A systematic review of computer-based softwares for educating patients with coronary heart disease

The effectiveness of video animations as information tools for patients and the general public: A systematic review

Background and objectives

Video animations are used increasingly as patient information tools; however, we do not know their value compared to other formats of delivery, such as printed materials, verbal consultations or static images.

Methods

This review compares the effectiveness of video animations as information tools vs. other formats of delivery on patient knowledge, attitudes and cognitions, and behaviours. Included studies had the following features: controlled design with random or quasi-random allocation; patients being informed about any health condition or members of the public being informed about a public health topic; comparing video animation with another delivery format. Multiple digital databases were searched from 1996-June 2021. We also undertook citation searching. We used dual, independent decision-making for inclusion assessment, data extraction and quality appraisal. Included studies were appraised using the Cochrane ROB2 tool. Findings were reported using narrative synthesis.

Results

We included 38 trials, focussed on: explaining medical or surgical procedures (n = 17); management of long-term conditions (n = 11); public health, health-promotion or illness-prevention (n = 10). Studies evaluated cartoon animations (n = 29), 3D animations (n = 6), or 2D animations, "white-board" animations or avatars (n = 1 each). Knowledge was assessed in 30 studies, showing greater knowledge from animations in 19 studies, compared to a range of comparators. Attitudes and cognitions were assessed in 21 studies, and animations resulted in positive outcomes in six studies, null effects in 14 studies, and less positive outcomes than standard care in one study. Patient behaviours were assessed in nine studies, with animations resulting in positive outcomes in four and null effects in the remainder. Overall risk of bias was "high" (n = 18), "some concerns" (n = 16) or "low" (n = 4). Common reasons for increased risk of bias were randomisation processes, small sample size or lack of sample size calculation, missing outcome data, and lack of protocol publication.

Discussion

The overall evidence base is highly variable, with mostly small trials. Video animations show promise as patient information tools, particularly for effects on knowledge, but further evaluation is needed in higher quality studies.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?, identifier: CRD42021236296.

Pharmacists' perceptions of the use of internet-based medication information by patients: A cross-sectional survey

PURPOSE

The credibility and the reliability of Internet webpages to seek medication-related information is questionable. The main objective of the current study was to evaluate perception and experience of pharmacists with the use of Internet-based medication information by their patients.

METHODS

This is a cross-sectional descriptive study that was conducted to evaluate perception and experience of pharmacists with the use of Internet-based medication information by their patients. During the study period, 200 pharmacists were approached to participate in the study using a paper-based survey to assess their perceptions and current experience with the use of Internet-based medication information by their patients. Data were analyzed using descriptive statistics (mean/standard deviation for continuous variables, and frequency/percentages for qualitative variables). Also, simple linear regression was utilized to screen factors affecting pharmacists' perception scores of the use of Internet-based medication information.

RESULTS

Among 161 recruited pharmacists, the majority (n = 129, 80.1%) reported receiving inquiries from patients about Internet-based medication information within the last year. Among them, only 22.6% (n = 29) of pharmacists believed that Internet-based medication information is somewhat or very accurate. Unfortunately, only 24.2% (n = 31) of them stated that they always had enough time for their patient to discuss their Internet-based medication information. Regarding pharmacists' perception of the use of Internet-based medication information by their patients, more than half of the pharmacists (>50%) believe that Internet-based medication information could increase the patient's role in taking responsibility. On the other hand, 54.7% (n = 88) of the pharmacists believed that Internet-based medication information would contribute to rising the healthcare cost by obtaining unnecessary medications by patients. Finally, pharmacists' educational level was found to significantly affect their perception scores toward patient use of Internet-based medication information where those with higher educational level showed lower perception score (r = -0.200, P-value = 0.011).

CONCLUSION

Although pharmacists felt that usage of Internet-based data by patients is beneficial, they also have believed that it has a negative impact in terms of rising the healthcare cost, and it promotes unnecessary fear or concern about medications. We suggest that pharmacists be trained on principles of critical appraisal to become professional in retrieval information on the Internet that might improve their delivery of healthcare information and their recommendations to patients.

Designing a Clinical Trial Protocol about the Impact of Family-Based Multimedia Education Based on Telephone Tracking (Tele Nursing) to Improve the Quality of Life and Self-Efficacy in Patients with Myocardial Infarction

Background:

Provision of education to a person with myocardial infarction and an active family member, who takes care of the patient can prevent or delay the onset of the disease. Telephone tracking is a very useful and inexpensive way to assess the patients’ needs and help them with their care problems. This clinical trial (interventional) protocol was conducted over the impact of family-based multimedia education based on the telephone tracking (tele-nursing) to improve the quality of life and self-efficacy in patients with myocardial infarction.

Methods:

Two phases are identified to design this study; the first phase includes designing a curriculum by investigating various studies and the panel of experts’ opinions. This phase will be conducted in the form of multimedia training and telephone contact. Multimedia training (including audio, video, image, and animation) over the patients’ lifestyle, nutrition, and care will be conducted through a one-day workshop in 2-3 hours for patients and one of their active family members. The active family member is defined as the primary caregiver, who spends more time with the patient. The educational course will be conducted at a coordinated date and time in the ward where the patients are hospitalized. The researcher will make telephone calls as the educational intervention and continue the follow-ups once a week for one month. The second phase of the intervention will contain a pre/post-test design along with application of Minnesota quality of life and Scherer general self-efficacy standard questionnaires in the intervention (with training) and control (without training) groups. The target participants will include all patients (and their active family members) admitted to CCUs of hospitals affiliated to Shahrekord University of Medical Sciences.

Discussion:

The present study provides useful data for designing a family-based multimedia educational intervention using the telephone-tracking method (tele-nursing) to improve the quality of life and self-efficacy in patients with myocardial infarction. It can also reduce their medical and treatment costs. The strategies of this program could be important and cost effective, and therefore we hope that the success of such a program is a step forward in improving cardiovascular patient’s health status.

Highlights

Randomized trial of a patient education tool about leiomyoma

OBJECTIVE

Uterine leiomyomata are a frequent indication for women seeking gynecologic care [1]. The objective of our study was to assess whether patient knowledge about leiomyomata, anxiety, or satisfaction with counseling differed in patients who received multimedia counseling versus standard counseling.

METHODS

Women with leiomyomata who presented to the gynecology clinic at a single institution were randomized to standard counseling or multimedia counseling using the drawMD OB/GYN iPad™ application. Participants completed a pre-counseling questionnaire, received the designated method of counseling, and completed a post-counseling questionnaire. Outcomes of the study included assessment of patient knowledge, satisfaction, and anxiety.

