Videotape versus computer interactive education in alcoholic and nonalcoholic controls

The impact of the use of video-based educational interventions on patient outcomes in hospital settings: A scoping review

OBJECTIVE

To summarize the literature on the impact of video-based educational interventions on patient outcomes in inpatient settings as compared to standard education techniques.

METHODS

This review followed a scoping review methodology. English language articles were searched in Pubmed, Medline, Cochrane, and CINAHL databases. Inclusion criteria were: use of video-based educational interventions, and inpatient hospital settings. Abstracts were reviewed and selected according to predetermined criteria, followed by full-text scrutiny.

RESULTS

Sixty-two empirical studies were identified, with 38 (61%) reporting a significant positive effect of video-based educational interventions on patient outcomes, compared to control groups (i.e., standard education). Three different types of video-based educational intervention formats were identified: animated presentations, professionals in practice, and patient narratives. Outcome types included: knowledge-based, clinical, emotional, and behavioral, with knowledge-based most prevalent.

CONCLUSION

Video-based educational interventions are common in the hospital setting. These interventions are effective at improving short-term health literacy goals, but their impact on behavior or lifestyle modifications is unclear. Their effectiveness also depends on presentation format, timing, and the patient's emotional well-being.

PRACTICE IMPLICATIONS

Video-based educational delivery is effective for improving short-term health literacy, however a combination of approaches delivered over an extended period of time may support improving longer-term health outcomes.

The effectiveness of electronic approaches to substance abuse prevention for adolescents

Systematic reviews of computer- and Web-based treatment approaches indicate that these interventions are effective in addressing abuse of alcohol, tobacco, and other substances. However, there are few studies evaluating the effectiveness of electronic approaches to substance abuse prevention. This review of the literature synthesizes the current research on interventions that use electronic media, including CD-ROM, video, and Internet modalities, for substance abuse prevention. Overall, the studies indicate that electronic-based and enhanced interventions are effective in preventing or reducing risk for substance use. We discuss trends in the current literature, research limitations, and implications for practice.

Computer-delivered interventions for health promotion and behavioral risk reduction: a meta-analysis of 75 randomized controlled trials, 1988-2007

OBJECTIVE

The use of computers to promote healthy behavior is increasing. To evaluate the efficacy of these computer-delivered interventions, we conducted a meta-analysis of the published literature.

METHOD

Studies examining health domains related to the leading health indicators outlined in Healthy People 2010 were selected. Data from 75 randomized controlled trials, published between 1988 and 2007, with 35,685 participants and 82 separate interventions were included. All studies were coded independently by two raters for study and participant characteristics, design and methodology, and intervention content. We calculated weighted mean effect sizes for theoretically-meaningful psychosocial and behavioral outcomes; moderator analyses determined the relation between study characteristics and the magnitude of effect sizes for heterogeneous outcomes.

RESULTS

Compared with controls, participants who received a computer-delivered intervention improved several hypothesized antecedents of health behavior (knowledge, attitudes, intentions); intervention recipients also improved health behaviors (nutrition, tobacco use, substance use, safer sexual behavior, binge/purge behaviors) and general health maintenance. Several sample, study and intervention characteristics moderated the psychosocial and behavioral outcomes.

CONCLUSION

Computer-delivered interventions can lead to improved behavioral health outcomes at first post-intervention assessment. Interventions evaluating outcomes at extended assessment periods are needed to evaluate the longer-term efficacy of computer-delivered interventions.

Therapeutic emails

Background

In this paper, we show how counselors and psychologists can use emails for online management of substance abusers, including the anatomy and content of emails that clinicians should send substance abusers. Some investigators have attempted to determine if providing mental health services online is an efficacious delivery of treatment. The question of efficacy is an empirical issue that cannot be settled unless we are explicitly clear about the content and nature of online treatment. We believe that it is not the communications via internet that matters, but the content of these communications. The purpose of this paper is to provide the content of our online counseling services so others can duplicate the work and investigate its efficacy.

Results

We have managed nearly 300 clients online for recovery from substance abuse. Treatment included individual counseling (motivational interviewing, cognitive-behavior therapy, relapse prevention assignments), participation in an electronic support group and the development of a recovery team. Our findings of success with these interventions are reported elsewhere. Our experience has led to development of a protocol of care that is described more fully in this paper. This protocol is based on stages of change and relapse prevention theories and follows a Motivational Interviewing method of counseling.

Conclusion

The use of electronic media in providing mental health treatment remains controversial due to concerns about confidentiality, security and legal considerations. More research is needed to validate and generalize the use of online treatment for mental health problems. If researchers have to build on each others work, it is paramount that we share our protocols of care, as we have done in this paper.

A computer-based information-tool for chronic pain patients. Computerized information to support the process of shared decision-making

OBJECTIVE

Assessment of the use of a computerized information-tool in the context of a shared decision-making process with chronic pain patients.

