ReviewMultimedia educational aids for improving consumer knowledge about illness management and treatment decisions: A review of randomized controlled trials
Introduction
One of the great challenges and opportunities facing clinicians today is the increasing complexity of healthcare treatment options. To make a truly informed healthcare decision, individuals need to comprehend key information about its purpose, potential risks and benefits, and available alternatives; similarly, for patients to be active participants in managing chronic illnesses, they need to have an adequate understanding of the illness, including needed dietary and lifestyle modifications, self measurement (such as glucose level, weight, etc.), and medication usage (Bodenheimer et al., 2002).
In recent years, psychiatric practice has becoming increasingly more complex in terms of the available treatment options, use of new technologies for assessments, and a need for psychiatric patients and their caregivers to be familiar with general medical procedures. Thus, in view of the recent FDA warnings about the risk of suicidality with antidepressants (FDA, 2005b) as well as that of diabetes, weight gain, strokes, and mortality with atypical antipsychotics (Jin et al., 2004, FDA, 2005a), there is an increasing responsibility on the clinician to ensure that patients and their caregivers are adequately informed about the risk: benefit ratio as well as alternative treatments and consequences of non-treatment of adolescents with depression or of persons with schizophrenia taking atypical antipsychotics. Medicare-approved use of PET scanning to assess risk of Alzheimer disease in vulnerable persons (Centers for Medicare and Medicaid Services, 2005) illustrates the use of complicated technological procedures such as functional brain imaging and genetic screening in routing clinical practice in near future. Furthermore, new treatments with techniques that may not be easy to explain verbally, such as the vagal nerve stimulation (Groves and Brown, 2005), point to a future with increasingly more technology-based interventions and evaluations in psychiatric practice. This trend will intensify in the years to come. Routine methods of providing information relevant to clinical decision making about healthcare evaluations or management are often suboptimal. Relatively little research has been done on enhancing the capacity of psychiatric patients and the caregivers to make truly informed decisions about management.
In this paper, we review studies that compared the effects of multimedia (video- or computer-based) educational aids with those of routine procedures to inform healthcare consumers about medical evaluations or management. To date most of this type of research has been conducted in non-psychiatric patients. However, we believe that the challenge of educating the recipients of mental healthcare as well as their caregivers may be even more important due to the cognitive impairment associated with a number of psychiatric disorders, and due to the growing need for providing greater information about the potential risks of some mental health treatments.
Numerous factors, including clinical and demographic variables, affect patients’ desire to be involved in decision making about their own illnesses. These include the type/complexity of decision, recency of related medical events, and potential outcome of the decision (Deber et al., 1996, Mansell et al., 2000). Coping style (active vs. passive), age, and education also play a role in patients’ desire for participation in the decision-making process (Arora and McHorney, 2000). Furthermore, learning styles vary widely among adults; no “one size fits all” strategy is likely to serve different purposes for different people. In this complex landscape of varying preferences for information and involvement, different learning styles, and increasingly complex medical information, patient education materials serve important communicative functions. These materials educate and inform, and in many cases, convey the uncertainty involved in decision making (DePalma, 2000). Patient education materials may also encourage and empower some patients to take more active roles in managing their illnesses (Von Korff et al., 2002).
While traditional patient education relies heavily on printed materials such as pamphlets, newer multimedia methods are raising exciting prospects in this area. Videotapes were heralded as an early multimedia electronic innovation in patient education. Investigators believed that videos could enhance education procedures (especially for persons with limited literacy), help model behaviors, be cost-effective, and increase standardization of information provided (Malone, 1983, Gagliano, 1988, Ward et al., 1984, Baker et al., 1996, Murphy et al., 2000, Huss et al., 1991). Prior reviews of studies that used videotape or television for patient education found short-term benefits in terms of patient knowledge, but concluded that more research was needed on how best to utilize them (Gagliano, 1988, Nielsen and Sheppard, 1988).
More recently, computer-based educational interventions have been tapped to deliver information. A recent Cochrane Review evaluated the existing literature on the use of decisional aids for helping patients make “preference sensitive” healthcare decisions, where there is no “single best choice, because people vary in the … personal importance that they place on the benefits versus the harms of the different options” (O’Connor et al., 2004). Consumer knowledge was one of the outcomes measured in many of the studies reviewed, and some of these investigations used video or computer-based education. However, many aspects of healthcare, such as chronic disease management, are not necessarily “preference sensitive” but still require that consumers be knowledgeable and active participants in their healthcare. We are not aware of any recent reviews of the effects of multimedia educational aids (defined as utilizing both an auditory-verbal channel, and a visual-pictorial channel (Mayer, 2002) on patients’ understanding of information relevant to illness management and healthcare decision-making. Yet, there is a need for systematically evaluating such new educational tools (Bergkamp, 1996, Rosoff, 1999).
Below we present a review of randomized controlled trials of multimedia tools to improve patients’ (or caregivers’) understanding of health-related information, with the primary outcome being improvement on an objective measure of knowledge. Tomorrow’s psychiatric practitioner will likely be using varied means of informing the users of mental healthcare and their family members. While a large majority of the studies reviewed here are from non-psychiatric fields, utilizing experiences from other areas of medicine could be valuable for psychiatrists too.
Section snippets
Methods
We conducted a literature search to identify published articles that empirically investigated the effects of multimedia programs to inform patients (or caregivers) about their medical evaluation or management. Only randomized controlled trials published in English which reported objective measures of knowledge or understanding were included. We excluded studies that focused on theoretical healthcare decisions because of potential concerns regarding the validity of hypothetical medical
Results
Thirty-seven studies were included in this review and are summarized in Table 2. Twenty three (61%) of the 37 studies reported positive results, and the remaining 14 reported negative results.
Discussion
We reviewed 37 randomized controlled trials evaluating the effects of video- or computer-based multimedia tools to improve patient or caregiver knowledge about medical evaluations or management. These articles were widely dispersed in different medical disciplines. Thirteen of the 22 video-based studies and 10/15 computer-based investigations (total 23/37) were labeled “positive”. A number of negative reports were characterized by comparable improvement in both experimental and control
Acknowledgements
This work was supported in part by NIMH Grants MH-43693, MH-49671, MH-59101, MH-01452, MH-64722, MH-62341, MH-66062, MH-64722, and MH-62341,by the National Alliance for Research on Schizophrenia and Depression (NARSAD), and by the Department of Veterans Affairs. We also acknowledge the technical expertise of several computer experts in our Research Center (Bernard Hernandez, Bob Fell, Nha Vo, Shah Golshan, and Anne Bailey) in comparing different technologies.
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