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Patient information for improved self care: a critical appraisal
PTkNT EdUCATioN ANd Cdi ELSEVIER
Patient Education and Counseling 27 (1996) 121-122
Editorial
Patient information for improved self care: a critical appraisal Self care is a basic tenet of health promotion that depends upon effective information transfer. Yet our knowledge of how best to provide information to people to allow informed decisionmaking and to enhance retention of information is still very incomplete. The current issue of Patient Efucation and Counselling includes a number of articles which explore information transfer and self care. While methodology flaws exist in papers, primarily related to non-random sample selection and small sample size, they can be viewed as attempts to further our understanding of the process of information transfer and retention. As such, they generate hypotheses which must be tested in experiments with more rigorous methodology in order to draw generalizable conclusions. Other papers in this issue suggest methodologic flaws to be avoided in experimental trials and clinical work, e.g. the need to assessreadability of test materials. Brook et al. report on a survey of 132 high school students in Israel regarding oral health knowledge attitudes and behaviour. They suggest that increased oral health education within the schools may result in improved knowledge and behaviour, a testable hypothesis. A questionnaire survey of adult rehabilitation learning needs during the following hospitalization is reported by McLennan et al. Both families and patients identified information needs. However, how best to provide information that would be retained and utilized requires further study. Gettham et al. studied the influence of patient and provider gender on the outcomes of medication-history interviewing by means of secondary
analysis of a partial data set which has been previously created from interviews with two simulated patients. It appears that female and male pharmacy students interview differently and that gender pairing affects patient satisfaction as well. The impact of two informational manoeuvres on retention of information about prenatal screening is assessedby Browner et al. Neither those exposed to the booklet alone nor the booklet plus a video, retained much information. Information retention appeared to vary by ethnicity and level of education and the video group remembered more. However, prospective studies are needed to test their analysis. Glazer et al. identified and assessed patient education literature about preventing detection and treatment of breast cancer for patients with low literacy skills. While the target population has a reading comprehension level of sixth grade or lower, the pamphlets analyzed required at least a ninth grade level of reading comprehension. Similarly, Dollahite et al. surveyed nutrition education materials for use with low literacy clients. They too found that 68% of publications $ere at ninth grade level or higher. These papers underline the importance of assessing readability before testing comprehension and retention of patient education in experimental tests. Patient education for oral rehydration therapy in the Central African Republic is reported by Naimoli et al. Their paper describes design and implementation of a health worker training program which resulted in increased messages communicated to mothers regarding management of diarrhea. Further studies are needed to determine
0738-3991/96/sl5.00 0 1996 Elsevier Science Ireland Ltd. All rights reserved PII 0738-3991(96)00863-4
122
Editorial
impact of patient education prevention and management of diarrheal disease. Hampson and Hibbard describe barriers to communication between providers and patients about the menopause and management options. They recommend changes in practice and research approaches to facilitate more effective providerpatient interactions. We should aim as researchers to improve the generaliibility of our findings while ensuring that
exploratory research is not prematurely forced into prositivist design. At the same time, as informed clinician-readers, we must be critical reviewers of the evidence provided in the literature for present practice for recommendations for change in practice. In this way, we can build the knowledge base in patient education for self care. Carol P. Herbert Co-Editor
Patient Education and Counseling 27 (1996) 121-122
Editorial
Patient information for improved self care: a critical appraisal Self care is a basic tenet of health promotion that depends upon effective information transfer. Yet our knowledge of how best to provide information to people to allow informed decisionmaking and to enhance retention of information is still very incomplete. The current issue of Patient Efucation and Counselling includes a number of articles which explore information transfer and self care. While methodology flaws exist in papers, primarily related to non-random sample selection and small sample size, they can be viewed as attempts to further our understanding of the process of information transfer and retention. As such, they generate hypotheses which must be tested in experiments with more rigorous methodology in order to draw generalizable conclusions. Other papers in this issue suggest methodologic flaws to be avoided in experimental trials and clinical work, e.g. the need to assessreadability of test materials. Brook et al. report on a survey of 132 high school students in Israel regarding oral health knowledge attitudes and behaviour. They suggest that increased oral health education within the schools may result in improved knowledge and behaviour, a testable hypothesis. A questionnaire survey of adult rehabilitation learning needs during the following hospitalization is reported by McLennan et al. Both families and patients identified information needs. However, how best to provide information that would be retained and utilized requires further study. Gettham et al. studied the influence of patient and provider gender on the outcomes of medication-history interviewing by means of secondary
analysis of a partial data set which has been previously created from interviews with two simulated patients. It appears that female and male pharmacy students interview differently and that gender pairing affects patient satisfaction as well. The impact of two informational manoeuvres on retention of information about prenatal screening is assessedby Browner et al. Neither those exposed to the booklet alone nor the booklet plus a video, retained much information. Information retention appeared to vary by ethnicity and level of education and the video group remembered more. However, prospective studies are needed to test their analysis. Glazer et al. identified and assessed patient education literature about preventing detection and treatment of breast cancer for patients with low literacy skills. While the target population has a reading comprehension level of sixth grade or lower, the pamphlets analyzed required at least a ninth grade level of reading comprehension. Similarly, Dollahite et al. surveyed nutrition education materials for use with low literacy clients. They too found that 68% of publications $ere at ninth grade level or higher. These papers underline the importance of assessing readability before testing comprehension and retention of patient education in experimental tests. Patient education for oral rehydration therapy in the Central African Republic is reported by Naimoli et al. Their paper describes design and implementation of a health worker training program which resulted in increased messages communicated to mothers regarding management of diarrhea. Further studies are needed to determine
0738-3991/96/sl5.00 0 1996 Elsevier Science Ireland Ltd. All rights reserved PII 0738-3991(96)00863-4
122
Editorial
impact of patient education prevention and management of diarrheal disease. Hampson and Hibbard describe barriers to communication between providers and patients about the menopause and management options. They recommend changes in practice and research approaches to facilitate more effective providerpatient interactions. We should aim as researchers to improve the generaliibility of our findings while ensuring that
exploratory research is not prematurely forced into prositivist design. At the same time, as informed clinician-readers, we must be critical reviewers of the evidence provided in the literature for present practice for recommendations for change in practice. In this way, we can build the knowledge base in patient education for self care. Carol P. Herbert Co-Editor