Computers in patient education

Evolution of Therapeutic Patient Education: A Systematic Scoping Review and Scientometric Analysis

Therapeutic patient education (TPE) aims to empower the patients and their caregivers to effectively care for and manage their conditions. Such educational programs have been shown to improve health behaviors, disease outcomes, and quality of life among different patient populations. The field of TPE has evolved extensively over decades, owing to interdisciplinary research. No study so far has been done to map this field, to identify the stakeholders and gaps requiring future research. By leveraging the theory of co-citation, CiteSpace was used to visualize the bibliographic data pertaining to TPE research. A total of 54,533 articles published in English language were analyzed to identify influential funders, regions, and institutes contributing to this field. Besides these, significant theoretical and empirical contributions that shaped this field were mapped. Our analysis revealed several important insights. Most of the important theories that helped shape TPE were inspired from the social sciences. Five important research themes were identified: disorders, study designs utilized in TPE research, the scope of the TPE literature and outcomes, and populations. The research focused on improving perceptions, behaviors, and attitudes toward health promotion, reducing stigma, self-management and medication adherence. Most of the research was developed in the context of high-income countries. Future research should involve patients and use digital technology. Meta-analytical studies need to be done to identify the effectiveness and moderators of TPE interventions across different disorders. Further research should involve low and middle-income countries (LMIC) to ensure knowledge and technology transfer.

Evolutionary Overview of Consumer Health Informatics: Bibliometric Study on the Web of Science from 1999 to 2019

BACKGROUND

Consumer health informatics (CHI) originated in the 1990s. With the rapid development of computer and information technology for health decision making, an increasing number of consumers have obtained health-related information through the internet, and CHI has also attracted the attention of an increasing number of scholars.

OBJECTIVE

The aim of this study was to analyze the research themes and evolution characteristics of different study periods and to discuss the dynamic evolution path and research theme rules in a time-series framework from the perspective of a strategy map and a data flow in CHI.

METHODS

The Web of Science core collection database of the Institute for Scientific Information was used as the data source to retrieve relevant articles in the field of CHI. SciMAT was used to preprocess the literature data and construct the overlapping map, evolution map, strategic diagram, and cluster network characterized by keywords. Besides, a bibliometric analysis of the general characteristics, the evolutionary characteristics of the theme, and the evolutionary path of the theme was conducted.

RESULTS

A total of 986 articles were obtained after the retrieval, and 931 articles met the document-type requirement. In the past 21 years, the number of articles increased every year, with a remarkable growth after 2015. The research content in 4 different study periods formed the following 38 themes: patient education, medicine, needs, and bibliographic database in the 1999-2003 study period; world wide web, patient education, eHealth, patients, medication, terminology, behavior, technology, and disease in the 2004-2008 study period; websites, information seeking, physicians, attitudes, technology, risk, food labeling, patient, strategies, patient education, and eHealth in the 2009-2014 study period; and electronic medical records, health information seeking, attitudes, health communication, breast cancer, health literacy, technology, natural language processing, user-centered design, pharmacy, academic libraries, costs, internet utilization, and online health information in the 2015-2019 study period. Besides, these themes formed 10 evolution paths in 3 research directions: patient education and intervention, consumer demand attitude and behavior, and internet information technology application.

CONCLUSIONS

Averaging 93 publications every year since 2015, CHI research is in a rapid growth period. The research themes mainly focus on patient education, health information needs, health information search behavior, health behavior intervention, health literacy, health information technology, eHealth, and other aspects. Patient education and intervention research, consumer demand, attitude, and behavior research comprise the main theme evolution path, whose evolution process has been relatively stable. This evolution path will continue to become the research hotspot in this field. Research on the internet and information technology application is a secondary theme evolution path with development potential.

Effectiveness of a Web-Based Health Education Program to Promote Oral Hygiene Care Among Stroke Survivors: Randomized Controlled Trial

Background

Oral hygiene care is of key importance among stroke patients to prevent complications that may compromise rehabilitation or potentially give rise to life-threatening infections such as aspiration pneumonia.

Objective

The aim of this study was to evaluate the effectiveness of a Web-based continuing professional development (CPD) program on “general intention” of the health carers to perform daily mouth cleaning for stroke patients using the theory of planned behavior (TPB).

Methods

A double-blind cluster randomized controlled trial was conducted among 547 stroke care providers across 10 hospitals in Malaysia. The centers were block randomized to receive either (1) test intervention (a Web-based CPD program on providing oral hygiene care to stroke patients using TPB) or (2) control intervention (a Web-based CPD program not specific to oral hygiene). Domains of TPB: “attitude,” “subjective norm” (SN), “perceived behavior control” (PBC), “general intention” (GI), and “knowledge” related to providing oral hygiene care were assessed preintervention and at 1 month and 6 months postintervention.

Results

The overall response rate was 68.2% (373/547). At 1 month, between the test and control groups, there was a significant difference in changes in scores of attitude (P=.004) and subjective norm (P=.01), but not in other TPB domains (GI, P=.11; PBC, P=.51; or knowledge, P=.08). At 6 months, there were significant differences in changes in scores of GI (P=.003), attitude (P=.009), SN (P<.001) and knowledge (P=.001) between the test and control groups. Regression analyses identified that the key factors associated with a change in GI at 6 months were changes in SN (beta=.36, P<.001) and changes in PBC (beta=.23, P<.001).

Conclusions

The Web-based CPD program based on TPB increased general intention, attitudes, subjective norms, and knowledge to provide oral hygiene care among stroke carers for their patients. Changing subjective norms and perceived behavioral control are key factors associated with changes in general intention to provide oral hygiene care.