RESULTS

Seventy-two participants were randomized. There was no significant difference in post-counseling anxiety between the groups (p = 0.86). For both groups, anxiety significantly improved after counseling. Both groups were satisfied with the counseling they received, however, there was no difference between groups. Participants in both groups significantly improved their knowledge about fibroids post-counseling.

CONCLUSION

Counseling of patients with leiomyomata improves patient satisfaction and knowledge. The addition of a multimedia tool may or may not enhance patient counseling.

PRACTICE IMPLICATIONS

This is the first prospective, randomized controlled trial evaluating the impact of a multimedia tool on patient education and counseling for patients with leiomyomata.

Online patient education interventions in type 2 diabetes or cardiovascular disease: A systematic review of systematic reviews

AIMS

Online patient education is a growing form of support to patients with chronic conditions, including type 2 diabetes (Type 2 DM) and cardiovascular disease (CVD). Multiple systematic reviews have been undertaken on this topic with conflicting results. We aim to explore the applications of online patient education in Type 2 DM and CVD and synthesise current evidence.

METHODS

A systematic review of systematic reviews was performed. Ovid Medline, EMBASE and Cochrane Database were searched between January 2005 and May 2018. Systematic reviews considering patient outcomes of online education interventions for adults with Type 2 DM and/or CVD were included. Quality assessment and data extraction was carried out in duplicate, and data combined using narrative synthesis. The PROSPERO registration number is CRD42016034018.

RESULTS

Twenty-three systematic reviews were eligible, synthesizing evidence from 87 distinct primary studies. Six reviews were high quality, nine used meta-analysis. Biological, behavioural, psychological, knowledge and self-efficacy measures are all potential targets. The outcomes most consistently showing benefits were knowledge and social support.

CONCLUSIONS

Online patient education has wide ranging benefits for people with Type 2 DM or CVD. Strengths of this review include its comprehensive synthesis of the large amount of literature on this topic.

The effectiveness of web-based patient education and action and coping plans as an adjunct to patient treatment in physiotherapy: A randomized controlled trial

Objective: The study investigated: (1) the effect of combining web-based patient education (WBPE) with action and coping plans on patients' adherence to physiotherapy and their subsequent functional outcomes; and (2) the participants' satisfaction with the WBPE program. Methods: One hundred and eight participants enrolled in this 8-week two group randomized controlled trial. They were allocated to either the WBPE planning group or the attention-control group. The WBPE group made action and coping plans and were familiarized with their web-based program. The attention control group was given access to a web-based neutral information program about shoulder injuries and physiotherapy rehabilitation. Throughout the 8-week study physiotherapists measured the participants' clinic-based adherence and participants recorded their home-based adherence using a self-report diary. Functional outcomes for all participants were measured at the beginning and end of the study. Participants provided feedback about their respective websites. Results: The intervention group had a significantly higher clinic based adherence than the control group (p < 0.04). Both groups had a significant improvement in shoulder function but there was no significant difference between them. Participants in the intervention group were highly satisfied with the WBPE program. The preferred delivery of physiotherapy by 87% of the intervention group was a combination of face-to-face appointments and WBPE. Control participants indicated that they would have appreciated information about shoulder exercises and the shoulder complex in their program. Discussion: The WBPE program was an effective adjunct to physiotherapy in terms of patient satisfaction and clinic-based treatment adherence.

Hard Copy Durable Patient Cancer Education Materials: Do They Still Matter?

Traditional hard copy information materials are still present in our cancer clinics. While their actual impact on patient care often goes un-assessed, it is important to understand their role in today's electronic age where information can easily be obtained from various sources. It has remained the practice in our melanoma clinic to provide an information booklet to all of our new patients. The purpose of this study was to evaluate how useful this booklet was, as well as determine the current resources our patients use to gather cancer information. All patients referred to the clinic in the previous 3 years were pooled from our prospective, IRB-approved, melanoma sentinel node database. Of these 205 patients, a valid email address was listed for 147. A ten-question survey was emailed to all of these patients, who were not told ahead of time that their experience with the booklet would be studied. Seventy-seven of the 147 (52 %) patients polled responded. Fifty-eight (75 %) remembered receiving the booklet at their initial consultation. Forty-four (76 %) of those patients rated it as extremely or very useful, and no patients reported the booklet as not useful at all. Eighty-eight percent of respondents found the information to be clear and helpful. Sixty-four percent remembered the provider reviewing the material with them, and nearly all of these patients found that helpful. When asked to rank the importance of the various resources for obtaining cancer information, providers were ranked as most important, followed by the information booklet and Internet information sites. Internet blogs and friends and family were rated as the least important sources of information. Even in the current electronic age, our results indicate that information shared by providers, including the hard copy education booklet, was the most important source of information for our newly referred melanoma patients.

Patient education in the management of coronary heart disease

BACKGROUND

Coronary heart disease (CHD) is the single most common cause of death globally. However, with falling CHD mortality rates, an increasing number of people live with CHD and may need support to manage their symptoms and improve prognosis. Cardiac rehabilitation is a complex multifaceted intervention which aims to improve the health outcomes of people with CHD. Cardiac rehabilitation consists of three core modalities: education, exercise training and psychological support. This is an update of a Cochrane systematic review previously published in 2011, which aims to investigate the specific impact of the educational component of cardiac rehabilitation.

OBJECTIVES

1. To assess the effects of patient education delivered as part of cardiac rehabilitation, compared with usual care on mortality, morbidity, health-related quality of life (HRQoL) and healthcare costs in patients with CHD.2. To explore the potential study level predictors of the effects of patient education in patients with CHD (e.g. individual versus group intervention, timing with respect to index cardiac event).

SEARCH METHODS

We updated searches from the previous Cochrane review, by searching the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library, Issue 6, 2016), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) in June 2016. Three trials registries, previous systematic reviews and reference lists of included studies were also searched. No language restrictions were applied.

SELECTION CRITERIA

1. Randomised controlled trials (RCTs) where the primary interventional intent was education delivered as part of cardiac rehabilitation.2. Studies with a minimum of six-months follow-up and published in 1990 or later.3. Adults with a diagnosis of CHD.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened all identified references for inclusion based on the above inclusion criteria. One author extracted study characteristics from the included trials and assessed their risk of bias; a second review author checked data. Two independent reviewers extracted outcome data onto a standardised collection form. For dichotomous variables, risk ratios and 95% confidence intervals (CI) were derived for each outcome. Heterogeneity amongst included studies was explored qualitatively and quantitatively. Where appropriate and possible, results from included studies were combined for each outcome to give an overall estimate of treatment effect. Given the degree of clinical heterogeneity seen in participant selection, interventions and comparators across studies, we decided it was appropriate to pool studies using random-effects modelling. We planned to undertake subgroup analysis and stratified meta-analysis, sensitivity analysis and meta-regression to examine potential treatment effect modifiers. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to evaluate the quality of the evidence and the GRADE profiler (GRADEpro GDT) to create summary of findings tables.