METHODS

In the scope of a prospective and randomized study on shared decision-making with Fibromyalgia patients, a total of 75 patients had access to computer-based information about their illness. Fibromyalgia is a condition of chronic wide-spread pain, belonging to rheumatism, which mainly affects mature female patients. The majority of the patients in our study are female (93%) with an average age of 50 years. The computer-based information-tool provided the patients with detailed information about pathogenesis, typical symptoms, treatment options and prognosis. Six evaluative questions were posed to the participants concerning the assessment of the information presented, the handling of the programme, the need for an introduction to the programme, the quality of the layout and the assessment of the length of time spent in front of the computer and the assessment of the usefulness of such a tool in general practitioners' offices. Furthermore, psychological self-assessment questionnaires were filled out by the participants.

RESULTS

The patients highly appreciate the possibility of using computer-based information-tools and endorse the implementation of such tools in general practitioners' offices.

CONCLUSION

Computerized information leads to a better understanding of the illness and the treatment options on the part of the patient.

PRACTICAL IMPLICATIONS

For further practical use it is crucial to provide an introduction to the handling of a computer to unskilled patients.

Readability of patient handout materials in a nationwide sample of alcohol and drug abuse treatment programs

The objective of this study was to assess the readability of a nationwide sample of alcohol and drug abuse treatment programs' materials. Of 646 programs that were randomly selected from the National Clearinghouse for Alcohol and Drug Information directory, 52 programs returned completed materials. The average readability grade level of materials was 11.84 (SD = 0.94). The program staff estimations were significantly lower than actual reading levels of materials, and no program characteristics correlated with readability levels. Thus, it was concluded that materials written at high readability levels may not be effective tools for all patients. Integrating knowledge regarding program materials' readability level and literacy levels of different populations could be successful aides to substance abuse treatment.

Engaging Client's Family and Friends in Online Counseling

This paper describes how online counseling can be used to engage family members in the recovery of clients. The counselor guides the client and the family member separately through the stages of change, helping them commit to joint action. Each participant thinks through his/her concerns and the advantages of getting involved, each makes a specific commitment to working together under the guidance of the counselor. Finally each celebrates, with specific rituals, their decision to work together. Once the client and the family members commit to working together, the counselor guides them through the stages of change as a group. In the pre-contemplation stage, the family members are taught the goals of working together and the procedures to avoid dysfunctional conflict. In the contemplation phase, the client and the family members examine the shared environment and its links to target behavior. In the commitment to action stage, the client and the family members decide on specific changes in their shared environment. In the maintenance phase, the client and the family members analyze if the change has led to improvements. They analyze relapses and make additional cycles of improvement.

Computer-based approaches to patient education: a review of the literature

All articles indexed in MEDLINE or CINAHL, related to the use of computer technology in patient education, and published in peer-reviewed journals between 1971 and 1998 were selected for review. Sixty-six articles, including 21 research-based reports, were identified. Forty-five percent of the studies were related to the management of chronic disease. Thirteen studies described an improvement in knowledge scores or clinical outcomes when computer-based patient education was compared with traditional instruction. Additional articles examined patients' computer experience, socioeconomic status, race, and gender and found no significant differences when compared with program outcomes. Sixteen of the 21 research-based studies had effect sizes greater than 0.5, indicating a significant change in the described outcome when the study subjects participated in computer-based patient education. The findings from this review support computer-based education as an effective strategy for transfer of knowledge and skill development for patients. The limited number of research studies (N = 21) points to the need for additional research. Recommendations for new studies include cost-benefit analysis and the impact of these new technologies on health outcomes over time.

Health care providers and purchasers and evaluation of interactive health communication applications. Science Panel on Interactive Communication and Health

Health care providers and purchasers of health services have an opportunity to improve patient care and potentially save costs through the wise purchase of interactive health communication applications for patients and employees. Purchasing decisions based on evaluation and evidence should drive the design and development of new systems. The cycle of evaluation includes a needs assessment before system development, usability testing during development, and studies of use and outcomes in natural settings. This type of evidence is critical to our understanding of how best to provide health information and decision assistance to patients, employees, and others.

Reading ability in patients in substance misuse treatment centers

Adult inpatients in state-supported (public) and private substance misuse treatment settings were tested for reading ability. Patient education materials and consent forms were assessed for readability levels. Public patients' mean reading levels were significantly lower than those of private patients, and were 4 to 5 years below the level needed to read and understand standard treatment materials. More than half of the public and almost one-third of the private patients tested were reading below a 9th grade level. Standard treatment materials were written on 11th to 12th grade reading levels; admission and consent forms were written on 12th to 18th grade levels. Patients in substance misuse settings should be tested for literacy levels upon admission and provided with materials commensurate with their reading ability.