Trial Registration

National Medical Research Register, Malaysia NMRR-13-1540-18833 (IIR); https://www.nmrr.gov.my/ fwbLoginPage.jsp

Development and usability testing of a web-based self-management intervention for oral cancer survivors and their family caregivers

Oral cancer (OC) survivors experience debilitating side effects that affect their quality of life (QOL) and that of their caregivers. This study aimed to develop and evaluate a dyadic, web-based intervention to improve survivor self-management and survivor/caregiver QOL. A qualitative needs assessment (semi-structured interviews) with 13 OC survivors and 12 caregivers was conducted to discern information and support needs as well as preferences regarding website features and tools. Results using Grounded Theory analysis showed that OC survivors and caregivers: (1) want and need practical advice about managing side effects; (2) want to reach out to other survivors/caregivers for information and support; and (3) have both overlapping and unique needs and preferences regarding website features. Usability testing (N = 6 survivors; 5 caregivers) uncovered problems with the intuitiveness, navigation and design of the website that were subsequently addressed. Users rated the website favourably on the dimensions of attractiveness, controllability, efficiency, intuitiveness and learnability, and gave it a total usability score of 80/100. Overall, this study demonstrates that OC survivors and caregivers are interested in using an online programme to improve QOL, and that providing tailored website content and features based on the person's role as survivor or caregiver is important in this population.

Effectiveness of computer-aided learning in oral health among patients and caregivers: a systematic review

Computer-aided learning (CAL) offers enormous potential in disseminating oral health care information to patients and caregivers. The effectiveness of CAL, however, remains unclear.

OBJECTIVES

The purpose of this study was to systematically review published evidence on the effectiveness of CAL in disseminating oral health care information to patients and caregivers.

MATERIALS AND METHODS

A structured comprehensive search was undertaken among 7 electronic databases (PUBMED, CINAHL Plus, EMBASE, SCOPUS, WEB of SCIENCE, the Cochrane Library, and PsycINFO) to identify relevant studies. Randomized controlled trials (RCTs) and observational studies were included in this review. Papers were screened by 2 independent reviewers, and studies that met the inclusion criteria were selected for further assessment.

RESULTS

A total of 2915 papers were screened, and full texts of 53 potentially relevant papers (κ = 0.885) were retrieved. A total of 5 studies that met the inclusion criteria (1 RCT, 1 quasi-experimental study, and 3 post-intervention studies) were identified. Outcome measures included knowledge, attitude, behavior, and oral health. Significant improvements in clinical oral health parameters (P < .05) and knowledge/attitudes (P < .001) were reported in 2 of the studies. The 3 remaining studies reported improved oral health behaviors and confidence.

CONCLUSION

There is a limited number of studies which have examined the effectiveness of CAL interventions for oral health care among patients and caregivers. Synthesis of the data suggests that CAL has positive impacts on knowledge, attitude, behavior, and oral health. Further high- quality studies on the effectiveness of CAL in promoting oral health are warranted.

A randomised, double-blinded clinical study on the efficacy of multimedia presentation using an iPad for patient education of postoperative hip surgery patients in a public hospital in Singapore

INTRODUCTION

This study compared patient satisfaction and recall of physiotherapy patient education among patients who had undergone hip surgery, with information presented via an iPad versus a standard paper booklet.

METHODS

Patients who had undergone hip surgery joined and completed this single-centre study, which utilised a randomised parallel group design. They were randomly allocated to either Group A (received information on hip surgery physiotherapy via an iPad) or Group B (received the same information via a paper booklet). The participants were blinded to the intervention received by the other group and the testers were blinded to the intervention received by the participants. The interventions were carried out during the patients' first four postoperative physiotherapy sessions. The outcome measures were recorded using pre-validated questionnaires.

RESULTS

A total of 42 participants (mean age 70 ± 12 years) were recruited. After the intervention, patients in both groups had improved recall of the information presented during patient education. However, the patients in Group A had a significantly better recall score than those in Group B (4.0 points higher, p < 0.001). The level of patient satisfaction was also significantly higher in Group A than in Group B (8.5 points higher, p < 0.001).

CONCLUSION

While the use of an iPad and a paper booklet both had positive outcomes for patient recall and satisfaction, the use of an iPad was found to be more effective at improving patient satisfaction and recall of physiotherapy patient education in the present study.

Digital asthma self-management interventions: a systematic review

BACKGROUND

Many people with asthma tolerate symptoms and lifestyle limitations unnecessarily by not utilizing proven therapies. Better support for self-management is known to improve asthma control, and increasingly the Internet and other digital media are being used to deliver that support.

OBJECTIVE

Our goal was to summarize current knowledge, evidenced through existing systematic reviews, of the effectiveness and implementation of digital self-management support for adults and children with asthma and to examine what features help or hinder the use of these programs.

METHODS

A comprehensive search strategy combined 3 facets of search terms: (1) online technology, (2) asthma, and (3) self-management/behavior change/patient experience. We undertook searches of 14 databases, and reference and citation searching. We included qualitative and quantitative systematic reviews about online or computerized interventions facilitating self-management. Title, abstract, full paper screening, and quality appraisal were performed by two researchers independently. Data extraction was undertaken using standardized forms.