MAIN RESULTS

This updated review included a total of 22 trials which randomised 76,864 people with CHD to an education intervention or a 'no education' comparator. Nine new trials (8215 people) were included for this update. We judged most included studies as low risk of bias across most domains. Educational 'dose' ranged from one 40 minute face-to-face session plus a 15 minute follow-up call, to a four-week residential stay with 11 months of follow-up sessions. Control groups received usual medical care, typically consisting of referral to an outpatient cardiologist, primary care physician, or both.We found evidence of no difference in effect of education-based interventions on total mortality (13 studies, 10,075 participants; 189/5187 (3.6%) versus 222/4888 (4.6%); random effects risk ratio (RR) 0.80, 95% CI 0.60 to 1.05; moderate quality evidence). Individual causes of mortality were reported rarely, and we were unable to report separate results for cardiovascular mortality or non-cardiovascular mortality. There was evidence of no difference in effect of education-based interventions on fatal and/or non fatal myocardial infarction (MI) (2 studies, 209 participants; 7/107 (6.5%) versus 12/102 (11.8%); random effects RR 0.63, 95% CI 0.26 to 1.48; very low quality of evidence). However, there was some evidence of a reduction with education in fatal and/or non-fatal cardiovascular events (2 studies, 310 studies; 21/152 (13.8%) versus 61/158 (38.6%); random effects RR 0.36, 95% CI 0.23 to 0.56; low quality evidence). There was evidence of no difference in effect of education on the rate of total revascularisations (3 studies, 456 participants; 5/228 (2.2%) versus 8/228 (3.5%); random effects RR 0.58, 95% CI 0.19 to 1.71; very low quality evidence) or hospitalisations (5 studies, 14,849 participants; 656/10048 (6.5%) versus 381/4801 (7.9%); random effects RR 0.93, 95% CI 0.71 to 1.21; very low quality evidence). There was evidence of no difference between groups for all cause withdrawal (17 studies, 10,972 participants; 525/5632 (9.3%) versus 493/5340 (9.2%); random effects RR 1.04, 95% CI 0.88 to 1.22; low quality evidence). Although some health-related quality of life (HRQoL) domain scores were higher with education, there was no consistent evidence of superiority across all domains.

AUTHORS' CONCLUSIONS

We found no reduction in total mortality, in people who received education delivered as part of cardiac rehabilitation, compared to people in control groups (moderate quality evidence). There were no improvements in fatal or non fatal MI, total revascularisations or hospitalisations, with education. There was some evidence of a reduction in fatal and/or non-fatal cardiovascular events with education, but this was based on only two studies. There was also some evidence to suggest that education-based interventions may improve HRQoL. Our findings are supportive of current national and international clinical guidelines that cardiac rehabilitation for people with CHD should be comprehensive and include educational interventions together with exercise and psychological therapy. Further definitive research into education interventions for people with CHD is needed.

The use of mobile technology in waiting rooms to leverage women's empowerment: A conceptual context

This article focuses on a conceptual framework that can be applied to the use of mobile technology in the waiting room with the goal of empowering women recently diagnosed with abnormal Pap test results. It further describes trends which indicate a need for improved and timely information dissemination. Genecology practice outpatients report a predominant feeling of worry on receipt of abnormal medical test results, along with a clearly expressed wish for additional information. This research suggests that there is room for improvement in existing processes through use of mobile technology with carefully vetted materials which indicate a doctor is interested in the patient's well-being.

Efficacy of three-dimensional visualization in mobile apps for patient education regarding orthognathic surgery

'Sur-face' is an interactive mobile app illustrating different orthognathic surgeries and their potential complications. This study aimed to evaluate the efficacy of Sur-face by comparing two methods of delivering patient information on orthognathic surgeries and their related potential complications: a mobile app with interactive three-dimensional (3D) animations and a voice recording containing verbal instructions only. For each method, the participants' acquired knowledge was assessed using a custom-designed questionnaire. Participants in the 'app' group performed significantly better (P<0.0034) than those in the 'voice' group and retained more knowledge, suggesting that interactive visualizations play a key role in improving understanding of the orthognathic surgical procedure and its associated complications. This study emphasizes the impact of 3D visualizations in delivering information regarding orthognathic surgery and highlights the advantage of delivering validated patient information through mobile apps.

How do patients with peripheral arterial disease communicate their knowledge about their illness and treatments? A qualitative descriptive study

BACKGROUND

Peripheral arterial disease is a chronic illness, and patients with peripheral arterial disease should receive advice about lifestyle changes and medical therapies to reduce further atherosclerotic complications. Previous research has indicated that patients with peripheral arterial disease lack information about their disease and secondary prevention measures. The aim was to elucidate how patients with peripheral arterial disease communicate their knowledge about their illness and treatments.

METHODS

During 2009, seven focus group interviews were conducted with twenty-one patients (50-81 years old) with peripheral arterial disease and were analysed using content analysis.

RESULTS

When respondents with PAD communicate their knowledge about the illness and its treatments they "Navigate through uncertainty, believes and facts about PAD, displaying an active or passive information-seeking behaviour". After discharge, they felt a feeling of relief at first, which was later exchanged into uncertainty from their restricted knowledge about the illness and how to behave following revascularisation. For example, during the discussions about risk factors, smoking was noted as a major risk factor, that triggered feelings of guilt. Thus, the respondents needed to consult other sources of information to manage their everyday lives.

CONCLUSIONS

Following endovascular treatment, the short amount of time spent with peripheral arterial disease patients requires innovative guidance in clinical practice to meet individuals' needs regardless of whether the patient actively or passively understands and manages their peripheral arterial disease.

U.S.A.B.I.L.I.T.Y. Framework for Older Adults

The purpose of the current study was to present a framework to determine potential usability of health websites by older adults. Review of the literature showed paucity of nursing theory related to the use of technology and usability, particularly in older adults. The Roy Adaptation Model, a widely used nursing theory, was chosen to provide framework for the new model. Technology constructs from the Technology Acceptance Model and United Theory of Acceptance and Use of Technology and behavioral control construct from the Theory of Planned Behavior were integrated into the construction of the derived model. The Use of Technology for Adaptation by Older Adults and/or Those With Limited Literacy (U.S.A.B.I.L.I.T.Y.) Model was constructed from the integration of diverse theoretical/conceptual perspectives. The four determinants of usability in the conceptual model include (a) efficiency, (b) learnability, (c) perceived user experience, and (d) perceived control. Because of the lack of well-validated survey questionnaires to measure these determinants, a U.S.A.B.I.L.I.T.Y. Survey was developed. A panel of experts evaluated face and content validity of the new instrument. Internal consistency of the new instrument was 0.96. Usability is key to accepting technology. The derived U.S.A.B.I.L.I.T.Y. framework could serve as a guide for nurses in formative evaluation of technology.

