information.

No abstract

Objectives-To determine if respondents differed by their demography (age group, race or ethnicity, and insurance status) in their tendency to correctly answer knowledge-based questions when they were in an agree-disagree instead of a multiple-choice format.Methods-Women aged 18-55 years seeking treatment in the emergency department completed surveys of preventive health knowledge on three cancer screening tests (Pap smears, breast selfexaminations, and mammograms) and two contraceptive measures (birth control pills and emergency contraception) that contained paired versions of questions in two different formats (agree-disagree format and multiple-choice format). Linear and ordinal regressions were used to determine demographic correlates of correctly answering the agree-disagree questions more often than the corresponding multiple-choice questions.Results-Of the 570 women included in this analysis, 64.6% were younger than 35 years, 62.1% were white, and 54.8% had private health care insurance. Older, white, and privately insured women demonstrated greater comprehension of all topics. Younger women, nonwhite women, and women without private health care insurance were more likely to respond to items correctly when they were in an agree-disagree format compared with a multiple-choice format.Conclusions-This study demonstrated that survey responses are influenced by the format of the questions, particularly in certain demographic groups. Policy makers and researchers might draw false conclusions about the baseline knowledge and need for education of patients, especially in these populations. The use of agree-disagree format questions in preventive health knowledge surveys should be avoided whenever possible.Keywords emergency medicine; questionnaires; women's health; preventive health services; survey methods; psychometrics; acquiescence biasThe Preventive Health Task Force of the Society for Academic Emergency Medicine and other groups advocate for the implementation of selected preventive health screening procedures in emergency departments (EDs). 1,2 Patient questionnaires are frequently used to assess knowledge about and need for these procedures. Policy decisions, such as the selection of interventions to create opportunities to provide these procedures in the ED, are partially based on presumptions about the quality of information that is obtained. Two common question formats utilized in patient surveys are the agree-disagree and the multiple-choice formats. Both formats have inherent problems that limit their effectiveness in evaluating respondent comprehension of the concepts being assessed. Agree-disagree questions restrict responses to a narrow range of extremes (agree vs. disagree) that do not allow respondents to fully express their beliefs, knowledge, or opinions; moreover, respondents have a tendency to choose "agree" when they do not fully understand the question. 3,4 For multiple-choice question formats, limitations include the propensity to encourage guessing through selection of any respon...

BackgroundLack of knowledge regarding preventive health services for women might impede campaigns to expand these services in the emergency department setting. For 18–55-year-old English-speaking women visiting an urban emergency department, we aimed to: (1) Ascertain their knowledge regarding the applicability, purpose, and recommended intervals of three women's cancer screening and three contraceptive methods; and (2) Determine if patient age, race/ethnicity, medical insurance status, and current or recent usage of these methods are associated with greater or lesser knowledge about them.MethodsEmergency department-based survey on recent or current usage and knowledge about Pap smears, breast self-examinations, mammograms, condoms, birth control, and emergency contraception. Analyses included calculation of summary statistics and creation of multivariable logistic regression models.ResultsOf 1,100 patients eligible for the study, 69.9% agreed to participate. Most of the participants were < age 35, white, single (never married and no partner), Catholic, and had private medical insurance. Participant's recent or current usage of a particular cancer screening or contraceptive method varied by type of method: Pap smear within the past year (69.1%), breast self-exam within the past month (45.5%), mammogram within the past year (65.7% for women age 45–55), condom usage during every episode of sexual intercourse (15.4%), current usage of birth control pills (17.8%), and ever use of emergency contraception (9.3%). The participants correctly answered 87.9% of all survey questions about condoms, 82.5% about birth control pills, 78.5% about breast self-exams, 52.9% about Pap smears, 35.4% about mammograms, and 25.0% about emergency contraception. In multivariable logistic regression models, survey participants who had private medical insurance and those who recently or currently used a given screening or contraceptive method had a greater odds of correctly answering all questions about each cancer screening or contraceptive method.ConclusionAlthough these female ED patients demonstrated strong knowledge on some women's cancer screening and contraceptive methods, there were several areas of knowledge deficit. Women without private medical insurance and those who have not used a particular cancer screening or contraceptive method demonstrated less knowledge. Reduced knowledge about women's cancer screening and contraceptive methods should be considered during clinical encounters and when instituting or evaluating emergency department-based initiatives that assess the need for these methods.