RESULTS

A total of 3810 unique papers were identified. Twenty-nine systematic reviews met inclusion criteria: the majority were from the United States (n=12), the rest from United Kingdom (n=6), Canada (n=3), Portugal (n=2), and Australia, France, Spain, Norway, Taiwan, and Greece (1 each). Only 10 systematic reviews fulfilled pre-determined quality standards, describing 19 clinical trials. Interventions were heterogeneous: duration of interventions ranging from single use, to 24-hour access for 12 months, and incorporating varying degrees of health professional involvement. Dropout rates ranged from 5-23%. Four RCTs were aimed at adults (overall range 3-65 years). Participants were inadequately described: socioeconomic status 0/19, ethnicity 6/19, and gender 15/19. No qualitative systematic reviews were included. Meta-analysis was not attempted due to heterogeneity and inadequate information provision within reviews. There was no evidence of harm from digital interventions. All RCTs that examined knowledge (n=2) and activity limitation (n=2) showed improvement in the intervention group. Digital interventions improved markers of self care (5/6), quality of life (4/7), and medication use (2/3). Effects on symptoms (6/12) and school absences (2/4) were equivocal, with no evidence of overall benefits on lung function (2/6), or health service use (2/15). No specific data on economic analyses were provided. Intervention descriptions were generally brief making it impossible to identify which specific "ingredients" of interventions contribute most to improving outcomes.

CONCLUSIONS

Digital self-management interventions show promise, with evidence of beneficial effects on some outcomes. There is no evidence about utility in those over 65 years and no information about socioeconomic status of participants, making understanding the "reach" of such interventions difficult. Digital interventions are poorly described within reviews, with insufficient information about barriers and facilitators to their uptake and utilization. To address these gaps, a detailed quantitative systematic review of digital asthma interventions and an examination of the primary qualitative literature are warranted, as well as greater emphasis on economic analysis within trials.

Efficacy of a nurse-led email reminder program for cardiovascular prevention risk reduction in hypertensive patients: a randomized controlled trial

BACKGROUND

Many strategies have been evaluated to improve the prevention and control of cardiovascular (CVD) risk factors. Nursing telephonic and tele-counseling individualized lifestyle educational programs have been found to improve blood pressure control and adherence to lifestyle recommendation. This study tested the efficacy of a nurse-led reminder program through email (NRP-e) to improve CVD risk factors among hypertensive adults.

METHODS

All participants received usual CVD prevention and a guideline-based educational program. Subjects in the NRP-e group also received weekly email alerts and phone calls from a nurse care manager for 6 months. Emails contained a reminder program on the need for adherence with a healthy lifestyle based upon current guidelines. Follow-up visits were scheduled at 1, 3 and 6 months after enrollment; randomization was made centrally and blood samples were evaluated into a single laboratory.

RESULTS

The final sample consisted of 98 (control) and 100 (NRP-e) subjects (mean age 59.0 ± 14.5 years; 51.0% males). After 6 months, the following CVD risk factors significantly improved in both groups: body mass index, alcohol and fruit consumption, cigarette smoking, adherence to therapy hours, systolic and diastolic blood pressure, fasting blood glucose, low-density lipoproteins (LDL) and total cholesterol, triglycerides, and physical activity. In the NRP-e group, however, the prevalence of several behaviors or conditions at risk decreased significantly more than in the control group: obesity (-16%), low fruit consumption (-24%), uncontrolled hypertension (-61%), LDL (-56%), and total cholesterol (-40%).

CONCLUSIONS

The NRP-e improved a range of CVD risk factors. The program had low costs, required only an average of <20 min per day in addition to normal practice, and may deserve further evaluation for the inclusion among existing care management approaches.

Knowledge expectations of surgical orthopaedic patients: a European survey

Ageing population entails a growing international problem of osteoarthritis. Best practices for education of these patients are lacking. This study focused on empowering education in Northern (Finland, Iceland, Lithuania and Sweden) and Southern Europe (Cyprus, Greece and Spain). The aim was to analyse associations between expected knowledge and background factors. The data were collected from European arthroplasty patients with the Knowledge Expectations of hospital patients- scale, (KE(hp) - scale), including bio-physiological, functional, experiential, ethical, social and financial dimensions. Patients had essential bio-physiological and functional knowledge expectations. Women expected more than men, employed less than retired, unemployed or who worked at home. Generally, patients in Northern countries expected more than in Southern countries. However, highest expectations were found in Sweden and Greece, lowest in Spain and Cyprus. There are differences in knowledge expectations based on patients' backgrounds. Development of common standards in European patient education needs further research.

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.

Capitalizing on the teachable moment: osteoarthritis physical activity and exercise net for improving physical activity in early knee osteoarthritis

BACKGROUND

Practice guidelines emphasize the use of exercise and weight reduction as the first line of management for knee osteoarthritis (OA). However, less than half of the people with mild OA participate in moderate intensity physical activity. Given that physical activities have been shown to reduce pain, improve quality of life, and have the potential to reduce the progression of joint damage, many people with OA are missing the benefits of this inexpensive intervention.

OBJECTIVE

The objectives of this study are (1) to develop a behavioral theory-informed Internet intervention called Osteoarthritis Physical Activity & Exercise Net (OPEN) for people with previously undiagnosed knee OA, and (2) to assess the efficacy of the OPEN website for improving physical activity participation through a proof-of-concept study.

METHODS

OPEN was developed based on the theory of planned behavior. Efficacy of this online intervention is being assessed by an ongoing proof-of-concept, single-blind randomized controlled trial in British Columbia, Canada. We are currently recruiting participants and plan to recruit a total of 252 sedentary people with previously undiagnosed knee OA using a set of validated criteria. Half of the participants will be randomized to use OPEN and receive an OA education pamphlet. The other half only will receive the pamphlet. Participants will complete an online questionnaire at baseline, 3 months, and 6 months about their participation in physical activities, health-related quality of life, and motivational outcomes. In addition, we will perform an aerobic fitness test in a sub-sample of participants (n=20 per study arm). In the primary analysis, we will use logistic regression to compare the proportion of participants reporting being physically active at or above the recommended level in the 2 groups, adjusting for baseline measurement, age, and sex.