How to become an expert educator: a qualitative study on the view of health professionals with experience in patient education

BACKGROUND

Health professionals with the level of competency necessary to provide high-quality patient education are central to meeting patients' needs. However, research on how competencies in patient education should be developed and health professionals trained in them, is lacking. The aim of this study was to investigate the characteristics of an expert educator according to health professionals experienced in patient education for patients with coronary heart disease, and their views on how to become an expert educator.

METHODS

This descriptive qualitative study was conducted through individual interviews with health professionals experienced in patient education in cardiac care. Participants were recruited from cardiac care units and by using a snowball sampling technique. The interviews were audiotaped and transcribed verbatim. The data were analyzed with thematic approaches, using systematic text condensation.

RESULTS

Nineteen Icelandic and Norwegian registered nurses, physiotherapists, and cardiologists, who had worked in cardiac care for 12 years on average, participated in the study. Being sensitive to the patient's interests and learning needs, and possessing the ability to tailor the education to each patient's needs and context of the situation was described as the hallmarks of an expert educator. To become an expert educator, motivation and active participation of the novice educator and a supportive learning environment were considered prerequisites. Supportive educational resources, observation and experiential training, and guidance from experienced educators were given as examples of resources that enhance competence development. Experienced educators expressed the need for peer support, inter-professional cooperation, and mentoring to further develop their competency.

CONCLUSIONS

Expert patient educators were described as those demonstrating sensitivity toward the patient's learning needs and an ability to individualize the patient's education. A supportive learning environment, inner motivation, and an awareness of the value of patient education were considered the main factors required to become an expert educator. The experienced educators expressed a need for continuing education and peer support.

Rede social e virtual de apoio ao adolescente que convive com doenças crônicas: uma revisão integrativa

Objetivo: identificar o papel do enfermeiro na rede social e virtual de apoio aos adolescentes que convivem com o diagnóstico de doença crônica. Metodologia: trata-se de uma revisão integrativa, realizada na base de dados: MEDLINE, LILACS e BDENF, no período de junho a novembro de 2013, com artigos indexados a partir de 2008 até 2013 e os descritores: “enfermagem”, “apoio social”, “adolescentes”, “doenças crônicas” e “rede social”. Resultados: os artigos descrevem que o apoio social de forma direta aos portadores de doenças crônicas ou por meio do apoio que os pais recebem, afetará positivamente no estado de saúde do portador. Conclusão: o enfermeiro deve estar preparado para fornecer o apoio necessário às famílias e ao portador de doença crônica com o objetivo de melhorar a saúde do paciente. Esse apoio por meio das redes sociais virtuais é um novo método que vem conquistando espaço e trazendo grandes benefícios para esses pacientes e seus familiares.

Community health education at student-run clinics leads to sustained improvement in patients' hepatitis B knowledge

While student-run clinics are often important healthcare safety nets for underserved populations, their efficacy for improving patient health knowledge has not been thoroughly explored. From September 2011 to April 2012, we assessed patients' retention of hepatitis B virus (HBV) knowledge after receiving student-led education at two student-run HBV screening and vaccination clinics. Patient education was provided by trained first and second-year medical, nursing, and pharmacy students, aided by a script and interpreters. Patient knowledge of HBV was evaluated at three points: before education, after the initial visit, and at one-month follow-up. Student-led education produced improved knowledge of HBV transmission, prevention, and management, which was retained 1 month after education for 52 patients tracked through time. Mean scores on an HBV knowledge survey improved from 56.4 % (SD = 15.2 %) at baseline to 66.6 % (SD = 15.1 %) after education, and 68.3 % (SD = 15.2 %) after one month. There was a statistically significant difference between the first and second (paired T test, p < 0.001) and the first and third tests (paired T test, p < 0.001), but no difference between the second and third tests (paired T test, p = 0.45). Multivariate analysis demonstrated that retention was correlated with patient educational background but independent of patient age, gender, income, primary language and number of years lived in the United States. Our study suggests that trained health professional students can effectively impart health knowledge that is retained by patients for at least 1 month. These results warrant consideration of student-led educational sessions at SRCs as a promising community health education model.

Educational benefits of Internet and computer-based programmes for prostate cancer patients: a systematic review

OBJECTIVE

This study aims to review systematically the available literature on Internet and computer-based patient education programmes, assess the quality of these studies and analyze the benefit of these programmes for prostate cancer patients.

METHODS

Complete databases were searched. Studies were included if they concerned patient education of prostate cancer patients, were qualitative or quantitative and examined Internet or interactive CD-ROM use.

RESULTS

Eighteen studies met the inclusion criteria. The majority of the studies reported a significant increase in the knowledge of the disease, satisfaction with treatment options and support for men. The benefit of the programmes was that the patients felt more empowered and obtained a heightened sense of control over their disease.

CONCLUSION

The Internet or computer-based programmes had a positive impact on prostate cancer patient education. Most papers reported that the programmes were beneficial, but few presented data from studies with rigorous research methodologies to support these claims.

PRACTICE IMPLICATIONS

Internet and computer-based programmes can be useful tools in prostate cancer patient education. In order to improve the benefits of the programmes, more Internet and computer-based programmes need to be developed and studied.

Role of 3D animation in periodontal patient education: a randomized controlled trial

AIM

This randomized controlled parallel trial investigates the effect of 3D animation on the increase and recall of knowledge on periodontitis by patients with periodontitis. The effects of a 3D animation (3D animation group) were compared with narration and drawing (control group) for periodontal patient education.

MATERIAL AND METHODS

A total of 68 periodontitis patients were stratified according to educational level and then randomly allocated to control or 3D animation groups. All patients received: (1) a pre-test (baseline knowledge), (2) a patient education video (3D animation or control video), (3) a post-test (knowledge immediately after looking at the video), and (4) a follow-up test (knowledge recall after 2 weeks). Each test contained 10 multiple-choice questions.

RESULTS

There was no significant difference in baseline knowledge. Patients receiving the 3D animations had significantly higher scores for both the post-test and the follow-up test, when compared with patients receiving sketch animations.

