Patient education

1. Patient education

2. PRINCIPLES: SIMPLICITY AND REINFORCEMENT Simplicitymeans that educational messages must be delivered so the patient can readily understand them. Health education can include extremely intricate information (e.g. triple screening, cardiac catheterisation). Topics such as these can be daunting to teach and difficult for an inexperienced patient to learn. The concept of simplicity, then, tells us to start by assessing what the patient knows before the teaching session. Never assume that the patient needs to be taught everything about a topic, it is possible that someone close to him has experienced this in the past and he knows a great deal already. In addition, overteaching must be avoided. Although it is tempting to teach the patient everything we know about a given topic, in the name of simplicity we need to avoid doing that. Realistically, it is far better to choose three or four essential concepts about a topic and teach those. Using the principle of simplicity to guide a teaching session, we should use reinforcement in every patient education encounter. When a concept is heard multiple times during a teaching session, it is more likely that the information will be retained.

3. Adult Learning Principles

4. Adults learn best when there is a perceived need. If an adult does not understand why he needs to be taught about a subject, little learning will occur. Therefore, we must be sure that our patients understand the underlying health problem we are trying to prevent or the illness we are trying to cure before we begin teaching.

5. Teaching of adults should progress from the known to the unknown. Always assess what the patient know about a topic before beginning a teaching session. Don't reteach the things they already understand, but use that extra time to teach more about the topic.

6. Teaching of adults should progress from the simpler concepts to more complex topics. When teaching about triple screening, for instance, start by asking if the patient knows about Down syndrome or about spina bifida. Explain what those entities are before going on to a discussion of how to screen for those health problems and what the triple screen might show and what choices the patient would be asked to make on receiving the results of the screening test.

7. Adults learn best using active participation. Classroom-type didactic lecturing is not usually interactive and should be avoided when teaching patients. Teaching sessions about a topic in which the patient is frequently asked to restate what has been discussed will inspire far more learning than a passive lecture in which the patient is expected to learn simply because someone spoke to them.

8. Adults require opportunities to practice new skills. Anytime a new manual skill is required (e.g., learning how to draw up and inject insulin or learning how to detect uterine contractions), it is essential that time be spent watching the patient practice these skills, giving return demonstrations of manual abilities.

9. Adults need the behaviour reinforced. Teaching about health topics needs reinforcement continually. If syringe skills have been taught, be sure to ask the patient to show you their technique on subsequent visits.

10. Immediate feedback and correction of misconceptions increases learning. Always ask the patient to restate what you have taught. Also ask them what they have heard about this topic from their friends or relatives. It could be that the "old wives tales" they have heard from family and friends will be retained as "true," whereas our formal teaching is extinguished within several days.

11. Methods of teaching • one to one consultation • group classes • group support • videotapes, cds, dvds • internet • written materials

12. Web sites are not always reliable sources of information. When using a Web site for health information, remember that: • Web sites affiliated with a university medical school or professional organizations have more credibility. • Credentials, educational backgrounds, affiliations, or board certifications of those providing the information on the Web site should be prominently listed. • The information should be referenced to identify the source of the data. • The date of the most recent posting should be included. • Web sites that contain extremely positive claims, especially those made by a commercial sponsor, should be viewed with scepticism. • The site should be easily accessible, easy to use and easy to read. • Researches found that clients taught how to use the Internet to retrieve health information were still using it 90 days later, and 66% of them were taking the information they found on the Internet to their health care providers when they had a scheduled visit. • More than 50% reported that using the Internet made them feel more satisfied with their treatments, because they felt more knowledgeable. Baker et al.[28] surveyed 4,764 individuals, finding that 40% of the respondents had used the Internet for information or advice about health or health care during the past year, and 67% reported that using the Internet or e-mail improved their understanding of symptoms, conditions, or treatments

13. Written informationdesign and layout • Help patients to navigate the information • Make sure headings are placed consistently and stand out by using either a larger font or by emboldening the text. • Judicious use of colour can help but make sure contrast is good and there are not too many colours which can in itself be a problem. • Patients like an index. This is very important if you are using a booklet format which is known to be more difficult to navigate. • Make sure the text size used is as large as possible and that there is good use of white space. Dense text means patients lose concentration and therefore cannot find the information required. • Long lists of side effects are frightening and short bullet points have been found to be helpful. Group the side effects by seriousness and make sure that where patients need to take urgent action this is clear. • Make sure related information is located together and not split over different columns or sides of the leaflet. • Information which appears before the index or in a box is overlooked by patients so these devices should not be used

14. Written informationcontent • Consistency • Complex language and medical jargon cause difficulty in understanding by patients. • Translate all the information into lay language. • Make sure you use colloquial English. • Written materials- it has been shown that it does not matter how high the reading ability of the targeted group might be; materials written at readability levels of sixth to eighth grade (US) are more effective in conveying health messages and have higher rates of recall across all educational levels. • Use short sentences and/or bullet points. • Do not use the system organ class arrangement for side effects as patients are unable to follow this logic. • Side effects should be grouped by seriousness to enable patients to understand when to take action and what that action should be. • Make sure risks are communicated clearly to patients.

15. Clinical information • Simple description of the condition • Prognosis/ clinical outcome • Symptoms • Overview of treatments, including doing nothing • Benefits of the intended treatment/ investigation • Risks, complications, side effects (impact on the quality of life) • How to prepare for treatment, how long it takes and what happens (including level of pain, sensory information, possible sensations) • Care following procedures • Do and don’ts on going home (rest, time off work, everyday activity, sexual activity, pain relief, alcohol, using toilet, driving, lifting, bathing, sickness certificate) • Stages to full recovery, length of recovery • When to seek further professional advice