RESULTS

This study evaluates a theory-informed behavioral intervention at a time when people affected with OA tend to be more motivated to adopt an active lifestyle (ie, at the early stage of OA). Our approach, which consisted of the identification of early knee OA followed immediately by an online intervention that directly targets physical inactivity, can be easily implemented across communities.

CONCLUSIONS

Our online intervention directly targets physical inactivity at a time when the joint damage tends to be mild. If OPEN is found to be effective in changing long-term physical activity behaviors, it opens further opportunities to promote early diagnosis and to implement lifestyle interventions.

TRIAL REGISTRATION

Clinicaltrial.gov: NCT01608282; http://clinicaltrials.gov/ct2/show/NCT01608282 (Archived by WebCite at http://www.webcitation.org/6G7sBBayI).

Self-management interventions in the digital age: new approaches to support people with rheumatologic conditions

Self-management interventions are considered a key component of rheumatologic care. Access to these programmes, however, is an issue for some patients, especially those working full time or living in rural and remote communities. Recently, there has been an increase in the use of digital media technologies to deliver self-management interventions. Digital media (e.g., websites, mobile applications, social networking tools, online games and animation) provide tremendous flexibility for delivering health information and resources at a time and place that is chosen by the individual; hence, they are consistent with the patient-centred approach. This review discusses: (1) innovations in self-management interventions for patients with arthritis and (2) research in the use of digital media for delivering self-management interventions.

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.

Ambulatory orthopaedic surgery patients' emotions when using different patient education methods

A randomised controlled trial was used to evaluate elective ambulatory orthopaedic surgery patients' emotions during internet-based patient education or face-to-face education with a nurse. The internet-based patient education was designed for this study and patients used websites individually based on their needs. Patients in the control group participated individually in face-to-face patient education with a nurse in the ambulatory surgery unit. The theoretical basis for both types of education was the same. Ambulatory orthopaedic surgery patients scored their emotions rather low at intervals throughout the whole surgical process, though their scores also changed during the surgical process. Emotion scores did not decrease after patient education. No differences in patients' emotions were found to result from either of the two different patient education methods.

A usability study of patients setting up a cardiac event loop recorder and BlackBerry gateway for remote monitoring at home

This article reports on a usability study of remote noninvasive cardiac testing in homes. We studied the Vitaphone 3100BT (Bluetooth®) event loop recorder (Vitaphone GmbH, Mannheim, Germany) and paired BlackBerry® Curve™ 8520 smartphone (Research In Motion, Ltd., Waterloo, ON, Canada). This application requires independent device set-up by patients in their own homes following receipt by mail out of the kit (instructions plus the event loop recorder and smartphone). The case studies of five participants, each with varying experience with technology, were documented as they interacted with the devices. Participants were videotaped following written instructions as they performed a "think aloud" procedure while completing 20 device set-up tasks. Interviews provided insight into how the independent device set-up and processes could be improved. This study concluded that gender, age, and familiarity with technology seemed to influence the participants' abilities to successfully set up these devices and that sending the kit by mail appeared to be an acceptable strategy to provide remote noninvasive cardiac diagnostic services. This study provides a foundation for future research assessing usability of mobile healthcare technology.

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.

Evaluation of satisfaction and use of electronic intervention for behavior change

This report describes use and satisfaction of a tailored intervention delivered via Web site and handheld computer. All participants used both delivery methods. Healthy women (N = 74) aged 40 to 60 years participated in this mixed-method descriptive study. Satisfaction was measured via Computer Satisfaction Questionnaire and open-ended comments. Data on use of the handheld computer were embedded into program and captured real time. Unique Internet provider addresses tracked Web site use from March 2007 through August 2008. Results indicate 80% of participants were very to extremely satisfied. There was no significant relationship between use and satisfaction. Knowledge but not self-efficacy scores differed over time. Usage was not related to knowledge scores. Handheld computer was used most frequently during the first week, with use decreasing over 7 weeks. Personal assessment of calcium intake and feedback sections were used most frequently. Handheld computer was used by 71% of participants for 4 weeks, 55% for 6 weeks, and 29% for the full 8 weeks. Participants commented on intervention content and positive and negative aspects of the devices and keyboard. This study presented an opportunity to examine data related to actual use. This dimension of intervention fidelity is more readily available in eHealth applications than with printed information.

Adoption of an Internet-based patient education programme in psychiatric hospitals

Internet-based patient support systems are widely assumed to predict a future trend in patient education. Coherent information is still lacking on how patient education is adopted in psychiatric hospitals and how information technology is used in it. Our aim was to describe nurses' adoption of an Internet-based patient education programme and the variables explaining it. The study was based on Rogers' model of the diffusion of innovation. The Internet-based patient education sessions were carried out by nurses on nine acute psychiatric inpatient wards in two Finnish hospitals. They were evaluated with reports and analysed statistically. Out of 100 nurses, 83 adopted the programme during the study period. The nurses fell into Rogers' groups, late majority (72%), laggards (17%), early majority (7%), early adopters (3%) and innovators (1%). Three groups were formed according to their activity: laggards, late majority, adopters (including early majority, early adopters, innovators). There was a statistical difference between the nurses' programme adoption between the two hospitals (P= 0.045): more laggards (65% vs. 35%) and adopters (73% vs. 27%) in the same hospital. The findings help to provide insight into the contexts and settings when adopting information technology programmes in the area of mental health care.