CONCLUSION

3D animations are more effective than real-time drawings for periodontal patient education in terms of knowledge recall. 3D animations may be a powerful tool for assisting in the information process.

Maximizing the healthcare environment: a systematic review exploring the potential of computer technology to promote self-management of chronic illness in healthcare settings

OBJECTIVE

The aim of this systematic review is to investigate the effectiveness of using computers to deliver patient self-management programs (PSMPs) to patients with chronic illness in health supported settings.

METHODS

We included randomized controlled trials (RCTs), where the experimental intervention was compared either with an equivalent 'standard' PSMP delivered by staff, usual care or no intervention and reported data either on clinical or behavioral outcomes. We conducted a narrative synthesis, incorporating a small quantitative analysis to enable comparisons across studies.

RESULTS

A total of 11 studies met the inclusion criteria. There was insufficient evidence to determine whether computer-based PSMPs were superior to standard programs. However, it appeared that these interventions were effective when compared to no intervention. Interventions incorporating behavior change techniques beyond the provision of information appeared more effective than those that did not.

CONCLUSION

Evidence from the current review, whilst limited, suggests that computer-based PSMPs, delivered in health-supported settings, show potential for changing health behaviors and improving clinical outcomes in patients with chronic illness.

PRACTICE IMPLICATIONS

Although the approach shows promise, it is premature to recommend the integration of these interventions into clinical practice. However, more well designed trials are warranted to test their efficacy and cost-benefit.

Evaluation of a real-time virtual intervention to empower persons living with HIV to use therapy self-management: study protocol for an online randomized controlled trial

BACKGROUND

Living with HIV makes considerable demands on a person in terms of self-management, especially as regards adherence to treatment and coping with adverse side-effects. The online HIV Treatment, Virtual Nursing Assistance and Education (Virus de I'immunodéficience Humaine-Traitement Assistance Virtuelle Infirmière et Enseignement; VIH-TAVIE™) intervention was developed to provide persons living with HIV (PLHIV) with personalized follow-up and real-time support in managing their medication intake on a daily basis. An online randomized controlled trial (RCT) will be conducted to evaluate the efficacy of this intervention primarily in optimizing adherence to combination anti-retroviral therapy (ART) among PLHIV.

METHODS/DESIGN

A convenience sample of 232 PLHIV will be split evenly and randomly between an experimental group that will use the web application, and a control group that will be handed a list of websites of interest. Participants must be aged 18 years or older, have been on ART for at least 6 months, and have internet access. The intervention is composed of four interactive computer sessions of 20 to 30 minutes hosted by a virtual nurse who engages the PLHIV in a skills-learning process aimed at improving self-management of medication intake. Adherence constitutes the principal outcome, and is defined as the intake of at least 95% of the prescribed tablets. The following intermediary measures will be assessed: self-efficacy and attitude towards antiretroviral medication, symptom-related discomfort, and emotional support. There will be three measurement times: baseline (T0), after 3 months (T3) and 6 months (T6) of baseline measurement. The principal analyses will focus on comparing the two groups in terms of treatment adherence at the end of follow-up at T6. An intention-to-treat (ITT) analysis will be carried out to evaluate the true value of the intervention in a real context.

DISCUSSION

Carrying out this online RCT poses various challenges in terms of recruitment, ethics, and data collection, including participant follow-up over an extended period. Collaboration between researchers from clinical disciplines (nursing, medicine), and experts in behavioral sciences information technology and media will be crucial to the development of innovative solutions to supplying and delivering health services.

TRIAL REGISTRATION

CE 11.184 / NCT 01510340.

Development and pilot test of a culturally sensitive CD-ROM for hypertensive, older Chinese immigrants

Hypertension control remains an issue for older Chinese immigrants because of the unique cultural health practices they use to manage their hypertension. Limited health education information on how to manage hypertension is available in Chinese. Because San Francisco has a large population of older Chinese immigrants, development of culturally sensitive educational material is important to help this population to achieve better blood pressure control. The purpose of this study was to develop and pilot test an innovative, culturally based CD-ROM with a focus on hypertension education and management, directed to the older Chinese immigrant population. The results of this pilot study found that the content of CD-ROM was culturally acceptable for the target population. Given a lack of educational material in Chinese in the United States, this CD-ROM has a potential to be used for a large population of Chinese elders in the United States.

Ambulatory orthopaedic surgery patients' knowledge with internet-based education

BACKGROUND

There is a growing need for patient education and an evaluation of its outcomes.

OBJECTIVES

The aim of this study was to compare ambulatory orthopaedic surgery patients' knowledge with Internet-based education and face-to-face education with a nurse. The following hypothesis was proposed: Internet-based patient education (experiment) is as effective as face-to-face education with a nurse (control) in increasing patients' level of knowledge and sufficiency of knowledge. In addition, the correlations of demographic variables were tested.

METHODS

The patients were randomized to either an experiment group (n = 72) or a control group (n = 75). Empirical data were collected with two instruments.

RESULTS

Patients in both groups showed improvement in their knowledge during their care. Patients in the experiment group improved their knowledge level significantly more in total than those patients in the control group. There were no differences in patients' sufficiency of knowledge between the groups. Knowledge was correlated especially with patients' age, gender and earlier ambulatory surgeries.

CONCLUSIONS

As a conclusion, positive results concerning patients' knowledge could be achieved with the Internet-based education. The Internet is a viable method in ambulatory care.

A questionnaire on treatment satisfaction and disease specific knowledge among patients with acute coronary syndrome. I: Are treatment satisfaction and disease specific knowledge continuous latent traits?

OBJECTIVE

To assess psychometric properties of a questionnaire covering treatment satisfaction and disease-specific knowledge among patients discharged after treatment for acute coronary syndrome.

METHODS

Comparative scaling of the questionnaire using latent class analysis (LCA) and exploratory factor analysis (EFA) in a consecutive sample of 2015 patients.

RESULTS

LCA revealed four qualitatively differing patterns of patients' knowledge and five distinct patterns of treatment satisfaction. EFA for patients' knowledge identified four uncorrelated "dimensions". Patient satisfaction was scored in a two-factor solution despite proven heterogeneity of persons.

CONCLUSIONS

LCA was helpful to identify classes of patients that cannot be scaled according to a latent trait model.

PRACTICE IMPLICATIONS

Specific patterns of insufficient disease-specific knowledge and satisfaction requiring specific interventions became visible.

Effect of educational software on self-efficacy of pregnant women to cope with labor: a randomized controlled trial

AIM

The aim of this study was to determine the effect of educational software on self-efficacy of Iranian pregnant women to cope with labor.

