Most of the studies identified in the current literature review addressed education for patients with chronic disease. Seven programs were designed to provide education for individuals with diabetes.[6,10,11,13,14,16,21] Asthma education was the focus for six programs.[5,17,28,29,30,31] Three programs focused on arthritis education.[4,8,12] Oncology education was the subject of two learning interventions.[20,33] The remaining programs focused on a wide range of topics including urine collection, recording of sexual history, medication recall, medication education, coronary artery disease, psychiatry, hyperlipidemia, nocturnal enuresis, contraceptive education, pain perception, human immunodeficiency virus (HIV), primary care, eating disorders, schizophrenia, and colonoscopy education.[3,7,9,15,18,19,22,23,24,25,26,27,32,34,35]
Most of the reviewed research studies documented significant changes in knowledge acquisition when patients were provided with access to computer-based learning programs.[4,6,8,14,15,19,20,23,24,28,29,31] Two investigators found that computer-based patient education was no more effective than traditional patient education in improving patient knowledge for children and adolescents with diabetes.[11,21]
Self-care management and self-care behaviors were improved for patients with chronic disease as a result of computer-based patient education.[4,5,8,14,21,26,29,33] Two of the studies demonstrating improved self-care behaviors addressed interventions for patients with arthritis.[4,8] Two studies were on the education of patients with asthma,[5,29] two on the education of patients with diabetes,[14,21] and one each on the education of patients with HIV and those with breast cancer. Clark et al documented no difference in the self-care behaviors of patients with hyperlipidemia when the results of computer-based education was compared with those of traditional patient education.
Three authors documented improved social support and a perceived improvement in health outlook for patients who used computer-based education systems.[4,26,33] Two studies by Gustafson report on the use of the Computerized Health Enhancement Support System (CHESS), respectively, for patients with HIV and those with breast cancer. The results of these studies substantiate an earlier finding by both Brennan et al[36,37] and Gustafson et al that social support is an important component of computer-based patient interventions. Cudney and Weinert described Women to Women, a computer-based support environment for rural women in Montana. Anecdotal evidence suggests that Women to Women participants experienced feelings of increased social support and 'connectedness.'
Four authors measuring adherence to healthcare management regimens found that in two studies adherence was improved,[9,12] and that in two studies computer-based education was no more effective than traditional education in improving adherence.[4,19] Liao et al noted that persons with coronary artery disease reported an increased confidence in their choice of treatment after viewing an interactive video educational program. Improved satisfaction with the healthcare provider and the amount of information provided also was noted for patients receiving computer-based education.[7,10,21,33,35]
Computer-based patient education helped patients with diabetes to reduce HgbA 1 C levels,[6,14,16] decrease insulin requirements, and improve mealtime glucose levels. Other authors noted that HgbA 1 C levels were significantly better for both the computer-based education group and the group that received traditional instruction.[10,11,13,21] Although patients with asthma had reduced hospital admissions[17,29] as well as better symptom control and increased functional status when exposed to computer-based education, other asthma-related outcomes improved equally well with traditional education.[29,31] With computer-based interventions, Clark et al noted a decrease in plasma cholesterol among patients with hyperlipidemia, and Goldsmith and Safran noted a reduction in postoperative perceptions of pain. For schizophrenia patients, there was no difference across interventions for psychiatric outcomes. Shaw et al noted a decrease in preprocedure anxiety for first-time colonoscopy patients, regardless of educational approach.
School-age children from kindergarten through adolescence responded positively to computer-based patient education.[5,10,11,21,29,31] Computer-based patient education was effective in changing the healthcare behaviors and health outcomes of the children who participated in these studies, including improved knowledge and communication with parents and care providers and a reduction in hospitalizations.
Elderly clients with very little prior computer experience also have been successful in using computer-based learning applications. Ogozalek found that elderly patients with no prior computer experience were able to accomplish learning tasks significantly better when using interactive videos. Takabayashi et al reported that although elderly patients (age, > 65 years) took more time to complete an asthma education program, only one required assistance from clinical staff in the use of the computer. Helwig et al noted that elderly family practice patients were less likely to have previous Internet searching experience. However, they were effectively able to use the computer with minimal assistance. When a group of elderly women (average age, 71.8 years) with breast cancer were given access to CHESS, they averaged 6.8 uses a week. Leaffer and Gonda looked specifically at seniors' use of the Internet for healthcare information. In their study, 100 seniors received training on using the Internet to acquire healthcare information. Follow-up surveys found that two-thirds of the study participants who searched for healthcare information discussed the information they found in subsequent communications with their physicians, and one half reported increased satisfaction with their treatment as a result of the Internet information and subsequent patient-provider discussions.
Low literacy is an education issue across healthcare settings. Numerous studies, such as the one by Duffy and Snyder, have noted that many patients read at or below the sixth-grade level. Computer-based education also may be useful for these patients. Pernotto et al reported that the use of graphics and audio made an interactive program for patients undergoing endoscopic procedures more understandable for people with limited reading ability. In another study, Liao et al found that patients who had little education benefited most from an interactive video program. One key area, however, in which readability may be a significant issue is the Internet. Graber et al found that much Web-based material was 'too difficult' for most consumers, and not readable for those with low literacy levels.
The 'digital divide' usually refers to disparities in access to information technology that results from inequities related to race, education, or economic status. Winzelberg et al found no significant differences in access across racial demographics in their study of white, African American, Asian, and Hispanic young women with eating disorders who used an Internet-based education program. Mold et al found that urban patients are twice as likely to own computers as their rural counterparts. Horton et al surveyed 400 patients in an urban medical center regarding their current use of the Internet. They found that 50% of the patients owned a personal computer, and that 89% of these had Internet access. In contrast, Robinson et al surveyed 152 patients in an inner-city county hospital clinic regarding their Internet awareness and access to technology. The findings showed that 85% had heard about the Internet and 73% were aware of e-mail, but that only 18% owned a computer and only 5% had used the Internet for healthcare information. Finkelstein et al assessed inner-city patients' use of a home asthma telemonitoring system that collects spirometry data and symptom reports and then transmits these data and reports to a medical center's clinical information system. Although most of these patients had no prior computer experience, they indicated that performing the spirometry test and working with the palm-top computer was 'not difficult at all.' In a study of young women with breast cancer, Gustafson et al noted that the benefits of CHESS appeared to be greater for patients who are economically disadvantaged.
Comput Inform Nurs. 2003;21(2) © 2003 Lippincott Williams & Wilkins
Cite this: Computers in Patient Education - Medscape - Mar 01, 2003.