The effects of web-based diabetes education on diabetes care results: a randomized control study

This study aimed to test the effects of providing Web-based diabetes education to individuals with type 2 diabetes on the A1c level and health check attendance. The study participants comprised 122 individuals with type 2 diabetes, who had access to the Internet, had completed their basic diabetes education, and had similar basic situational factors. Using a randomization method, these participants were chosen from the patients being monitored by the diabetes nurses. The experimental group (n = 61) was monitored via the Web. From measurements recorded in the sixth month of monitoring, we found that A1c levels of the individuals with diabetes who were monitored through the Web decreased (t = 6.63; P < .05), and the rate of attending health check visits increased (z = 5.97; P< .05), while no difference was detected in the control group (t = -0.63; P = .534; z = -0.80; P = .426). To maintain glycemic control, Web use could be adopted as a complementary tool for monitoring individuals with diabetes.

The effects of web-based diabetes education on diabetes care results: a randomized control study

This study aimed to test the effects of providing Web-based diabetes education to individuals with type 2 diabetes on the A1c level and health check attendance. The study participants comprised 122 individuals with type 2 diabetes, who had access to the Internet, had completed their basic diabetes education, and had similar basic situational factors. Using a randomization method, these participants were chosen from the patients being monitored by the diabetes nurses. The experimental group (n = 61) was monitored via the Web. From measurements recorded in the sixth month of monitoring, we found that A1c levels of the individuals with diabetes who were monitored through the Web decreased (t = 6.63; P < .05), and the rate of attending health check visits increased (z = 5.97; P< .05), while no difference was detected in the control group (t = -0.63; P = .534; z = -0.80; P = .426). To maintain glycemic control, Web use could be adopted as a complementary tool for monitoring individuals with diabetes.

Online Support Intervention for Adolescents With Asthma and Allergies

Objectives. To determine appropriate components and contents of an online peer support intervention for young adolescents and to evaluate intervention processes, perceived benefits, and satisfaction with the intervention.

Methods. Three months of support were provided through synchronous chat, e-mail exchange, instant messaging, and bulletin boards. Online support group sessions were facilitated by trained peer mentors (older youth/young adults with asthma and allergies) and health professionals. Participant use of online options was tracked (eg, log-ons, e-mails, chat minutes). Qualitative data were elicited from peer mentor reports, online support group chat transcripts, project coordinators’ field notes, peer mentor exit interviews, and adolescent telephone interviews.

Results. Almost all adolescents were satisfied with this online support intervention. Topics discussed in the support groups were pertinent to their educational and support needs. Peer mentors provided emotional, affirmation, and information support. Participants appreciated opportunities for social comparison and reciprocal exchange of support with peers.

Conclusion and implications. A major contribution was documentation of the complex intervention ingredients and processes through qualitative and quantitative methods that elicited diverse stakeholders’ perspectives. This strategy enables adaptation and integration into practice. Adolescents who benefited most felt isolated, suggesting the importance of targeting vulnerable youth for support programs.

Patients' perceptions of patient education on psychiatric inpatient wards: a qualitative study

This study describes patients' perceptions of different types of patient education interventions and areas where patient education should be improved on psychiatric wards. Thematic interviews were conducted with 16 patients who had completed the information technology (IT)-based patient education, conventional patient education with leaflets or patient education according to ward standards during their hospital stay. Data were analysed using inductive content analysis. Patients' perceptions of patient education varied depending on which patient education group they had participated in. Patients participating in IT-based or conventional patient education perceived education as a systematic and planned process. However, especially patients in the patient education group applying ward standard education perceived patient education as occasional information dissemination situations. To improve patient education, patients suggested that it should be based on their individual needs and offered with different methods systematically to all patients. The results indicate that patients find structured and systematic patient education programmes useful. Different educational methods should be used, not forgetting interaction between patient and nurse, which was reportedly as an essential element of patient education.

Principles for the wise use of computers by children

Computer use by children at home and school is now common in many countries. Child computer exposure varies with the type of computer technology available and the child's age, gender and social group. This paper reviews the current exposure data and the evidence for positive and negative effects of computer use by children. Potential positive effects of computer use by children include enhanced cognitive development and school achievement, reduced barriers to social interaction, enhanced fine motor skills and visual processing and effective rehabilitation. Potential negative effects include threats to child safety, inappropriate content, exposure to violence, bullying, Internet 'addiction', displacement of moderate/vigorous physical activity, exposure to junk food advertising, sleep displacement, vision problems and musculoskeletal problems. The case for child specific evidence-based guidelines for wise use of computers is presented based on children using computers differently to adults, being physically, cognitively and socially different to adults, being in a state of change and development and the potential to impact on later adult risk. Progress towards child-specific guidelines is reported. Finally, a set of guideline principles is presented as the basis for more detailed guidelines on the physical, cognitive and social impact of computer use by children. The principles cover computer literacy, technology safety, child safety and privacy and appropriate social, cognitive and physical development. The majority of children in affluent communities now have substantial exposure to computers. This is likely to have significant effects on child physical, cognitive and social development. Ergonomics can provide and promote guidelines for wise use of computers by children and by doing so promote the positive effects and reduce the negative effects of computer-child, and subsequent computer-adult, interaction.