METHODS

This study was a randomized controlled trial which was carried out on 150 Iranian nulliparous pregnant women randomly assigned to two groups of 75 women each. The control group routinely did not receive any kind of childbirth education and the intervention group only received the childbirth educational software for 6-8 weeks. In order to determine self-efficacy, the Childbirth Self Efficacy Questionnaire (CBSEI) was used which measures the outcome expectancy and the self-efficacy expectancy of the first and second stages of labor separately. This questionnaire was completed at 28-32-week gestation as a pre-test and at 36-38 weeks as a post-test by the participants. Data were analyzed using Chi-square, Mann-Whitney U and Wilcoxon tests.

RESULTS

After the intervention, the median and mean of CBSEI scores for the intervention and the control groups were 607, 604/20 ± 16/630 and 394, 392/51 ± 16/758, respectively. There was a statistical difference between the two groups (p = 0.001). Also, statistically significant differences existed in the median of outcome expectancy and self-efficacy expectancy after intervention in both stages of labor between the two groups (p = 0.001).

CONCLUSIONS

The educational software program significantly increased self-efficacy of Iranian pregnant women to cope with labor. Despite lack of educational childbirth classes in Iran, the use of this method is recommended. However, to find whether this technique can be substituted for the educational classes, further studies are needed.

Teaching on three-dimensional presentation does not improve the understanding of according CT images: a randomized controlled study

BACKGROUND

Randomized studies have already described the advantages of three dimensional (3D) presentations in understanding complex spatial interactions. However, the clinical setting is mainly characterized by presentations of two dimensional (2D) images.

PURPOSE

This study evaluates whether training on 3D presentation enhances the understanding of 2D images.

METHODS

A teaching module was used consisting of one learning part and two examination parts (EP). Students were randomized to training with either 2D or 3D.

RESULTS

This study of 73 students showed that training on 3D presentations did not improve the ability to interpret 2D images. Further, the results revealed no significant differences between the results of Week 1 (2D: M = 6.5, SD = 1.8; 3D: M = 6.6, SD = 1.4; p > .95) and Week 2 (2D: M = 6.1, SD = 1.9; 3D: M = 6.0, SD = 1.4; p > .7). There were no significant gender differences. However, students randomized to 2D who completed only the first EP performed significantly worse if compared to students who completed both EP ( p = .04).

CONCLUSIONS

This randomized controlled study shows that correct interpretation of 2D imaging does not differ in students trained with either 3D or 2D.

Patient education in the management of coronary heart disease

BACKGROUND

Cardiac rehabilitation (CR) is a complex multifaceted intervention consisting of three core modalities: education, exercise training and psychological support. Whilst exercise and psychological interventions for patients with coronary heart disease (CHD) have been the subject of Cochrane systematic reviews, the specific impact of the educational component of CR has not previously been investigated.

OBJECTIVES

1. Assess effects of patient education on mortality, morbidity, health-related quality of life (HRQofL) and healthcare costs in patients with CHD.2. Explore study level predictors of the effects of patient education (e.g. individual versus group intervention, timing with respect to index cardiac event).

SEARCH METHODS

The following databases were searched: The Cochrane Library, (CENTRAL, CDSR, DARE, HTA, NHSEED), MEDLINE (OVID), EMBASE (OVID), PsycINFO (EBSCOhost) and CINAHL (EBSCOhost). Previous systematic reviews and reference lists of included studies were also searched. No language restrictions were applied.

SELECTION CRITERIA

1. Randomised controlled trials (RCTs) where the primary interventional intent was education.2. Studies with a minimum of six-months follow-up and published in 1990 or later.3. Adults with diagnosis of CHD.

DATA COLLECTION AND ANALYSIS

Two review authors selected studies and extracted data. Attempts were made to contact all study authors to obtain relevant information not available in the published manuscript. For dichotomous variables, risk ratios and 95% confidence intervals (CI) were derived for each outcome. For continuous variables, mean differences and 95% CI were calculated for each outcome.

MAIN RESULTS

Thirteen RCTs involving 68,556 subjects with CHD and follow-up from six to 60 months were found. Overall, methodological quality of included studies was moderate to good. Educational 'dose' ranged from a total of two clinic visits to a four-week residential stay with 11 months of follow-up sessions. Control groups typically received usual medical care. There was no strong evidence of an effect of education on all-cause mortality (Relative Risk (RR): 0.79, 95% CI 0.55 to 1.13), cardiac morbidity (subsequent myocardial infarction RR: 0.63, 95% CI 0.26 to 1.48, revascularisation RR: 0.58, 95% CI 0.19 to 1.71) or hospitalisation (RR: 0.83, 95% CI:0.65 to 1.07). Whilst some HRQofL domain scores were higher with education, there was no consistent evidence of superiority across all domains. Different currencies and years studies were performed making direct comparison of healthcare costs challenging, although there is evidence to suggest education may be cost-saving by reducing subsequent healthcare utilisation.This review had insufficient power to exclude clinically important effects of education on mortality and morbidity of patients with CHD.

AUTHORS' CONCLUSIONS

We did not find strong evidence that education reduced all cause mortality, cardiac morbidity, revascularisation or hospitalisation compared to control. There was some evidence to suggest that education may improve HRQofL and reduce overall healthcare costs. Whilst our findings are generally supportive of current guidelines that CR should include not only exercise and psychological interventions, further research into education is needed.

Description and initial evaluation of an educational and psychosocial support model for adults with congenitally malformed hearts

OBJECTIVE

Various programmes for adults with congenitally malformed hearts have been developed, but detailed descriptions of content, rationale and goals are often missing. The aim of this study was to describe and make an initial evaluation of a follow-up model for adults with congenitally malformed hearts, focusing on education and psychosocial support by a multidisciplinary team (EPS).

METHODS

The model is described in steps and evaluated with regards to perceptions of knowledge, anxiety and satisfaction.

RESULTS

The EPS model included a policlinic visit to the physician/nurse (medical consultation, computer-based and individual education face-to-face as well as psychosocial support) and a 1-month telephone follow-up. Fifty-five adults (mean age 34, 29 women) with the nine most common forms of congenitally malformed hearts participated in the EPS model as well as the 3-months follow-up. Knowledge about congenital heart malformation had increased in 40% of the participants at the 3-months follow-up.

CONCLUSION

This study describes and evaluates a model that combines a multidisciplinary approach and computer-based education for follow-up of adults with congenitally malformed hearts. The EPS model was found to increase self-estimated knowledge, but further evaluations need to be conducted to prove patient-centred outcomes over time.

PRACTICE IMPLICATIONS

The model is now ready to be implemented in adults with congenitally malformed hearts.

Health education in patients with a recent stroke or transient ischaemic attack: a comprehensive review

Health education aims at the acquisition of skills and attitudes to modify behaviour that influences health, leads to a modification of risk factors and ultimately to a decrease in disability and case fatality from stroke. Health education is an underdeveloped but important aspect of stroke care. Health education could promote compliance and healthy behaviour, improve patients' understanding of their health status and treatment options and facilitate communication. We reviewed the effect of health education in stroke and transient ischaemic attack patients, aiming at feasibility, effectiveness at the level of knowledge, attitude and skills, health behaviour changes and stroke outcome. We also describe the current status of health education for patients with recent coronary artery disease and public health education in stroke. Basic knowledge of stroke and transient ischaemic attack patients of their disease and associated risk factors is not sufficient. This is also observed in patients with coronary artery disease and in the general population. A beneficial effect of health education in stroke and transient ischaemic attack patients on health behaviour, risk reduction or stroke outcome has not been proven. Trials in patients with coronary artery disease, however, have shown that health education could result in a change of lifestyle. No specific method is superior, although the individualised, repetitive and active methods appear more successful. More intervention studies of health education in stroke and transient ischaemic attack patients are needed. Future trials should be large, have a long follow-up, should use an intensive and repetitive approach and involve patients' relatives to induce and maintain a healthy lifestyle.

Comparison of traditional methods with 3D computer models in the instruction of hepatobiliary anatomy

This study was designed to determine whether an interactive three-dimensional presentation depicting liver and biliary anatomy is more effective for teaching medical students than a traditional textbook format presentation of the same material. Forty-six medical students volunteered for participation in this study. Baseline demographic information, spatial ability, and knowledge of relevant anatomy were measured. Participants were randomized into two groups and presented with a computer-based interactive learning module comprised of animations and still images to highlight various anatomical structures (3D group), or a computer-based text document containing the same images and text without animation or interactive features (2D group). Following each teaching module, students completed a satisfaction survey and nine-item anatomic knowledge post-test. The 3D group scored higher on the post-test than the 2D group, with a mean score of 74% and 64%, respectively; however, when baseline differences in pretest scores were accounted for, this difference was not statistically significant (P = 0.33). Spatial ability did not statistically significantly correlate with post-test scores for the 3D group or the 2D group. In the post-test satisfaction survey the 3D group expressed a statistically significantly higher overall satisfaction rating compared to students in the 2D control group (4.5 versus 3.7 out of 5, P = 0.02). While the interactive 3D multimedia module received higher satisfaction ratings from students, it neither enhanced nor inhibited learning of complex hepatobiliary anatomy compared to an informationally equivalent traditional textbook style approach. .

Effective teaching strategies and methods of delivery for patient education: a systematic review and practice guideline recommendations

The objective of this study was to determine effective teaching strategies and methods of delivery for patient education (PE). A systematic review was conducted and reviews with or without meta-analyses, which examined teaching strategies and methods of delivery for PE, were included. Teaching strategies identified are traditional lectures, discussions, simulated games, computer technology, written material, audiovisual sources, verbal recall, demonstration, and role playing. Methods of delivery focused on how to deliver the teaching strategies. Teaching strategies that increased knowledge, decreased anxiety, and increased satisfaction included computer technology, audio and videotapes, written materials, and demonstrations. Various teaching strategies used in combination were similarly successful. Moreover, structured-, culturally appropriate- and patient-specific teachings were found to be better than ad hoc teaching or generalized teaching. Findings provide guidance for establishing provincial standards for the delivery of PE. Recommendations concerning the efficacy of the teaching strategies and delivery methods are provided.

Three-dimensional visualisation improves understanding of surgical liver anatomy

OBJECTIVES

Three-dimensional (3-D) representation is thought to improve understanding of complex spatial interactions and is being used more frequently in diagnostic and therapeutic procedures. It has been suggested that males benefit more than females from 3-D presentations. There have been few randomised trials to confirm these issues. We carried out a randomised trial, based on the identification of complex surgical liver anatomy, to evaluate whether 3-D presentation has a beneficial impact and if gender differences were evident.

METHODS

A computer-based teaching module (TM) was developed to test whether two-dimensional (2-D) computed tomography (CT) images or 3-D presentations result in better understanding of liver anatomy. Following a PowerPoint lecture, students were randomly selected to participate in computer-based testing which used either 2-D images presented as consecutive transversal slices, or one of two 3-D variations. In one of these the vessel tree of portal and hepatic veins was shown in one colour (3-D) and in the other the two vessel systems were coloured differently (3-Dc). Participants were asked to answer 11 medical questions concerning surgical anatomy and four questions on their subjective assessment of the TM.

RESULTS

Of the 160 Year 4 and 5 medical students (56.8% female) who participated in this prospective randomised trial, students exposed to 3-D presentation performed significantly better than those exposed to 2-D images (p < 0.001). Comparison of the number of correct answers revealed no significant differences between the 3-D and 3-Dc modalities p > 0.1). Male students gave significantly more correct answers in the 3-D and 3-Dc modalities than female students (p < 0.03). The gender difference observed in both 3-D modalities was not evident in the 2-D group (p = 0.21).

CONCLUSIONS

This study showed that 3-D imaging significantly improved the identification of complex surgical liver anatomy. Male students benefited significantly more than female students from 3-D presentations. Use of colour in 3-D presentation did not improve student performance.

Multi-site heart disease risk assessment service provided by pharmacy students

OBJECTIVE

To evaluate a pharmacy student service focused on patient coronary heart disease (CHD) risk assessment.

DESIGN

Fourth-year pharmacy students offered a CHD risk assessment service at 5 physicians' offices as part of ambulatory care advanced pharmacy practice experience (APPE). Patient acceptance of the service was assessed using a satisfaction survey instrument.

ASSESSMENT

Fifty-seven students educated 311 patients about CHD risk. Of the 258 patients who completed the satisfaction survey, 245 (95%) reported that the service was helpful in understanding CHD risk, and 79 (31%) learned of a personal CHD risk factor of which they were not previously aware. Student knowledge was assessed using a multiple-choice pretest and posttest focused on CHD knowledge recall. Students' test scores improved from pretest to posttest (mean 51.6 % +/- 1.1 vs. 64. 8% +/- 1.0. respectively; p = 0.01).

CONCLUSIONS

A CHD risk assessment service provided by APPE students in ambulatory care settings was educational for both students and patients.