A systematic review of the literature reporting on studies that examined the impact of interactive, computer-based patient education programs

OBJECTIVE

To evaluate studies that examined the impact of interactive, computer-based education (ICBE) programs on patient education.

METHODS

The Medline and CINAHL databases were searched to identify randomized controlled studies that evaluated the impact of ICBE programs.

RESULTS

The 25 studies that met the selection criteria generally supported the ability of ICBE programs to promote knowledge gains. Results related to economic or clinical outcomes were less consistent. Significant variations were noted across studies in program features, implementation and integration strategies, and in comparison program attributes and quality. It is likely that these differences contributed to the disparity in findings across studies.

CONCLUSION

Although significant inconsistencies in results were noted, the research provided collective evidence that ICBE programs had the potential to add great value to the patient education process. Programs must be properly designed and implementation and integration processes effectively planned in order to achieve consistently positive outcomes.

PRACTICE IMPLICATIONS

Consideration of the "best practices" derived from the research and noted in this report will assist healthcare providers in designing, selecting, and implementing effective ICBE programs.

Surrogate consent for genomics research in intensive care

Surrogate decision makers may be poorly prepared to give informed consent for genomics research for their loved ones in intensive care. A review of the challenges and strategies associated with obtaining surrogates' consent for genomics research in intensive care patients revealed that few well-controlled studies have been done on this topic. Yet, a major theme in the literature is the role of health care professionals in guiding surrogates through the informed consent process rather than simply witnessing a signature. Informed consent requires explicit strategies to approach potential surrogates effectively, educate them, and ensure that informed consent has been attained.

The creation and impact evaluation of "Your guide to diet and diabetes," an interactive web-based diabetes tutorial

BACKGROUND

Millions of Americans turn to the Internet for health information. A need for a comprehensive website that provides information on diet and diabetes management was identified. Therefore, the goal of this study was to develop an easy-to-use website that provided accurate information about diet and diabetes management in an interactive format that was widely accessible.

METHODS

The "Your Guide to Diet and Diabetes" website was developed through issue identification, expert panel review, and face validity phase for content and knowledge/skill assessment surveys. During the first 2 weeks of the website's availability, impact data were collected from website visitors. Responses to demographic questions, knowledge, and skill questions were collected in a database.

RESULTS

Of the 406 individuals who completed a demographic question, a maximum of 104 respondents chose to answer one or more of the interactive knowledge or skills questions.

CONCLUSIONS

"Your Guide to Diet and Diabetes" filled a need for an easy-to-use website that addressed the issues of diet and diabetes. Based on the number of visits to the login page (n = 6,124) and number of individuals who answered demographic questions, the site was well received. While a smaller group of participants elected to complete the interactive knowledge and skills questions, responses to these questions demonstrated that participants obtained knowledge from the website. In particular, participants increased their knowledge of food sources and appropriate serving sizes of carbohydrate. The "making a plate" skill activity was used with much greater frequency than the more conceptually complex carbohydrate counting skill activity.

Design and development process of patient-centered computer-based support system for patients with schizophrenia spectrum psychosis

BACKGROUND

Schizophrenia is a serious mental illness requiring self-management skills and information about the illness, its treatment, and where to get help with daily routines. Despite the systematic development of computer-based approaches in mental health, less systematic development of such methods can be found for patients with schizophrenia or psychosis.

OBJECTIVE

The aim is to describe the design and development process of patient-centered computer-based support system (Mieli.Net portal) for patients with schizophrenia spectrum psychoses.

METHODS

The process with a mixed methods approach includes four phases: analysis of users' needs, development of key patient information areas, development of a software prototype and to pilot the portal, and user evaluation by health care staff.

RESULTS

The computer-based patient support system is a promising health-promoting service to schizophrenic patients. It is important, that users of technology are involved in the development process, which will ensure that sites are user-friendly, information can be personalized, and mental patients' voices are heard in the development of patient education.

CONCLUSIONS

The effectiveness needs to be evaluated carefully in future clinical trials. This will offer valuable information for policymakers, organizations and health care practitioners about the usability of web-based patient education in the area of mental health care.

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.

An interactive CD-ROM to inform patients about stem cell transplantation

OBJECTIVE

Cancer patients receiving chemotherapy or a Stem Cell Transplantation (SCT) are in need of information about their disease, treatment options and side effects. Patient education usually has to be given within limited time. Under these circumstances, patients may find it difficult to completely understand and to retain the information given.

METHODS

As a supplement to standard information methods we developed an interactive CD-ROM with information on SCT. This CD-ROM provides both medical information and more subjective patients' experiences. Part one provides information regarding the treatment course from diagnosis through to post-discharge care. The second part consists of interviews with former patients and describes their experiences. As the system is interactive, it can be utilised according to the patient's individual preferences. The CD-ROM comprises audio, video, animations, pictures, and text. Printing of certain sections is optional. The technical format of the CD-ROM makes it relatively simple to utilise the information and to make it suitable for other institutions or even other treatments. In this preliminary study the acceptability of the interactive CD-ROM by patients undergoing a SCT is described.

RESULTS

Patients' overall evaluations of the interactive CD-ROM were highly positive. For example, 90.2% (N=51) found it interesting, clear, useful and valued getting information by means of a CD-ROM. Most patients would recommend the interactive CD-ROM to other patients in the same situation.

CONCLUSION

The content of the CD-ROM on SCT as well as the computer-based interactive method are well accepted by patients.

PRACTICE IMPLICATIONS

Computer-based education may enhance patient education and thus the quality of patient care. We must now establish the program's effectiveness. Moreover, plans have been developed to disseminate the information on SCT over the Internet. Future development of comparable programs and their evaluation should be encouraged to promote the well-being of cancer patients.