Review of nursing care for patients undergoing percutaneous coronary intervention: a patient journey approach

AIM

To evaluate the existing literature to inform nursing management of people undergoing percutaneous coronary intervention. BACKGROUND. Percutaneous coronary intervention is an increasingly important revascularisation strategy in coronary heart disease management and can be an emergent, planned or rescue procedure. Nurses play a critical role in delivering care in both the independent and collaborative contexts of percutaneous coronary intervention management.

DESIGN

Systematic review.

METHOD

The method of an integrative literature review, using the conceptual framework of the patient journey, was used to describe existing evidence and to determine important areas for future research. The electronic data bases CINAHL, Medline, Cochrane and the Joanna Briggs data bases were searched using terms including: (angioplasty, transulminal, percutaneous coronary), nursing care, postprocedure complications (haemorrhage, ecchymosis, haematoma), rehabilitation, emergency medical services (transportation of patients, triage).

RESULTS

Despite the frequency of the procedure, there are limited data to inform nursing care for people undergoing percutaneous coronary intervention. Currently, there are no widely accessible nursing practice guidelines focusing on the nursing management in percutaneous coronary intervention. Findings of the review were summarised under the headings: Symptom recognition; Treatment decision; Peri-percutaneous coronary intervention care, describing the acute management and Postpercutaneous coronary intervention management identifying the discharge planning and secondary prevention phase.

CONCLUSIONS

Cardiovascular nurses need to engage in developing evidence to support guideline development. Developing consensus on nurse sensitive patient outcome indicators may enable benchmarking strategies and inform clinical trial design.

RELEVANCE TO CLINICAL PRACTICE

To improve the care given to individuals undergoing percutaneous coronary intervention, it is important to base practice on high-level evidence. Where this is lacking, clinicians need to arrive at a consensus as to appropriate standards of practice while also engaging in developing evidence. This must be considered, however, from the central perspective of the patient and their family.

Coping with cancer: a Web-based educational program for early and middle adolescents

Educating patients is a primary responsibility of all nurses; however, because of time constraints and staff shortages, pediatric oncology nurses are often unable to adequately prepare patients for cancer treatment. Instead, patients frequently rely on the Internet as a source of information about cancer, some of which can be outdated and inaccurate. Adolescents regard the Internet as a valuable source of health information as it is easily accessible, less threatening, and confidential. Considering the need for accurate, readily available information for adolescents with cancer, the purpose of this study was to develop and validate an innovative, interactive Web-based educational program to prepare early and middle adolescents for cancer treatment. Titled "Coping With Cancer," this program was developed by the investigator after conducting in-depth interviews of adolescent cancer survivors and their parents. Based on the transactional model of coping, the program focuses on enhancing the adolescent's knowledge of cancer, cancer treatment, and healthy coping strategies. Coping With Cancer can be an effective resource for pediatric oncology nurses in providing ongoing education for adolescents with cancer.

A comparison of two educational interventions for the cognitive empowerment of ambulatory orthopaedic surgery patients

OBJECTIVE

The aim of this study was to compare the cognitive empowerment of ambulatory orthopaedic surgery patients when using Internet-based education (experiment) in contrast to face to face education conducted by a nurse (control).

METHODS

Elective ambulatory orthopaedic surgery patients were randomized to either an experiment group (n = 72) receiving Internet-based education, or to a control group (n = 75) receiving face-to-face education with a nurse. The data were collected at three different time points: before the preoperative education session, after preoperative education and 2 weeks after the operation. Three structured instruments were used: the Knowledge Test, the Sufficiency of Knowledge and the Orthopaedic Patient Knowledge Instrument.

RESULTS

Patients in both groups showed improvement in their knowledge. However, patients who received Internet-based education improved their knowledge level significantly more in the ethical (p = 0.005) and functional (p = 0.023) dimensions and also in total (p = 0.033) than those patients who underwent face-to-face education with a nurse. In addition, patients in the experiment group had higher scores in sufficiency of knowledge in the experiential (p = 0.050) and financial (p = 0.048) dimensions and, moreover, their scores in sufficiency of knowledge in the ethical dimension improved significantly more (p = 0.008) during the study period than patients in the control group.

CONCLUSION

Improvements in the patients' level and sufficiency of knowledge within both groups indicates an increase in patients' cognitive empowerment.

PRACTICE IMPLICATIONS

Internet-based education can be used in ambulatory orthopaedic surgery patient education for increasing patients' cognitive empowerment.

Patients' perceptions of Internet usage and their opportunity to obtain health information

The World Wide Web is increasingly an essential resource to obtain information for health promotion. Coherent information is still missing as to whether patients' opportunities to use the Internet and to access health information have changed at the same time. This study examines and compares, between two different time periods, patients' perceptions of Internet use, to obtain health information and associated factors. A two-stage survey design with a non-equivalent group was used. The data were collected with questionnaires from hospital patients during their discharge process and analysed using descriptive statistics. The vast majority of the patients had Internet access either at home or work. The proportion of Internet usage increased during the study period. Patients agree on the importance of using technology for health-information delivery, but they still prefer to receive information from health-care staff by face-to-face contacts. Well-educated and young respondents reported more frequent access to the Internet.

Can face-to-face patient education be replaced by computer-based patient education? A randomised trial

OBJECTIVE

Computer-based patient education is an effective (therapeutic) tool. More and more studies prove that it can be an effective additive for face-to-face education, but it is still unclear if it is possible to educate patients by only using a computer. Our objective was to compare knowledge levels and satisfaction scores after computer-based patient education versus doctor-based patient education.

METHODS

We started a randomised and stratified trial in a large plastic surgery clinic in the Netherlands. One hundred thirteen patients with carpal tunnel syndrome (CTS), scheduled for operation were included. One group received CTS education by a doctor using a checklist (group A). The other group received the same CTS education by specially designed interactive computer program (group B). After 2 weeks, knowledge levels and satisfaction scores were tested by using a questionnaire.

RESULTS

One hundred thirteen patients were included, 96 patients finished the questionnaire. With respect to knowledge levels the doctor group (A) scored 20.2 points (max 40 points), and the computer group (B) scored 23.5 points. After correction the difference was 2.8 points (p=0.001). The total satisfaction score in group A was 7.6 and in group B 7.5; a difference of -0.16 (p=0.585).

CONCLUSIONS

The results suggest that educating patients can result in a higher knowledge levels by using a computer than by using a doctor. Satisfaction seems equal after both methods of education.

PRACTICE IMPLICATIONS

Knowing that you can educate patients without seeing a doctor or nurse seems promising. Patient can be educated by computer-based education programs leaving more time in a consultation for asking questions and discussing treatment options. The discussion will be at a more equal level of knowledge. Possibly it can save time and money resulting in a more efficient patient care, without dissatisfying our patients.