Patient, caregiver, and health care practitioner knowledge of, beliefs about, and attitudes toward epilepsy

The medical literature related to knowledge of, beliefs about, and attitudes toward epilepsy was reviewed from the perspective of patients, caregivers, and health care providers. The literature points to a desire for enhanced epilepsy education by patients and caregivers; however, these needs have not been met by primary or specialty care. Surveys of general practitioners (GPs) point to limitations in knowledge and negative attitudes. GPs view their role in epilepsy care as primarily educational and tend to acknowledge their limitations by referring difficult cases. Ongoing education for GPs is important, as is an improved partnership in defining roles for care and education. Health care professionals specialized in epilepsy care acknowledge their own set of barriers to optimal care. Epilepsy education programs have been able to improve knowledge; however, long-term improvements in behavioral outcomes or quality of life are less documented. Suggestions for improvements are provided.

Mental health: patients' experiences of patient education during inpatient care

AIMS AND OBJECTIVES

This study aimed to explore psychiatric patients' experiences of patient education on psychiatric inpatient wards.

BACKGROUND

Patient education seems to be an effective way to support psychiatric patients' capacity for independent living, compliance and insight. Despite the development of various patient education interventions there is still a lack of coherent information on how to improve patient education in the field of psychiatric care, especially from patients' own perspectives.

DESIGN AND METHOD

Data were collected through interviews with 51 inpatients during their discharge process. This exploratory study employs a mixed methods design in data collection and analysis. The structured questions were analysed using descriptive statistics (percentages, frequencies, Mann-Whitney U-test, t-test). Open-ended questions were analysed using inductive content analysis.

RESULTS

Patients perceived different informational areas to be important for them, although some variation was found. However, patient education was not realized in these same areas. Problems related to patient education described by patients were lack of information, problems in patient-staff interaction and a lack of prerequisite knowledge among patients and staff. Patients' suggestions for future development of patient education were more innovative methods in patient education, paying attention to patient-staff interaction and personnel's professional knowledge. A majority of patients wanted to receive information through discussions with staff. However, other patient education methods were also suggested.

CONCLUSIONS

Patient education in psychiatric hospitals is an important area to be developed, therefore, more innovative methods should be developed and their effectiveness should be tested.

RELEVANCE TO CLINICAL PRACTICE

Development of patient education can be implemented through tailoring patient education to patients' individual needs and provide patient education using more innovative methods.

Barriers and facilitators influencing the implementation of an interactive Internet-portal application for patient education in psychiatric hospitals

OBJECTIVE

The purpose of this study was to identify barriers and facilitators influencing the implementation of an interactive Internet-portal application for patient education in psychiatric hospitals.

METHODS

The data were collected from nurses by means of a questionnaire with thematic open-ended questions. The data was analysed using qualitative content analysis.

RESULTS

Four main categories were formed to describe barriers and facilitators of portal implementation in psychiatric wards. These categories were organisational resources, nurses' individual characteristics, patient-related factors and portal-related factors. Some major barriers were identified restricting the use of the portal in patient education: lack of computers, lack of time for patients, nurses' negative attitudes towards computer use and lack of education. The main facilitators for portal use were appropriate technological resources, easy Internet access, enough time for portal use, and level of motivation among staff to use computers.

CONCLUSION

The specific challenge in achieving patient education with the computer in psychiatric care is to ensure technological resources and that the staff are motivated to use computers. At the same time, attention should be paid the relationship between patient and nurse.

PRACTICE IMPLICATIONS

It is important to examine the patient-nurse relationship in the education process and also to define the usability of the application from the patients' point of view.

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.

A preliminary usability evaluation of Web-based portal application for patients with schizophrenia

This study evaluated the usability of a Web-based portal application developed for the use of nursing staff with patients suffering from schizophrenia and related psychosis. The study was designed solely to gain direct inputs from the nursing staff (N = 76, n = 38) in acute inpatient wards in two Finnish psychiatric hospitals. The data were collected by questionnaire covering the functionality, content and benefits of the portal. The evaluation showed that the portal is user-friendly enabling a user to move inside the service and to find the relevant information. The content of the portal was interesting, understandable and easy to read. Some nurses were concerned about the effects of the portal on the patients' care, well-being or personal contacts between nursing staff and patients. Some nurses have difficulties in evaluating the portal because they did not actively use it in clinical practice during the testing period. Emphasis should be put on nurses' motivation and concerns regarding possible negative effects of the portal, which may influence the future implementation of eHealth applications in clinical practice.

Testing the satisfaction and feasibility of a computer-based teaching module in the neonatal intensive care unit

PURPOSE

To examine the satisfaction with and feasibility of a computer-based teaching module to teach healthcare professionals how to use and apply the Premature Infant Pain Profile (PIPP) to clinical scenarios.

SUBJECTS

Sixty-eight healthcare professionals who were employed in the neonatal intensive care unit (NICU) on a full-time or part-time basis and had received an educational session regarding the PIPP.

DESIGN AND METHODS

A pilot study using an exploratory descriptive design was used to answer: (1) How satisfied are healthcare professionals with the computer-based teaching module? and (2) What is the feasibility of a computer-based teaching module in the clinical setting? Satisfaction was measured using an investigator-developed 5-point Likert scale. Feasibility was measured in terms of time to complete the module, satisfaction with instructions and ability to navigate through the module, acceptability of the module as a teaching method, and format with the computer-based module.

PRINCIPAL RESULTS

Ninety percent of those sampled were very satisfied with the computer-based teaching method. Use of video and audio clips and photographs enhanced the learning process. Healthcare professionals identified the computer-based teaching method as an effective way of learning about the PIPP and thought that it was feasible to use within the clinical setting.

CONCLUSIONS

Computer-based teaching is a feasible method for educating NICU healthcare professionals about the PIPP. Additional research is required to examine the effectiveness of this teaching method on relevant patient outcomes such as pain management.

Completing a Life: Comfort Level and Ease of Use of a CD-ROM Among Seriously III Patients

PURPOSE/OBJECTIVES

To evaluate use of a CD-ROM titled Completing a Life among patients diagnosed with serious illnesses for comfort level with content and ease of computer use.

DESIGN

A prospective pilot study collected a convenience sample of 50 people diagnosed with life-limiting illnesses during a six-month period.

SETTING

The hematology/oncology department of a large healthcare system located in a metropolitan area in the midwestern United States.

SAMPLE

Convenience sample of 50 patients diagnosed with life-limiting illnesses. Of the patients enrolled (age range = 38-93 years), 72% were female, 68% were Caucasian, 50% were diagnosed with breast cancer or nonsolid tumors, and 40% were newly diagnosed.

METHODS

Subjects viewed the CD-ROM and completed pre- and post-intervention surveys.

MAIN RESEARCH VARIABLES

Comfort level with educational media, comfort level of information viewed, and areas of CD-ROM viewed compared to age and stage of illness.

FINDINGS

Ninety percent of patients reported that they were somewhat or very comfortable with the CD-ROM as a learning tool, and ease of use was rated at 98%. Patients' comfort level with the material increased from 76% to 90% after they viewed the CD-ROM.

CONCLUSIONS

The pilot study suggests that the Completing a Life CD-ROM can be used with patients facing serious or life-limiting illnesses as an additional resource tool for information.

IMPLICATIONS FOR NURSING

Nurses typically provide the bulk of educational material for their patients. With limited resources available regarding management of life-limiting illnesses, this resource may provide an excellent addition to resources currently available.

Using Computers to Improve the Psychosocial Care of Implantable Cardioverter Defibrillator Recipients

Person-to-person psychosocial interventions (e.g., psychological, social) enhance the well-being of implantable cardioverter defibrillator (ICD) patients. Computerized care, though, represents an opportunity to further capitalize on techniques that have already been deemed effective. This includes the provision of tailored, effective patient education; reducing device-specific anxiety; and enhancing social support networks. The aim of this paper is to identify the ways in which computerized psychosocial care could potentially enhance the well-being of ICD recipients. For example, computers may be particularly adept at providing patient education due to the ease in which content can be adapted to meet patient needs. Further, evidenced-based treatments for anxiety and depression (e.g., cognitive behavioral therapy) have demonstrated good applicability to computerized formats. Social support can also be provided online in the form of bulletin boards, email list-servs, or structured online support groups. Despite the existence of some limitations, the use of computers in affecting psychosocial outcomes in implantable defibrillator recipients warrants greater attention.

Computer-based education for patients with chronic heart failure. A randomised, controlled, multicentre trial of the effects on knowledge, compliance and quality of life

OBJECTIVE

To evaluate the effects of a single-session, interactive computer-based educational program on knowledge, compliance and quality of life in heart failure patients with special emphasis on gender differences.

METHODS

One hundred and fifty-four patients, mean age 70 years, from five heart failure clinics were randomised to either receiving only standard education (n=72) or standard education and additional computer-based education (n=82).

RESULTS

Knowledge was increased in both groups after 1 month with a trend towards higher knowledge (P=0.07) in the computer-based group. The increase in knowledge was significantly higher in the computer-based group after 6 months (P=0.03). No differences were found between the groups with regard to compliance with treatment and self-care or quality of life. The women had significantly lower quality of life and did not improve after 6 months as the men did (P=0.0001).

CONCLUSION

Computer-based education gave increased knowledge about heart failure.

PRACTICE IMPLICATIONS

Computers can be a useful tool in heart failure education, but to improve compliance a single-session educational intervention is not sufficient. Gender differences in learning and quality of life should be further evaluated.

[Use of Internet resources in nursing: a review]

Resources of Internet system are widely popularized in most of all human activities in the society. This paper aims to identify and to describe major modalities of Internet utilization in nursing areas of Education, Care, and Research. This is a bibliographic review which data source was MEDLINE database, using pertinent descriptors for the focused areas. From referred publications, it was selected 63 articles. Major utilization in Education area is the development of applications to promote distance education; in Patient Education area is the development of applications to make health information available; in Care area are the applications to make care protocols available to promote evidence-based practice, and in Research area is online data collection. It was concluded that nursing is using Internet resources in a satisfactory way, and it has contributed for the profession evolution.

Caring connection: developing an Internet resource for family caregivers of children with cancer

This article describes the development of a family-focused Internet resource, the Caring Connection Web site, designed to provide individualized clinical information, patient-centered information, and access to online communication for caregivers of children with cancer. Data from surveys with family caregivers described the scope and characteristics of their current Internet use. Web site prototype development and user testing provided additional insights that inform the ongoing design of the Caring Connection Web site. The family caregivers and oncology healthcare providers who participated are active users of Internet health information. The preliminary data they provided support the feasibility and usability of the Caring Connection prototype. Ongoing development of the Caring Connection Web site will provide an innovative approach to assist these family caregivers in meeting currently unmet information and communication needs, and will provide evidence regarding "best practice" in design and development of Internet resources to support communication and information sharing.